Large and irregular private sector market for TB drugs risks fuelling drug resistance

4 May 2011 - New York - Private sector healthcare providers are buying and selling as many tuberculosis (TB) drugs as the public sector in many countries, but are often providing irregular dosages to patients, according to new research conducted by the TB Alliance and IMS Health.

The researchers say that in 10 high-burden countries, private sector pharmacies, drug shops, doctors, clinics and hospitals are buying and selling as many TB drugs as those who are associated with national TB programmes. But at least a third of the volume of first-line TB drugs supplied by the private sector is in dosages that do not comply with national and international treatment recommendations.

These variations raise the risk of unsuccessful treatment and the development of drug resistance, and are evidence that further constructive engagement with the private sector is needed, the report argues.

The research is the first detailed study of the private TB drug market across multiple countries with a high burden of TB. Sixty percent of the world’s TB burden is present in the 10 countries studied - Bangladesh, China, India, Indonesia, Pakistan, Philippines, Russian Federation, South Africa, Thailand and Viet Nam. For each of the countries studied the researchers defined the private market as channels that are not used or influenced by national TB programmes.

TB treatment requires lengthy, supervised treatment to maximize cure rates and minimize the development of drug resistance, and in low-income settings this task is thought to be more achievable in the public sector, the report says. By contrast, the private sector treatment landscape in these countries is largely unregulated and fragmented. The study detected 111 different first-line TB drug dosages and combinations, compared to the 14 deemed necessary by the Stop TB Partnership’s Global Drug Facility.

"The private sector is keeping alive the confusion that existed previously in the public sector," said Dr. William Wells, the study’s lead author and Director of Market Access at the TB Alliance. "With this new baseline understanding of the TB drug market, we can no longer ignore the private sector’s critical role in the access equation for TB treatment and in the task of protecting both current drugs and new regimens from the development of resistance."

The report also says that four of the biggest high-burden countries - India, Indonesia, Pakistan, and Philippines - have particularly large private sectors. Enough TB drugs are sold in these countries' private sectors to provide all, or nearly all, of each country’s TB patients with a full course of treatment.

Read the full report