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  1. 1
    Peer Reviewed

    Tuberculosis in Africa - combating an HIV-driven crisis.

    Chaisson RE; Martinson NA

    New England Journal of Medicine. 2008 Mar 13; 358(11):1089-1092.

    Africa is facing the worst tuberculosis epidemic since the advent of the antibiotic era. Driven by a generalized human immunodeficiency virus (HIV) epidemic and compounded by weak health care systems, inadequate laboratories, and conditions that promote transmission of infection, this devastating situation has steadily worsened, exacerbated by the emergence of drug-resistant strains of tuberculosis. Africa, home to 11% of the world's population, carries 29% of the global burden of tuberculosis cases and 34% of related deaths, and the challenges of controlling the disease in the region have never been greater. The World Health Organization (WHO) estimates that the average incidence of tuberculosis in African countries more than doubled between 1990 and 2005, from 149 to 343 per 100,000 population (see maps) - a stark contrast to the stable or declining rates in all other regions during this period. In 1990, two African countries, Mali and Togo, had an incidence greater than 300 per 100,000; by 2005, 25 countries had reached that level, and 8 of them had an incidence at least twice that high. (excerpt)
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  2. 2

    Delay in tuberculosis care: One link in a long chain of social inequities [editorial]

    Allebeck P

    European Journal of Public Health. 2007 Oct; 17(5):409.

    In public health teaching, tuberculosis (TB) has been a traditional example of how disease occurrence is determined by the triad agent, environment, host. And it has since long been standard textbook knowledge that there are strong socioeconomic determinants behind all three components: The agent is more prevalent and is spread more easily in conditions of crowding and poor hygienic conditions, and under these conditions several host factors are also more prevalent, such as malnutrition and alcoholism. In recent years another dimension has been added to the socioeconomic patterning of TB: An already very solid mass of research has highlighted the social and economic aspects of care and follow-up of patients with TB. A recent example of this research is the paper by Wang et al. in this issue of the journal, on differences in both patient's delay and doctor's delay in the diagnosis of TB, when comparing residents and non-residents (rural immigrants) in Shanghai. (excerpt)
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  3. 3
    Peer Reviewed

    Progress towards improved tuberculosis diagnostics for developing countries.

    Perkins MD; Roscigno G; Zumla A

    Lancet. 2006 Mar 18; 367(9514):942-943.

    The lack of accurate, robust, and rapid diagnostics for tuberculosis impedes management of patients and disease control. For individual patients, the cost, complexity, and potential toxicity of 6 months of standard treatment demands certainty in diagnosis. For communities, the risk of transmission from undetected cases requires widespread access to diagnostic services and early detection. Unfortunately, diagnostic services in most places where tuberculosis is endemic fail both the individual and the community. Patients are often diagnosed after weeks to months of waiting, at substantial cost to themselves, and at huge cost to society. Many patients are never diagnosed, and contribute to the astonishing number of yearly deaths from tuberculosis worldwide. (excerpt)
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  4. 4

    Interim policy on collaborative TB / HIV activities.

    Getahun H; van Gorkom J; Harries A; Harrington M; Nunn P

    Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2004. 19 p. (WHO/HTM/TB/2004.330; WHO/HTM/HIV/2004.1)

    This policy responds to a demand from countries for immediate guidance on which collaborative TB/HIV activities to implement and under what circumstances. It is complementary to and in synergy with the established core activities of tuberculosis and HIV/AIDS prevention and control programmes. Implementing the DOTS strategy is the core activity for tuberculosis control. Similarly, infection and disease prevention and health promotion activities and the provision of treatment and care form the basis for HIV/AIDS control. This policy does not call for the institution of a new specialist or independent disease control programme. It rather promotes enhanced collaboration between tuberculosis and HIV/AIDS programmes in the provision of a continuum of quality care at service-delivery level for people with, or at risk of tuberculosis and people living with HIV/AIDS. While there is good evidence for the cost effectiveness of the DOTS strategy and several HIV prevention measures, the evidence for collaborative TB/HIV activities is limited and is still being generated in different settings. Existing evidence from randomized controlled trials, non-randomized trials and other analytical and descriptive observational studies, operational research and expert opinion based on sound clinical and field experience was used for this interim policy document. It is a rolling policy, which will be continuously updated to reflect new evidence and best practices. (excerpt)
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