drug resistant (XDR) tuberculosis (TB) treatment
World Health Organisation (WHO)
24 January 2007
WHO places prevention and care of XDR-TB as a priority through the
strengthening of basic TB control and the necessary interventions to cure
existing cases. This includes strengthening political will throughout affected
countries to reduce the burden of TB, rapid accurate bacteriological diagnosis,
a secure supply of high quality drugs, supervised and standardised treatment,
and recording of the outcome of every single patient at the end of treatment.
It also includes ensuring that the capacity to identify and treat
drug-resistant TB is in place, with a secure supply of second-line anti-TB
drugs required for treating multi drug resistant (MDR) TB obtained through the
Green Light Committee (in resource-limited settings)(1), as well as
implementing good infection control procedures.
These measures are currently the best approach to the prevention and care of
XDR-TB and were listed among the recommendations supported by international
health experts at the first meeting of the WHO Global Task Force on XDR-TB in
October 2006(2).
WHO's position with respect to the legal and ethical issues surrounding
compulsory TB treatment was published in 2001(3) with the specific purpose of
ensuring prevention and control is strengthened within a legal and human
rights' framework. The publication of a PLoS Medicine journal report (4) has
highlighted again the issues around compulsory treatment, particularly in
relation to drug-resistant TB.
WHO strongly recommends that governments must ensure, as their top priority,
that every patient has access to high quality TB diagnosis and treatment for TB
and drug-resistant forms of TB. It also fully supports the rights and
responsibilities of TB patients as recommended in the Patients' Charter for TB
Care(5).
In this regard, if a patient wilfully refuses treatment and, as a result, is
a danger to the public, the serious threat posed by XDR-TB means that limiting
that individual's human rights may be necessary to protect the wider public.
Therefore, interference with freedom of movement when instituting quarantine or
isolation for a communicable disease such as MDR-TB and XDR-TB may be necessary
for the public good, and could be considered legitimate under international
human rights law.
This must be viewed as a last resort, and justified only after all voluntary
measures to isolate such a patient have failed.
A key factor in determining if the necessary protections exist when rights
are restricted is that each one of the five criteria of the Siracusa
Principles(6) must be met, but should be of a limited duration and subject to
review and appeal. The Siracusa principles are:
* The restriction is provided for and carried out in accordance with the
law.
* The restriction is in the interest of a legitimate objective of general
interest.
* The restriction is strictly necessary in a democratic society to achieve the
objective.
* There are no less intrusive and restrictive means available to reach the same
objective.
* The restriction is based on scientific evidence and not drafted or imposed
arbitrarily i.e. in an unreasonable or otherwise discriminatory manner.
Responsibilities of TB treatment-providers to their patients are detailed in
The International Standards for Tuberculosis Care(7).
Footnotes
(1) Instructions for Applying to the Green Light Committee for Access to
Second-Line Anti-TB Drugs (WHO, 2006)
http://whqlibdoc.who.int/hq/2006/WHO_HTM_TB_2006.369_eng.pdf
[pdf 404kb]
(2) Report of the meeting of the WHO Global Task Force on XDR-TB (WHO,
2006)
http://www.who.int/tb/xdr/globaltaskforcereport_oct06.pdf
[pdf 608kb]
(3) Good Practice in Legislation and Regulations for TB Control: An
Indicator of Political Will (WHO, 2001)
http://whqlibdoc.who.int/hq/2001/WHO_CDS_TB_2001.290.pdf
[pdf 163kb]
(4) Medicine journal (Public Library of Science, 22 January 2007)
http://www.plosmedicine.org/perlserv/?request=get-document&doi=10.1
371/journal.pmed.0040050
(5) The Patients' Charter for TB Care (World Care Council, 2006)
http://www.who.int/tb/publications/2006/istc_charter.pdf
[pdf 1.01Mb]
(6) Siracusa Principles on the Limitation and Derogation Provisions in the
International Covenant on Civil and Political Rights (United Nations, Economic
and Social Council, 1985)
http://www1.umn.edu/humanrts/instree/siracusaprinciples.html
(7) International Standards for TB Care (TB Coalition for Technical
Assistance, 2006)
http://www.who.int/tb/publications/2006/istc_report.pdf
[pdf 1.99Mb]
(Source: http://www.who.int/tb/xdr/involuntary_treatment/en/index.html)
Issued by: Department of Health
24 January 2007
Source: Department of Health (http://www.doh.gov.za/)
