1. Sources of Limited Access to Treatment High Cost of Treatment Lack of Pilot Projects Lack of Evidence Lack of Policy Lack of Demand

2. Treatment Regimen Costs 0 10000 20000 30000 40000 50000 60000 HRHRESHRESZK Resistance Pattern Per Patient Drug Cost (USD) Standard Reference Country Cost (USA) High Income Country Average Cost Low Income Country Average Cost Green Light Committee Cost Gupta, et al., Science 2001.

3. Linking Independent Concepts GLC ACCESS RATIONAL USE POLICY

4. Green Light Committee (GLC) Releases preferentially-priced, quality-assured drugs Decision process –application review Instructions for Applying to the Green Light Committee for Access to Second-line Anti-TB Drugs Guidelines for Establishing DOTS-Plus Pilot Projects for the Management of MDR-TB –site visit Continual monitoring of projects Technical assistance Gupta, et al. Trop Med Intl Health, 2001

5. Changing Global Health Policy New guidelines for MDR-TB treatment Expanding DOTS framework to include MDR-TB –HIV, public-private mix Improving allocation of financial resources Increasing new funds for TB control Scaling up primary health care/capacity building Bridging equity gap No longer whether or not to treat patients, but how to best treat patients

6. Similarities between HIV and MDR-TB Multidrug regimen given for extended periods with adverse events Disproportionately affects disadvantaged Access to drugs Drug resistance Laboratory requirements Lack of standard international policy Most experience in resource-wealthy settings