{"id":2215,"date":"2015-12-13T18:47:02","date_gmt":"2015-12-13T18:47:02","guid":{"rendered":"http:\/\/www.foretiafoundation.org\/?p=2215"},"modified":"2015-12-13T18:48:52","modified_gmt":"2015-12-13T18:48:52","slug":"la-resistance-aux-medicaments-un-obstacle-a-la-lutte-contre-la-tuberculose-au-cameroun","status":"publish","type":"post","link":"https:\/\/www.foretiafoundation.org\/staging\/la-resistance-aux-medicaments-un-obstacle-a-la-lutte-contre-la-tuberculose-au-cameroun\/","title":{"rendered":"La r\u00e9sistance aux m\u00e9dicaments: un obstacle \u00e0 la lutte contre la tuberculose au Cameroun"},"content":{"rendered":"

Par Kareen Atekem<\/a>, MPH<\/em><\/p>\n

\"Global<\/a>[dropcap type=”circle” color=”#FFFFFF” background=”#8C212A”]L[\/dropcap]a tuberculose (TB), une maladie caus\u00e9e par l’organisme Mycobacterium tuberculosis<\/em>, et transmise par des gouttelettes infectieuses, demeure l’une des plus meurtri\u00e8res maladies transmissibles dans le monde. Selon les derni\u00e8res donn\u00e9es de l’OMS sur la tuberculose publi\u00e9es en mai 2014, le Cameroun a \u00e9t\u00e9 class\u00e9 25\u00e8me dans le monde, avec une mortalit\u00e9 sp\u00e9cifique atteignant 2,89%, soit 6267 d\u00e9c\u00e8s au total. Selon le Plan strat\u00e9gique national de lutte contre la tuberculeuse au Cameroun pour la p\u00e9riode 2010-2014, la population \u00e2g\u00e9e de 15 \u00e0 40 ans (tranche d\u2019\u00e2ge active de la population) est la plus touch\u00e9e par la tuberculose. Selon les directives de l’OMS, le traitement de la tuberculose n\u00e9cessite une p\u00e9riode de six mois durant laquelle les malades doivent prendre trois \u00e0 quatre comprim\u00e9s chaque jour. Compte tenu de la n\u00e9cessit\u00e9 de prendre autant de pilules, certains patients peuvent manquer les moments de prise des m\u00e9dicaments ainsi les dates de rendez-vous de collecte de m\u00e9dicaments dans les centres de traitement, ce qui conduit in\u00e9vitablement \u00e0 l’interruption du traitement, la rechute, et, dans le pire des cas entraine une r\u00e9sistance aux m\u00e9dicaments. La r\u00e9sistance aux m\u00e9dicaments antituberculeux est consid\u00e9r\u00e9e comme un probl\u00e8me de sant\u00e9 publique et un obstacle majeur dans la lutte contre la tuberculose au Cameroun, le principal probl\u00e8me \u00e9tant les Tuberculose multi-r\u00e9sistantes (MDR-TB).<\/p>\n

Anti-TB Drug Resistance Burden au Cameroun<\/strong><\/p>\n

Globalement, on estime que 3,5% des nouveaux cas de tuberculose et 20,5% des cas d\u00e9j\u00e0 trait\u00e9s pr\u00e9sentent une multi-r\u00e9sistance aux antituberculeux (OMS, 2014). En 2012, on estime que 450.000 personnes ont d\u00e9velopp\u00e9 une tuberculose multi r\u00e9sistante, avec environ 170.000 d\u00e9c\u00e8s dus \u00e0 la MDR-TB. En 2013, on note une augmentation estim\u00e9e \u00e0 480.000 nouveaux cas de Tuberculose multi-r\u00e9sistante dans le monde, et une augmentation d’environ 210 000 d\u00e9c\u00e8s dus \u00e0 la MDR-TB. Selon l’\u00e9tude de la r\u00e9sistance aux m\u00e9dicaments en Afrique men\u00e9e par Alwyn Mwinga, le Cameroun a enregistr\u00e9 le deuxi\u00e8me taux le plus de r\u00e9sistance aux m\u00e9dicaments chez des patients sans ant\u00e9c\u00e9dents de traitement avec 38,1%, apr\u00e8s le Ghana avec 54,5%. La pr\u00e9valence de la r\u00e9sistance aux antituberculeux dans une \u00e9tude \u00e0 Yaound\u00e9 par Kuaban et al, a \u00e9t\u00e9 estim\u00e9e \u00e0 27,6%. Par aillaeurs, la pr\u00e9valence de la r\u00e9sistance \u00e0 au moins un m\u00e9dicament antituberculeux \u00e9tait de 27,7%, et la multi-r\u00e9sistance de 5,9%, selon une \u00e9tude men\u00e9e dans les r\u00e9gions du Nord-Ouest et le Sud-ouest du pays (Meriki et al., 2013).<\/p>\n

Le fardeau \u00e9conomique de la r\u00e9sistance aux antituberculeux<\/strong><\/p>\n

L’\u00e9mergence de la tuberculose multir\u00e9sistante est une grande pr\u00e9occupation car elle n\u00e9cessite l’utilisation de m\u00e9dicaments de deuxi\u00e8me ligne qui sont difficiles \u00e0 obtenir, et sont beaucoup plus toxiques et plus co\u00fbteux que ceux utilis\u00e9s en traitement de premi\u00e8re intention (Espinal et al., 2001). Le co\u00fbt direct du traitement n\u2019est pas directement pris en charge par les patients car les traitements contre la Tuberculose sont livr\u00e9s gratuitement \u00e0 tous les centres de traitement. Cependant, les patients supportent les co\u00fbts indirects li\u00e9s \u00e0 la prolongation de la p\u00e9riode de traitement (une phase intensive d’une dur\u00e9e minimale de huit mois avec une dur\u00e9e totale de traitement d’au moins vingt mois). Le Rapport mondial de 2014 sur la tuberculose indique qu’il y a eu une augmentation significative du financement pour les Tuberculoses multi-r\u00e9sistantes, en comparativement \u00e0 l\u2019ann\u00e9e 2009. Le co\u00fbt par patient trait\u00e9 contre la tuberculose \u00e9tait g\u00e9n\u00e9ralement de l’ordre de US $ 100 – $ 1,000, et pour les Tuberculoses multi r\u00e9sistantes, le co\u00fbt du traitement par patient varie d’une moyenne de 9235 $ US dans les pays \u00e0 faible revenu, \u00e0 US $ 48 553 dans les pays \u00e0 revenu interm\u00e9diaire et sup\u00e9rieur. Le co\u00fbt moyen des m\u00e9dicaments de premi\u00e8re ligne utilis\u00e9s dans le traitement de la tuberculose \u00e9tait de 46 $, comparativement \u00e0 un co\u00fbt moyen beaucoup plus \u00e9lev\u00e9 de 5,240 US $ pour les m\u00e9dicaments de deuxi\u00e8me ligne n\u00e9cessaires pour traiter un patient avec une Tuberculose multi r\u00e9sistante. \u00c0 la fin de l\u2019ann\u00e9e 2015, environ 20% des 8 milliards de US dollars requis par les pays \u00e0 revenu faible et interm\u00e9diaire pour les soins et la lutte contre la Tuberculose sera n\u00e9cessaire au traitement des Tuberculoses multi r\u00e9sistantes, soit une augmentation de 0,6% par rapport \u00e0 l\u2019ann\u00e9e 2013 (OMS 2013 mettre \u00e0 jour sur MDR-TB).<\/p>\n

L’augmentation de la r\u00e9sistance aux antituberculeux, particuli\u00e8rement les multi r\u00e9sistances, est le r\u00e9sultat de la mauvaise utilisation des m\u00e9dicaments anti-tuberculeux au cours du traitement de la tuberculose. Cette mauvaise utilisation inclue l’administration de doses et de sch\u00e9mas th\u00e9rapeutiques inappropri\u00e9s associ\u00e9s \u00e0 l\u2019incapacit\u00e9 de s\u2019assurer que les patients prennent compl\u00e8tement et enti\u00e8rement leur traitement. Ainsi, l’OMS recommande l’utilisation de la strat\u00e9gie DOTS (\u2018\u2019Directly Observed treatment, short course\u2019\u2019 \/ traitement directement observ\u00e9, courte dur\u00e9e) comme une priorit\u00e9 pour un contr\u00f4le efficace de la tuberculose, et comme un moyen de r\u00e9duire le d\u00e9veloppement des r\u00e9sistances aux m\u00e9dicaments. Le personnel de sant\u00e9 travaillant dans les centres de traitement doivent ainsi donner le traitement au malade et observer ce dernier avaler le m\u00e9dicament avant qu\u2019il ne quitte le Centre de traitement. Malheureusement, cela ne se fait pas dans la plupart des centres de traitement en raison du manque de personnel de sant\u00e9, et du fait qu\u2019un nombre tr\u00e8s importants de malades de tuberculose viennent chercher leurs m\u00e9dicaments sur une base quotidienne en suivant leurs dates de nomination.<\/p>\n

Le gouvernement a mis sur pieds des outils afin de lutter contre cette maladie. Il s\u2019agit par exemple du Programme national de lutte contre la tuberculose (PNLT), cr\u00e9\u00e9 en 1996, dont le but est de lutter contre la tuberculose, r\u00e9duire son incidence et sa pr\u00e9valence \u00e0 travers la formation et la supervision du personnel, concevoir, contr\u00f4ler les outils de collecte et de monitoring des statistiques de la tuberculose. Le PNLT fournit \u00e9galement des m\u00e9dicaments antituberculeux et du mat\u00e9riel de laboratoire pour les h\u00f4pitaux de District.<\/p>\n

La Surveillance\u00a0: un d\u00e9fi majeur<\/strong><\/p>\n

Surveillance de la tuberculose multi r\u00e9sistante \u00e0 travers la communication des donn\u00e9es et la sensibilisation du public a \u00e9t\u00e9 un d\u00e9fi majeur pour le PNLT. Le Cameroun ne dispose pas de donn\u00e9es sur la surveillance nationale de la r\u00e9sistance aux m\u00e9dicaments. Le Minist\u00e8re de la Sant\u00e9 publique, en collaboration avec les Services de Sant\u00e9 de District, doivent fournir davantage d\u2019efforts pour am\u00e9liorer la disponibilit\u00e9 des donn\u00e9es et des estimations des tendances de MDR-TB, deux aspects importants dans la lutte contre la Tuberculose multi r\u00e9sistante. Cet effort conjoint permettra de soutenir et de renforcer la capacit\u00e9 de surveillance du syst\u00e8me de sant\u00e9. En outre, les d\u00e9fis du syst\u00e8me de sant\u00e9 essentiels tels que: le nombre limit\u00e9 de centres de traitement, le manque d’acc\u00e8s aux services de diagnostic et de traitement, la p\u00e9nurie en personnel de sant\u00e9, la faiblesse des syst\u00e8mes de suivi des malades pendant le traitement, et les interruptions dans l\u2019approvisionnement m\u00e9dicaments antituberculeux entravent consid\u00e9rablement les efforts pour identifier et traiter efficacement les cas multi r\u00e9sistants.<\/p>\n

Conclusion et recommandations<\/strong><\/p>\n

En conclusion, la r\u00e9sistance aux antituberculeux varie de la r\u00e9sistance \u00e0 un seul antituberculeux \u00e0 la r\u00e9sistance multiple, et \u00e0 la Tuberculose ultrar\u00e9sistante (XDR-TB), qui est une r\u00e9sistance \u00e0 certains des m\u00e9dicaments antituberculeux les plus efficaces. Tuberculose ultrar\u00e9sistante r\u00e9sulte d\u2019une mauvaise gestion des personnes atteintes de Tuberculose multi r\u00e9sistante, et est associ\u00e9e \u00e0 un taux de mortalit\u00e9 beaucoup plus \u00e9lev\u00e9 que celui de la MDR-TB; le r\u00e9sultat d’un nombre r\u00e9duit d’options de traitement efficaces. Les principales mesures de lutte contre le probl\u00e8me de r\u00e9sistance aux m\u00e9dicaments antituberculeux en Afrique (Cameroun inclus) incluent le d\u00e9veloppement et la mise \u00e0 l’\u00e9chelle des proc\u00e9dures de gestion programmatique des r\u00e9sistances aux antituberculeux, l\u2019\u00e9tablissement des syst\u00e8mes de surveillance en laboratoire, et la mise en \u0153uvre des mesures de contr\u00f4le de la tuberculose permettant de diagnostiquer et surveiller les MDR-TB et XDR TB. L’inaction dans le renforcement des programmes de lutte antituberculeuse avec des politiques efficaces pour la lutte contre les r\u00e9sistances aux m\u00e9dicaments peut conduire \u00e0 une nouvelle \u00e9pid\u00e9mie ayant de graves cons\u00e9quences pour la Sant\u00e9 Publique.<\/p>\n

Perspectives <\/strong><\/p>\n

L’OMS a vu la n\u00e9cessit\u00e9 d\u2019\u00e9valuer le programme de neuf mois mis sur pieds au Bangladesh dans d’autres pays, ce \u00e0 l’issue de l’essai clinique sur l’\u00e9valuation d’un r\u00e9gime de traitement standardis\u00e9 par des antituberculeux pour les patients atteints de tuberculose multi-r\u00e9sistante (STREAM) au Bangladesh (Nunn et al., 2014). Le STREAM est un essai multicentrique randomis\u00e9 comparant un r\u00e9gime de neuf mois de traitement \u00e0 celui actuellement recommand\u00e9 par l’OMS (quatorze \u00e0 vingt mois). La longueur r\u00e9duite du r\u00e9gime de traitement r\u00e9duirait les enjeux li\u00e9s au traitement de la Tuberculose multi r\u00e9sistante, aussi bien pour les patients que pour les syst\u00e8mes de sant\u00e9, produisant ainsi de meilleurs r\u00e9sultats.<\/p>\n

***<\/p>\n

\"Kareen<\/a>Kareen Atekem<\/span><\/a>, MPH, est une assistante de recherche en Analyse des Politiques de sant\u00e9 \u00e0 l’Institut Politique Nkafu, un think tank camerounais au sein de la Fondation Denis et Lenora Foretia. Elle peut \u00eatre contact\u00e9e \u00e0 katekem@foretiafoundation.org<\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Par Kareen Atekem, MPH [dropcap type=”circle” color=”#FFFFFF” background=”#8C212A”]L[\/dropcap]a tuberculose (TB), […]<\/p>\n","protected":false},"author":1,"featured_media":2045,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"give_campaign_id":0,"_eb_attr":"","content-type":"","footnotes":""},"categories":[14,26,61],"tags":[75,76],"class_list":["post-2215","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general","category-public-health-topics","category-httpwww-foretiafoundation-orgpolicy-advocacy","tag-sante","tag-tb"],"acf":[],"yoast_head":"\nLa r\u00e9sistance aux m\u00e9dicaments: un obstacle \u00e0 la lutte contre la tuberculose au Cameroun - Denis & Lenora Foretia Foundation | Catalyzing Africa's Economic Transformation<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.foretiafoundation.org\/staging\/la-resistance-aux-medicaments-un-obstacle-a-la-lutte-contre-la-tuberculose-au-cameroun\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"La r\u00e9sistance aux m\u00e9dicaments: un obstacle \u00e0 la lutte contre la tuberculose au Cameroun - 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