Situational Analysis of the 10 High Drug Resistant Tuberculosis Burden Countries Two Years Post-UNHLM Declaration: Progress and Setbacks in a Changing Landscape

Drug-resistant tuberculosis (DR-TB) is the greater exponent and, leading global cause of death related to antimicrobial resistance comprising close to 500,000 cases per year. In 2018 the first United Nations high level meeting (UNHLM) on tuberculosis was held, declaring TB and, its resistant forms a first order world public health concern. Bold country targets were established for 2018-2022. Currently 10 countries account for the 70% of the global DR-TB burden (Bangladesh, China, India, Indonesia, Myanmar, Nigeria, Pakistan, Philippines, Russian Federation, and, South Africa). The present study reviews these 10 countries situation in 2018, the levels of DR-TB related UNHLM target accomplishment and, it is complemented with a survey to ascertain key advances and, setbacks at 2 years from the UNHLM declaration.  Although most countries are showing an historical advance and, were on track for the 2018 and, 2019 targets, according to the DR-TB country cascade of care, no country is capable of providing care for even 50% of the estimated patients.   Increasing levels of fluoroquinolone resistance and, the difficulties in obtaining timely susceptibility results can jeopardize ongoing adoption of shorter, all-oral regimens.  Proportions of diagnoses and, enrolled on treatment of children with DR-TB remain minimal. Achievements for 2020 and, beyond are going to be affected by COVID-19 pandemic and, the measures to contain it. Triggered by COVID-19 pandemic, there is a risk of a step back in DR-TB care, with long-term consequences in deaths, suffering and, antimicrobial resistant transmission. Investing in and, supporting DR-TB services is more important than ever to meet the UNHLM aspirations. Funding Information: The study was funded by a GDI initiative with no involvement of any pharmaceutical company or, other agency. Declaration of Interests: No author declared any conflicts of interest.