RPM Plus: What We Do: TB - Technical Leadership: GLC Collaboration

Pailin Drug Shop, Cambodia. Photo by Olya Duzey

The spread of multidrug-resistant tuberculosis (MDR-TB)—defined as bacilli resistant to at least two first-line medicines used in TB treatment (isoniazid and rifampicin)—is a growing global concern.

MDR-TB is the result of inappropriate treatment stemming from problems such as poor patient adherence to treatment, inappropriate prescribing, and poor-quality medicines.

In addition, it is well known that monotherapy (taking a single medicine) leads to development of resistance more rapidly than combination therapy does; yet, in many countries, monotherapy continues to be the norm.

Treatment of MDR-TB is possible, but the medicine costs are considerably higher (prohibitively expensive in many cases), treatment is significantly longer, and side effects are much worse. Poor management of second-line medicines could in turn lead to super-infection and even death.

The Green Light Committee (GLC), a subgroup of the WHO Working Group on DOTS-Plus for MDR-TB, was established to—

Review projects and advise WHO on which projects should benefit from preferentially priced, quality-assured second-line medicines
Monitor approved projects
Collect evidence to use in the development of a treatment policy for MDR-TB within the DOTS framework

Focus on Joint Projects with the GLC

At GLC's request, RPM Plus developed materials for a practical workshop on Pharmaceutical Management of MDR-TB, using second-line TB medicines, which was field-tested in Moscow, Russia, June 23 - 27, 2003.

Other collaborators for the Moscow workshop were the U.S. Centers for Disease Control, WHO, Partners in Health/Harvard University, United States Pharmacopeia Drug Quality and Information (USPDQI) Program, the All-Russia Drug Information Network (ARDIN), originally created by the RPM Project and USP, and the Russian Center for Pharmaceutical and Medico-Technical Information (PHARMEDINFO).

After field-testing, the materials were modified and then used at workshops in Moldova, Romania, and Mexico.

In response to needs in other regions, RPM Plus developed a combined workshop on pharmaceutical management of both first-line and second-line TB medicines. This combined workshop has been given to date in Egypt, for participant countries in the eastern Mediterranean and northern Africa regions, as well as in Tbilisi, Georgia, for the Caucasus region.

» View RPM Plus TB Events to learn more about this.

RPM Plus has also provided technical assistance to the GLC to develop a computerized system for monitoring pharmaceutical management linking DOTS-Plus recipients of GLC medicines, the GLC, and suppliers of second-line medicines.

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