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Your search found 25 Results

  1. 1
    371803

    Working together with businesses. Guidance on TB and TB/HIV prevention, diagnosis, treatment and care in the workplace.

    Dias HM; Uplekar; Amekudzi K; Reid A; Hsu LN; Wilburn S; Mohaupt D

    Geneva, Switzerland, World Health Organization {WHO], 2012. 46 p.

    The corporate and business sector belong to a wide range of care providers that offer TB and HIV care to significant proportions of working populations. While considerable literature is now available on diverse public-private mix interventions for TB care and control, there is a dearth of documentation and updated guidance on business sector initiatives in TB care. To address the need for guiding principles to initiate and scale up the engagement of the business sector in TB and HIV care, the WHO in collaboration with ILO, UNAIDS and other partners conducted an assessment of business sector initiatives to address TB and TB/HIV, documented working examples on the ground, and organized an expert consultation to discuss and draw lessons from available evidence. The purpose of this document is to capitalize on the untapped potential of the business sector to respond to these two epidemics. Built on the 2003 guidelines on contribution of workplaces to TB control prepared jointly by the ILO and WHO, these guidelines should help capitalize on increased awareness about TB and HIV and their impact on businesses, and strengthen partnerships between national TB programmes, national HIV programmes, and the business sector to improve TB and HIV prevention, treatment and care activities. Existing guidance to facilitate business participation predominantly focuses on HIV. This document is therefore principally centred on TB prevention, treatment and care and it’s linkages with HIV. This document is designed to provide guidance to TB and HIV programme managers, employers, workers organizations, occupational health staff and other partners on the need and ways to work in partnership to design and implement workplace TB/HIV prevention, treatment and care programmes integrated with occupational health and HIV workplace programmes where relevant. (excerpt)
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  2. 2
    351595
    Peer Reviewed

    [Clinical, epidemiological and microbiological characteristics of a cohort of pulmonary tuberculosis patients in Cali, Colombia] Caracteristicas clinicas, epidemiologicas y microbiologicas de una cohorte de pacientes con tuberculosis pulmonar en Cali, Colombia.

    Rojas CM; Villegas SL; Pineros HM; Chamorro EM; Duran CE; Hernandez EL; Pacheco R; Ferro BE

    Biomedica. 2010 Oct-Dec; 30(4):482-91.

    INTRODUCTION: The World Health Organization recommended strategy for global tuberculosis control is a short-course, clinically administered treatment, This approach has approximately 70% coverage in Colombia. OBJECTIVE: The clinical, epidemiological and microbiological characteristics along with drug therapy outcomes were described in newly diagnosed, pulmonary tuberculosis patients. MATERIALS AND METHODS: This was a descriptive study, conducted as part of a multicenter clinical trial of tuberculosis treatment. A cohort of 106 patients with pulmonary tuberculosis were recruited from several public health facilities in Cali between April 2005 and June 2006. Sputum smear microscopy, culture, drug susceptibility tests to first-line anti-tuberculosis drugs, chest X- ray and HIV-ELISA were performed. Clinical and epidemiological information was collected for each participant. Treatment was administered by the local tuberculosis health facility. Food and transportation incentives were provided during a 30 month follow-up period. RESULTS: The majority of patients were young males with a diagnostic delay longer than 9 weeks and a high sputum smear grade (2+ or 3+). The initial drug resistance was 7.5% for single drug treatment and 1.9% for multidrug treatments. The incidence of adverse events associated with treatment was 8.5%. HIV co-infection was present in 5.7% of the cases. Eighty-six percent of the patients completed the treatment and were considered cured. The radiographic presentation varied within a broad range and differed from the classic progression to cavity formation. CONCLUSION: Delay in tuberculosis diagnosis was identified as a risk factor for treatment compliance failure. The study population had similar baseline epidemiologic characteristics to those described in other cohort studies.
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  3. 3
    343860
    Peer Reviewed

    Tuberculosis retreatment category predicts resistance in hospitalized retreatment patients in a high HIV prevalence area.

    Schreiber YS; Herrera AF; Wilson D; Wallengren K; Draper R; Muller J; Dawood H; Doucette S; Cameron DW; Alvarez GG

    International Journal of Tuberculosis and Lung Disease. 2009 Oct; 13(10):1274-80.

    SETTING: Rates of multidrug-resistant tuberculosis (MDR-TB) are currently as high as 7.7% in retreatment cases in KwaZulu-Natal, South Africa. MDR-TB prevalence is known to be high in patients categorized as treatment failures. Recent reports have questioned the effectiveness of the World Health Organization (WHO) Category II regimen in retreatment TB cases. OBJECTIVE: To determine whether treatment category predicts susceptibility patterns and outcomes in a hospitalized population of retreatment TB cases. DESIGN: Retrospective cohort of 197 pulmonary retreatment cases. RESULTS: Retreatment cases treated with the standard retreatment regimen had a high in-hospital mortality (19.8%), or poor outcome (26.4%) and a high rate of MDR-TB (16.2%). The 'treatment failure' category predicted resistance, with 57.1% of patients exhibiting any resistance compared to other treatment categories (P = 0.02); 53.8% of patients with any resistance experienced poor outcomes, compared to 16.6% of pan-susceptible cases (P = 0.02). There was a trend towards poor outcome in the treatment failure category (42.9%, P = 0.13). CONCLUSION: The retreatment category 'treatment failure' is associated with a high prevalence of resistance in an area of high human immunodeficiency virus (HIV) prevalence. The 'treatment failure' category should be used to identify patients who may benefit from alternative regimens using directed, intensified therapy or second-line agents instead of the current standard retreatment regimen.
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  4. 4
    342823
    Peer Reviewed

    Two vs. three sputum samples for microscopic detection of tuberculosis in a high HIV prevalence population.

    Noeske J; Dopico E; Torrea G; Wang H; Van Deun A

    International Journal of Tuberculosis and Lung Disease. 2009 Jul; 13(7):842-7.

    SETTING: A busy urban hospital in Cameroon. OBJECTIVES: To compare the yield in bacteriologically proven tuberculosis (TB) cases examining two morning vs. three spot-morning-spot sputum specimens (MM vs. SMS) by direct microscopy for acid-fast bacilli (AFB). DESIGN: Repeated temporal cross-over between MM and SMS sampling for successive TB suspects, using culture as gold standard. RESULTS: A total of 799 suspects were screened using the MM strategy, identifying 223 smear-positives, and 808 suspects with the SMS strategy, yielding 236 smear-positives. Of the MM, 256 were culture-positive, of whom 195 (76%) were smear-positive. For SMS, these figures were respectively 281 and 206 (73%), a non-significant difference. The MM and SMS strategies also detected respectively 28 and 30 smear-positive cases not confirmed by culture. No cases were lost to treatment with either strategy. CONCLUSIONS: In this population with a high prevalence of human immunodeficiency virus (HIV) with late case presentation, smear microscopy of two morning specimens detected at least as many positive cases as the classical strategy, and no cases were lost before treatment. Two specimens for initial TB suspect screening can thus be recommended, also without excessive workload. Comparative studies in populations presenting with paucibacillary sputum are needed to determine the equivalent quality and yield of an alternative strategy with two spot specimens at consultation.
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  5. 5
    322608
    Peer Reviewed

    Treatment outcome of new pulmonary tuberculosis in Guangzhou, China 1993 -- 2002: A register-based cohort study.

    Bao QS; Du YH; Lu CY

    BMC Public Health. 2007 Nov 29; 7:344.

    Completion of treatment for tuberculosis (TB) is of utmost priority of TB control programs. The aims of this study were to evaluate the treatment outcome of TB cases registered in Guangzhou during the period 1993-2002, and to identify factors associated with treatment success. Two (of eight) districts in Guangzhou were selected randomly as objects of study and their surveillance database was analyzed to assess the treatment outcome and identify factors associated with treatment success for TB cases registered in Guangzhou. Six treatment outcome criteria were assessed based on guidelines set by the World Health Organization (WHO). Logistic regression was used to estimate risk factors for treatment outcome. A total of 6743 pulmonary tuberculosis cases (4903 males, 1840 females) were included in this study. The treatment success rate (including cured and complete treatment) was 88% (95%CI 87%-89%). One hundred and eight-six (2.8%) patients died and 401 (5.9%) patients defaulted treatment. In multivariate analysis, treatment success was found to be associated with young age, lack of cavitation and compliance with treatment. The total treatment success rate in the current study was similar to the WHO target for all smear positive cases, while the failure rate and the default rate in 2002 were slightly higher. Good care of elderly patients, early diagnosis of cavitation and compliance with treatment could improve the success rate of TB treatment. (author's)
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  6. 6
    318625
    Peer Reviewed

    Tuberculosis and HIV infection: The global setting.

    Nunn P; Reid A; De Cock KM

    Journal of Infectious Diseases. 2007 Aug 15; 196 Suppl 1:S5-S14.

    Tuberculosis (TB) and human immunodeficiency virus (HIV) infection make each other's control significantly more difficult. Coordination in addressing this "cursed duet" is insufficient at both global and national levels. However, global policy for TB/HIV coordination has been set, and there is consensus around this policy from both the TB and HIV control communities. The policy aims to provide all necessary care for the prevention and management of HIV-associated TB, but its implementation is hindered by real technical difficulties and shortages of resources. All major global-level institutions involved in HIV care and prevention must include TB control as part of their corporate policy. Country-level decision makers need to work together to expand both TB and HIV services, and civil society and community representatives need to hold those responsible accountable for their delivery. The TB and HIV communities should join forces to address the health-sector weaknesses that confront them both. (author's)
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  7. 7
    318624
    Peer Reviewed

    Tuberculosis and HIV coinfection: Genesis of the supplement and sponsors' contribution.

    Hoxie JA; Miller V; Walker B

    Journal of Infectious Diseases. 2007 Aug; 196 Suppl 1:S4-.

    This supplement to the Journal of Infectious Diseases on tuberculosis (TB)/HIV coinfection came together as a result of a collaboration between the National Institutes of Health (NIH)-funded Centers for AIDS Research (CFARs) at Harvard University and at the University of Pennsylvania, and the Forum for Collaborative HIV Research. It is based on 2 programs addressing TB/HIV coinfection research challenges. A steering committee, consisting of Bruce Walker, Edward Nardell, Megan Murray, and Eric Rubin (Harvard University); Gerald Friedland (Yale University); and James Hoxie (University of Pennsylvania); with the support of the national network of CFARs, organized a symposium entitled "Confronting TB/HIV Co-infection" that was held on 30 June 2005 at Harvard University. The Forum for Collaborative HIV Research, together with the International AIDS Society and the Agence National de Recherches sur le Sida et les Hepatites Virales, with special support from Tibotec, sponsored a special session entitled "HIV/TB: New Visions, New Directions" during the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment in Rio de Janeiro on 25 July 2005, followed by a roundtable discussion with representatives from the World Health Organization HIV/ AIDS and Stop TB departments; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the NIH; the Centers for Disease Control and Prevention (CDC); and leaders from the pharmaceutical industry, research networks, and advocacy organizations. (excerpt)
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  8. 8
    313696
    Peer Reviewed

    The evolving cost of HIV in South Africa: Changes in health care cost with duration on antiretroviral therapy for public sector patients.

    Harling G; Wood R

    Journal of Acquired Immune Deficiency Syndromes. 2007 Jul; 45(3):348-354.

    A retrospective costing study of 212 patients enrolled in a nongovernmental organization-supported public sector antiretroviral treatment (ART) program near Cape Town, South Africa was performed from a health care system perspective. t-Regression was used to analyze total costs in 3 periods: Pre-ART (median length = 30 days), first 48 weeks on ART (Year One), and 49 to 112 weeks on ART (Year Two). Average cost per patient Pre-ART was $404. Average cost per patient-year of observation was $2502 in Year One and $1372 in Year Two. The proportion of costs attributable to hospital care fell from 70% Pre-ART to 24% by Year Two; the proportion attributable to ART rose from 31% in Year One to 55% in Year Two. In multivariate analysis, Pre-ART and Year One costs were significantly lower for asymptomatic patients compared with those with AIDS. Costs were significantly higher for those who died Pre-ART or in Year One. In Year Two, only week 48 CD4 cell count and being male were significantly associated with lower costs. This analysis suggests that the total cost of treatment for patients on ART falls by almost half after 1 year, largely attributable to a reduction in hospital costs. (author's)
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  9. 9
    303243

    Further studies of geographic variation in naturally acquired tuberculin sensitivity.

    World Health Organization [WHO]. Tuberculosis Research Office

    Bulletin of the World Health Organization. 1955; 22:63-83.

    This paper presents the results of the tuberculin-testing of over 3,600 patients in tuberculosis hospitals and of nearly 34,000 schoolchildren in widely separated areas where arrangements could be made for specially trained personnel to work uniform materials and techniques. Both patients and children were tested with an intradermal dose of 5 TU, and the children were retested with 100 TU if the reactions were less than 5 mm. The results confirm those of earlier papers, that at least two different kinds of naturally acquired tuberculin sensitivity are found in many human populations: a high-grade sensitivity, designated as specific for virulent tuberculous infection, and a low-grade kind designated as non-specific, or not specific for tuberculous infection. Specific sensitivity is the kind found in tuberculous patients and in some schoolchildren everywhere. It follows a remarkably uniform pattern wherever it is found, apparently varying only in prevalence, not in degree, from place to place. In contrast, non- specific sensitivity varies both in prevalence and in degree. It ranges from nearly universal prevalence in some localities to almost complete absence in others, from a low degree to a relatively high degree approaching that of specific sensitivity. Non-specific sensitivity is not correlated with specific sensitivity and may have different causes in different places. (excerpt)
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  10. 10
    291869
    Peer Reviewed

    WHO clinical staging of HIV infection and disease, tuberculosis and eligibility for antiretroviral treatment: relationship to CD4 lymphocyte counts.

    Teck R; Ascurra O; Gomani P; Manzi M; Pasulani O

    International Journal of Tuberculosis and Lung Disease. 2005 Mar; 9(3):258-262.

    Setting: Thyolo district, Malawi. Objectives: To determine in HIV- positive individuals aged over 13 years CD4 lymphocyte counts in patients classified as WHO Clinical Stage III and IV and patients with active and previous tuberculosis (TB). Design: Cross-sectional study. Methods: CD4 lymphocyte counts were determined in all consecutive HIV-positive individuals presenting to the antiretroviral clinic in WHO Stage III and IV. Results: A CD4 lymphocyte count of =350 cells/µl was found in 413 (90%) of 457 individuals in WHO Stage III and IV, 96% of 77 individuals with active TB, 92% of 65 individuals with a history of pulmonary TB (PTB) in the last year, 91% of 89 individuals with a previous history of PTB beyond 1 year, 81% of 32 individuals with a previous history of extra-pulmonary TB, 93% of 107 individuals with active or past TB with another HIV-related disease and 89% of 158 individuals with active or past TB without another HIV-related disease. Conclusions: In our setting, nine of 10 HIV-positive individuals presenting in WHO Stage III and IV and with active or previous TB have CD4 counts of =350 cells/µl. It would thus be reasonable, in this or similar settings where CD4 counts are unavailable for clinical management, for all such patients to be considered eligible for antiretroviral therapy. (author's)
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  11. 11
    287950
    Peer Reviewed

    Surveillance of drug resistance in tuberculosis in the state of Tamil Nadu.

    Paramasivan CN; Bhaskarair K; Venkataraman P; Chandrasekaran V; Narayanan PR

    Indian Journal of Tuberculosis. 2000; 47(1):27-33.

    Surveillance of drug resistance was carried out at State level to obtain data which are standardised and compaiable using guidelines prescribed by the WHO/IUATLD Working Group on Anti-tuberculosis Drug Resistance Surveillance. The objective was to determine the proportion of initial and acquired drug resistance in cases of pulmonary tuberculosis in Tamil Nadu, m order to use the level of drug resistance as a performance indicator of the National Tuberculosis Programme. Two specimens of sputum from each of a total of 713 patients attending 145 participating centres all over the state were tested by smear and culture examination and drug susceptibility tests of Isoniazid, Rifampicin, Ethambutol and Streptomycin. Out of 400 patients for whom drug susceptibility results were available, 384 (96%) had no history of previous anti-tuberculosis treatment. Of these, 312 (81%) were susceptible to all the drugs tested. Resistance to Isoniazid was seen in 15.4% of patients and to Rifampicin in 4.4%, including resistance to Isoniazid and Rifampicin in 3.4%. There has been a gradual increase in initial drug resistance over the years in this part of the country. (author's)
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  12. 12
    287875

    Impact of external assistance: review of the tuberculosis programme in Karnataka, India (1999-2001).

    Ashoksahni

    Health Administrator. 2003 Jan-Jul; 15(1-2):102-105.

    RNTCP in Karnataka is a centrally sponsored project financed by the World Bank at a total cost of about 18 crores. Inspite of the fact that Karnataka has been a pioneer in initiating Tuberculosis Programme, the state stands listed with Assam, Bihar, J&K, Madhya Pradesh, Meghalaya, Mizoram, Punjab and Uttar Pradesh as the most difficult areas for implementation. Questions are raised as to the impact of external assistance in the control and implementation of the Tuberculosis Programme. (excerpt)
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  13. 13
    287878

    Advances in tuberculosis diagnostics.

    Kar A; Modi-Parekh K; Chakroborty AK

    Health Administrator. 2003 Jan-Jul; 15(1-2):118-123.

    A world wide effort is under way to develop new tools to diagnose tuberculosis, spearheaded by the World Health Organization (WHO) under its Tuberculosis Diagnostic Initiative (TBDI). This article discusses the advanced diagnostics being developed, and highlights the feasibility of use of these technologies in the public health facilities involved in tuberculosis control in India. (excerpt)
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  14. 14
    282827

    Regional strategic plan to stop TB in the Western Pacific.

    World Health Organization [WHO]. Regional Office for the Western Pacific. Taskforce for Stop TB

    Manila, Philippines, WHO, Regional Office for the Western Pacific, 2000. [42] p.

    Mission statement: to significantly reduce morbidity and mortality due to tuberculosis by promoting accessibility and sustainability of the DOTS strategy as part of health system development. The objectives of the Stop TB special project in the Western Pacific are to: reduce the prevalence and mortality of tuberculosis in the Region by half within ten years (by 2010); and ensure that the DOTS strategy is incorporated into country plans for health sector development. (excerpt)
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  15. 15
    282180

    Reaching the poor: challenges for the TB programmes in the Western Pacific Region.

    Coll-Black S; Van Maaren P; Ahn D; Kasai T; Bhushan A

    Manila, Philippines, WHO, Regional Office for the Western Pacific, Stop TB, 2004. [41] p.

    Globally, over 98% of the deaths caused by tuberculosis (TB) annually are in developing countries. Within the Western Pacific Region, the seven countries that account for 94% of the TB prevalence are low or lower middle-income economies. Within countries, as well, poor and marginalized communities suffer disproportionately from TB. Importantly, TB affects the most economically and socially productive age group, as 77% of TB deaths occur within the ages of 15 – 54. This evidence points to the important relationship between poverty and TB. The deprivation associated with poverty, such as overcrowding, poor ventilation and malnutrition, increases the rate of transmission and progression from infection to disease. In turn, the costs of TB can further impoverish poor households. This is because poor households must dedicate a larger proportion of their income to meet the direct and indirect costs of seeking TB care than the non-poor. The opportunity costs are likewise higher for the poor than non-poor. For the poor, a decrease in productivity or an increase in time away from work because of illness leads to a reduction in income. Moreover, coping mechanisms employed by poor households during periods of illness may reduce household productivity in the long-term. TB has important social costs as well, which are more likely to affect women with TB than men. For example, stigma and isolation resulting from TB can reduce an individual's social position. (excerpt)
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  16. 16
    282178

    Pacific strategic plan to Stop TB, 2000.

    World Health Organization [WHO]. Regional Office for the Western Pacific. Taskforce for Stop TB

    Manila, Philippines, WHO, Regional Office for the Western Pacific, Stop TB, 2000. [31] p.

    In recognition of the tuberculosis problem in the Pacific islands, the Secretariat of the Pacific Community (SPC), in collaboration with WHO and with support from the New Zealand Official Development Assistance (NZODA), established a Pacific Regional Tuberculosis Control Project in 1998, to address tuberculosis crisis in four Pacific island countries. The Regional Stop TB special project aims to generate social and political commitment to tuberculosis control. The first step of the Stop TB special project, the first meeting of a Technical Advisory Group (TAG) to Stop TB in the Western Pacific Region, was held in February 2000. The meeting focused on reviewing and endorsing the Regional strategic plan, including regional objectives and targets, and collaboration with partners to reach the Regional targets for the special project. The Regional strategic plan emphasizes activities to expand DOTS in the context of health system development, surveillance, laboratory services, supporting activities and estimated budget requirements. (excerpt)
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  17. 17
    282171

    Guidelines for the control of tuberculosis through DOTS strategy in Pacific Island countries.

    Blanc L; Ahn DI; Diletto C

    Manila, Philippines, World Health Organization [WHO], Regional Office for the Western Pacific, 1999. [43] p.

    Each of the small Pacific island countries has its own characteristics that need specific approaches in the implementation of DOTS strategy. The available tuberculosis guidelines are often too complex and too difficult to adapt. So health managers and health workers of these small countries need to have operational guidelines that are practical and simple to assist them in implementing an effective tuberculosis control programme based on the WHO recommended DOTS strategy. The main objectives of the guidelines are as follows: to guide tuberculosis programme managers in the implementation of DOTS strategy and the control of tuberculosis; to guide health workers and community leaders in identifying and referring suspect cases; and to guide health workers, patients and their families towards achieving a cure. As the guidelines are tested in a variety of different situations in the field, comments would be welcome and will help to improve future editions. Comments can be sent to WHO Regional Office for the Western Pacific, Tuberculosis Programme, Chronic Communicable Disease Unit. (excerpt)
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  18. 18
    280675
    Peer Reviewed

    Barriers to sustainable tuberculosis control in the Russian Federation health system.

    Atun RA; Samyshkin YA; Drobniewski F; Skuratova NM; Gusarova G

    Bulletin of the World Health Organization. 2005; 83:217-223.

    The Russian Federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. In 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (DOT) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. The Director-General of WHO has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. These are a comprehensive engagement with the health system and a strengthening of the health system. The success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. We analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the Russian Federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. We demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. Instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries), multiple admissions to hospital and lengthy hospitalization. The implementation, and expansion and sustainability of WHO-approved methods of tuberculosis control in Russian Federation are unlikely to be realized under the prevailing system of service delivery. This is because implementation does not take into account the wider context of the health system. In order for the control programme to be sustainable, the health system will need to be changed to enable services to be reconfigured so that incentives are created to reward improvements in efficiency and outcomes. (author's)
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  19. 19
    274917

    Guidelines for HIV surveillance among tuberculosis patients. 2nd ed.

    Duffell E; Toskin I

    Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2004. [38] p. (WHO/HTM/TB/2004.339; WHO/HIV/2004.06; UNAIDS/04.30E)

    These guidelines are addressed to the managers of national tuberculosis programmes (NTP) and national AIDS programmes (NAP), those people responsible for HIV surveillance, and public health decision-makers at national and sub-national level. They form part of the TB/HIV series of documents produced by the Stop TB Department in the World Health Organization and also of the “Second Generation Surveillance” (SGS) series. The main objective of these guidelines is to provide a framework for the methods to be used for measuring HIV prevalence among tuberculosis patients and to encourage implementation of. HIV surveillance. Surveillance of HIV among TB patients is being increasingly recognized as important, as the HIV epidemic continues to fuel the global TB epidemic. In many countries, HIV prevalence in TB patients is a sensitive indicator of the spread of HIV into the general population. Information on HIV levels in TB patients is essential to respond to the increasing commitment to provide comprehensive HIV/AIDS care and support, including antiretroviral therapy (ART), to HIV-positive TB patients. (excerpt)
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  20. 20
    193980

    Tuberculosis in Pakistan: are we losing the battle? [editorial]

    Khan JA; Malik A

    Journal of the Pakistan Medical Association. 2003 Aug; 53(8):[2] p..

    How many private practitioners (PPs) listening to usual complaints of 'fever, cough and weakness for over two weeks' consider a diagnosis of active tuberculosis? In Pakistan, where TB is endemic and has assumed large proportions, the diagnosis would be considered and correctly treated by only a small percentage of PPs. A study recently conducted by the authors in Karachi showed that only 66% PPs ordered sputum microscopy as the preferred method for diagnosing TB. Only 50% thought themselves as capable enough to treat patients with pulmonary TB. Only 21% doctors prescribed a correct regimen in accordance with NTP or WHO guidelines. In such circumstances, if the PPs are treating 80% of patients presenting to them with tuberculosis1, one can imagine how worse the situation can get. Despite the fact that World Health Organization (WHO), in its effort to control TB, declared it a global emergency in 1993, TB still continues to account for the largest burden of mortality by any infectious agent worldwide. It is the second leading cause of adult death in impoverished communities of Karachi. Globally, Pakistan ranks 8th in terms of estimated number of cases by WHO, with an incidence of 175/100,000 persons. Pakistan alone accounts for 44% of total TB burden in the Eastern Mediterranean Region of the WHO comprising 23 countries. (excerpt)
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  21. 21
    187229

    Meeting the need.

    Averyt A

    InterDependent. 2004 Spring; 22-23.

    However, there is reason for optimism. Proven methods of prevention and treatment exist and there is mounting evidence that the disease can be brought under control. The problem is resources. While the level of funding and political commitment to address the epidemic has improved dramatically in the last few years, more is needed. The U.N. estimates that by 2005, over $10.5 billion will be required per year to combat the disease in developing countries, where 95 percent of those infected with HIV live. Yet, in 2003, only about $4.7 billion was spent for this purpose. Recognizing the crucial importance of generating increased financing, the international community, led by U.N. Secretary-General Kofi Annan, began calling for the creation of a global health fund in early 2000. With strong support from the United States, the Global Fund to Fight AIDS, Tuberculosis and Malaria was established in January 2002 to dramatically increase resources to fight three of the world's most devastating diseases. (excerpt)
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  22. 22
    191558
    Peer Reviewed

    Tuberculosis control goals unlikely to be met by 2005.

    Sharma DC

    Lancet. 2004 Apr 3; 363(9415):1122.

    With just 20 months to go before the World Health Assembly’s (WHA) tuberculosis (TB) treatment target is due to be met, it is clear that the deadline will not be reached. In May, 2000, the WHA pledged to combat TB— which infects 9 million people each year and kills 2 million—by setting goals that demand detection of 70% of cases of infectious TB, and treatment of 85% of these by December, 2005. But, new data announced at the second meeting of Stop TB Partners’ Forum (March 24–25, 2004; New Delhi, India), where WHO’s 2004 Global Tuberculosis Report was also released, confirmed fears that TB is still far from under control. Treatment is now successful in 82% of cases, just 3% shy of the cure target. But smear-positive case detection remains low at 37%—just over half the goal of 70%. (excerpt)
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  23. 23
    191339
    Peer Reviewed

    Drug resistant tuberculosis soars in eastern Europe.

    Odigwe C

    BMJ. British Medical Journal. 2004; 328:[3] p..

    Multidrug resistant tuberculosis in parts of eastern Europe and the former Soviet Union is 10 times as common as in most parts of the world, a new report from the World Health Organization said this week. The report, which is WHO's third on drug resistant tuberculosis, contains new data obtained from the WHO/IUATLD (International Union Against Tuberculosis and Lung Disease) Global Project on Anti- Tuberculosis Drug Resistance Surveillance. Speaking at the report's launch in London this week, Dr Paul Nunn, coordinator of tuberculosis, HIV, and drug resistance at the Stop TB department of WHO, said: "We see about nine million cases worldwide every year and about two million deaths." He said: "This report . . . covers 77 geographic settings, most of which are countries—except in certain instances like China, where several settings are in one country. Thirty nine of the settings are new, and 67 657 cases were tested. (excerpt)
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  24. 24
    188261

    Treatment of tuberculosis [editorial]

    Maher D; Uplekar M; Blanc L; Raviglione M

    BMJ. British Medical Journal. 2003 Oct 11; 327:822-823.

    The likelihood of successful treatment of tuberculosis depends on the extent to which patients complete the prescribed treatment regimen (usually called compliance with, or adherence to, treatment). Interrupted treatment of tuberculosis results in ongoing transmission of disease. Without support throughout the full course of treatment, many patients with tuberculosis adhere to treatment until symptoms have resolved and then stop, since patients may equate disease and therefore the need to continue treatment with illness (symptoms). The consequent risks of failure of treatment, relapse, death, and drug resistance, threaten not only patients but also communities. Recognition in the 1950s of the importance of providing intensive support to patients with tuberculosis to promote adherence to treatment paved the way for later promotion of directly observed therapy (DOT) for adherence to treatment. (excerpt)
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  25. 25
    188262

    Directly observed treatment for tuberculosis [editorial]

    Garner P; Volmink J

    BMJ. British Medical Journal. 2003 Oct 11; 327:823-824.

    Drugs cure tuberculosis. So why does the disease remain in the top 10 causes of global mortality, with 1.8 million deaths a year? Most deaths are in low and middle income countries, where a major challenge is to ensure that drugs are available and people complete the long treatment. The World Health Organization has been tackling the global problem of inadequate tuberculosis control for some years and launched a new programme of integrated care in 1994, called directly observed treatment, short course (DOTS). By using a six month course of drugs, including rifampicin, WHO has mobilised money, people, and systems in countries to tackle the global problem with good progress.3 Its strategy is divided into five key aspects: political commitment, access to sputum microscopy, short course chemotherapy using direct observation of treatment, an uninterrupted supply of drugs, and a recording and reporting system. (excerpt)
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