🔬  The COVID-19 pandemic has significantly disrupted the global fight against drug-resistant tuberculosis (DR-TB), particularly in countries with already vulnerable health systems. In the Philippines, a country with approximately one million people affected by TB, service interruptions have led to decreased case notifications and reduced access to treatment for DR-TB.

The country now ranks among the top ten contributors to the global gap between estimated DR-TB incidence and the number of patients receiving treatment.

🧪 Diagnostic Hurdles

A critical issue is the limited access to drug susceptibility testing (DST)—only 57% of newly diagnosed TB patients are tested to determine if their infection is drug-resistant. To address this, the Xpert MTB/XDR assay, a molecular diagnostic test capable of detecting resistance to first- and second-line drugs, was integrated into the national diagnostic algorithm.

While this tool is efficient and scalable, several implementation challenges remain:

• Shortage of test cartridges
• Prolonged turnaround times
• Weak digital systems that delay case tracking and referrals
• High patient drop-off rates in community-based programs

These gaps contribute to missed diagnoses and interrupted treatment, increasing the risk of disease progression and further resistance.

💸 Funding and Access Barriers

Access to DR-TB care in the Philippines is impeded by systemic constraints:

• The National Tuberculosis Program is underfunded, meeting just 37% of actual resource needs
• PhilHealth, the national insurance provider, does not cover DR-TB treatment or necessary diagnostics like Xpert and culture
• Healthcare workers are concentrated in private tertiary facilities, leaving public and rural settings underserved

Areas with high DR-TB burden—geographically isolated communities and correctional facilities—face even greater challenges due to infrastructure and workforce limitations. As a result, many high-risk individuals go unscreened.

🛰 A Call for Smarter Surveillance and Patient-Centered Care

Addressing these issues requires more than diagnostics—it demands a shift toward data-driven, integrated public health strategies. Priorities include:

1. Sentinel surveillance systems to monitor resistance patterns
2. Integration of next-generation sequencing into national surveys to guide tailored treatment
3. Transition from paper to case-based digital systems for real-time monitoring and response
4. Predictive analytics and hotspot mapping to improve early detection
5. Improved patient referral pathways and adherence support to reduce treatment failure and resistance

🩺 Moving Toward a More Resilient TB Response

To effectively combat drug-resistant tuberculosis, the Philippines must invest in digital health infrastructure, decentralized diagnostics, and sustainable health financing. Strengthening epidemiological surveillance and ensuring continuity of care are central to preventing the further spread of resistant strains.

As the world continues to rebound from COVID-19, supporting frontline TB programs in high-burden countries is vital to achieving global TB elimination goals.

📖 Reference

The Lancet Infectious Diseases. (2022). The way forward for drug-resistant tuberculosis in the Philippines. Retrieved from https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00285-7/fulltext