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  1. 1
    322023

    Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach. 2006 revision.

    World Health Organization [WHO]. HIV / AIDS Programme. Guidelines Development Group

    Geneva, Switzerland, WHO, 2006. 127 p.

    This publication is intended to serve as a reference tool for countries with limited resources as they develop or revise national guidelines for the use of ART in adults and postpubertal adolescents (see Annex 9 for pubertal Tanner staging; prepubertal adolescents should follow the WHO paediatric guidelines). The material presented takes updated evidence into account, including new ART treatment options, and draws on the experience of established ART scale-up programmes. The simplified approach, with evidence-based standards, continues to be the basis of WHO recommendations for the initiation and monitoring of ART. The guidelines are primarily intended for use by national and regional HIV programme managers, managers of nongovernmental organizations delivering HIV care services, and other policy-makers who are involved in the scaling up of comprehensive HIV care and ART in resource-limited countries. The comprehensive, up-to-date technical and clinical information on the use of ART, however, also makes these guidelines useful for clinicians in resource-limited settings. The recommendations contained in these guidelines are made on the basis of different levels of evidence from randomized clinical trials, high-quality scientific studies, observational cohort data and, where insufficient evidence is available, expert opinion. The strengths of the recommendations in Table 1 are intended to indicate the degrees to which the recommendations should be considered by regional and country programmes. Cost-effectiveness is not explicitly considered as part of the recommendations, although the realities of human resources, health system infrastructures and socioeconomic issues should be taken into account when the recommendations are being adapted to regional and country programmes. (excerpt)
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  2. 2
    308332

    Integration between sexual and reproductive health and HIV and AIDS and malaria: opportunities and strategic options for the Global Fund to Fight AIDS, Tuberculosis and Malaria. Discussion piece.

    Dickinson C

    [London, England], HLSP, 2006 Nov. [47] p.

    There is a growing body of knowledge which emphasises integration of sexual and reproductive health (SRH) as critical to the effectiveness of responses to HIV and AIDS, and the success of HIV and AIDS programmes. Further, accelerated headway in malaria prevention and/or treatment can be achieved through integration with SRH efforts. This paper briefly explores the evidence base for integration, identifies the enabling environment at global and national levels and discusses the opportunities and challenges for supporting integration by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). The paper concludes with strategic options for the Global Fund. (excerpt)
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  3. 3
    312576

    WHO training course for TB consultants: RPM Plus drug management sessions in Sondalo, Italy, September 28 - October 1, 2006: trip report.

    Barillas E

    Arlington, Virginia, Management Sciences for Health, Center for Pharmaceutical Management, Rational Pharmaceutical Management Plus, 2006 Oct 18. 26 p. (USAID Cooperative Agreement No. HRN-A-00-00-00016-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ACI-323)

    WHO, Stop-TB Partners, and NGOs that support country programs for DOTS implementation and expansion require capable consultants in assessing the capacity of countries to manage TB pharmaceuticals in their programs, developing interventions, and providing direct technical assistance to improve availability and accessibility of quality TB medicines. Beginning in 2001, RPM Plus, in addition to its own formal courses on pharmaceutical management for tuberculosis, has contributed modules and facilitated sessions on specific aspects of pharmaceutical management to the WHO Courses for TB Consultants in Sondalo. The WHO TB Course for TB Consultants was developed and initiated in 2001 by the WHO Collaborating Centre for Tuberculosis and Lung Diseases, the S. Maugeri Foundation, the Morelli Hospital, and TB CTA. The main goal of the course is to increase the pool of international level TB consultants. As of December 2005, over 150 international TB consultants have participated in the training, a majority ofwhom have already been employed in consultancy activities by the WHO and international donors. In 2006 fiscal year RPM Plus received funds from USAID to continue supporting the Sondalo Course, which allowed RPM Plus to facilitate sessions on pharmaceutical management for TB at four courses in May, June, July, and October of 2006. RPM Plus Senior Program Associate, Edgar Barillas, traveled to Sondalo from September 28 to October 1 to facilitate the TB pharmaceutical management session at the WHO course for TB Consultants in Sondalo, Italy. (excerpt)
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  4. 4
    312473

    Advocacy, communication and social mobilization to fight TB : a 10-year framework for action.

    Deane J; Parks W

    Geneva, Switzerland, World Health Organization [WHO], 2006. 93 p. (WHO/HTM/STB/2006.37)

    A significant scaling up of advocacy, communication and social mobilization (ACSM) will be needed to achieve the global targets for tuberculosis control as detailed in the Global Plan to Stop TB 2006--2015. In 2005, the ACSM Working Group (ACSM WG) was established as the seventh working group of the Stop TB Partnership to mobilize political, social and financial resources; to sustain and expand the global movement to eliminate TB; and to foster the development of more effective ACSM programming at country level in support of TB control. It succeeded an earlier Partnership Task Force on Advocacy and Communications. This work-plan focuses on those areas where ACSM has most to offer and where ACSM strategies can be most effectively concentrated to help address four key challenges to TB control at country level: Improving case detection and treatment adherence; Combating stigma and discrimination; Empowering people affected by TB; Mobilizing political commitment and resources for TB. (excerpt)
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  5. 5
    312471

    Strategic approach for the strengthening of laboratory services for tuberculosis control, 2006-2009.

    Abdel Aziz M; Ryszewska K; Laszlo A; Blanc L

    Geneva, Switzerland, World Health Organization [WHO], 2006. [21] p. (WHO/HTM/TB/2006.364)

    Bacteriology is one of the fundamental aspects of national tuberculosis (TB) control programmes (NTPs) and a key component of the DOTS strategy. However, TB laboratory services are often neglected components of these programmes. Given existing constraints, it will be difficult for many countries to achieve the global targets of 70% detection of infectious cases and 85% cure of these incidents by the year 2005. Although the global success rate under DOTS has reached 82%, the detection rate of the estimated prevalence has increased at a far slower rate (53% in 2004). In order to improve the case-detection rate, a global strategy for the development and strengthening of TB laboratory networks needs to be implemented urgently. In addition to improving sputum smear microscopy, the strategy recognizes the need to upgrade existing laboratory services and to strengthen/build capacity to perform culture and drug susceptibility testing (DST) in areas experiencing a high burden of acid-fast bacilli (AFB) smear-negative TB associated with human immunodeficiency virus (HIV) infection and to support DOTS-Plus projects. (excerpt)
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  6. 6
    312470

    Procurement manual for the DOTS-Plus projects approved by the Green Light Committee.

    Jille I; Jouberton F; Jaramillo E; Sereguina M; Wehrens R

    Geneva, Switzerland, World Health Organization [WHO], 2006 Apr. 20 p. (WHO/HTM/TB/2003.328 Rev.2)

    The IDA Foundation is a non-profit organization supporting health care in low- and middle-income countries by providing high-quality drugs and medical supplies at the lowest possible price. In addition, IDA provides procurement agency services and offers consultancy and training on topics related to the various aspects of pharmaceutical supply management. IDA is based in the Netherlands and is ISO 9002-2000 and GDP certified. The quality of IDA products is verified in IDA's GcLP-approved laboratories. GLC is a subgroup of the Stop TB Working Group on DOTS-Plus for MDR-TB. GLC has been established to review applications from potential DOTS-Plus pilot projects and determine whether they are in compliance with WHO's Guidelines for establishing DOTSPlus pilot projects for the management of MDR-TB. Projects that are approved will benefit from second-line anti-TB drugs at concessional prices and from technical assistance from the GLC. (excerpt)
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  7. 7
    312464

    Guidelines for the programmatic management of drug-resistant tuberculosis.

    Rich M; Cegielski P; Jaramillo E; Lambregts K

    Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2006. [184] p. (WHO/HTM/TB/2006.361)

    The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug-resistant TB (MDR-TB), has become a significant public health problem in a number of countries and an obstacle to effective global TB control. In many other countries, the extent of drug resistance is unknown and the management of patients with MDR-TB is inadequate. In countries where drug resistance has been identified, specific measures need to be taken within TB control programmes to address the problem through appropriate management of patients and adoption of strategies to prevent the propagation and dissemination of drug-resistant TB, including MDR-TB. These guidelines offer updated recommendations for TB control programmes and medical workers in middle- and low-income countries faced with drug-resistant forms of TB, especially MDR-TB. They replace two previous publications by the World Health Organization (WHO) on drug-resistant TB. Taking account of important developments in recent years, the new guidelines aim to disseminate consistent, up-to-date recommendations for national TB control programmes and medical practitioners on the diagnosis and management of drug-resistant TB in a variety of geographical, political, economic and social settings. The guidelines can be adapted to suit diverse local circumstances because they are structured around a flexible framework approach, combining a consistent core of principles and requirements with various alternatives that can be tailored to the specific local situation. (excerpt)
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  8. 8
    312461

    Engaging all health care providers in TB control. Guidance on implementing public-private mix approaches.

    Uplekar M; Lonnroth K

    Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2006. 52 p. (WHO/HTM/TB/2006.360)

    A great deal of progress has been made in global tuberculosis control in recent years through the large-scale implementation of DOTS. It has been acknowledged though that TB control efforts worldwide, although impressive, are not sufficient. The global TB targets -- detecting 70% of TB cases and successfully treating 85% of them, and halving the prevalence and mortality of the disease by 2015 as part of the Millennium Development Goals (MDGs) -- are likely to be met only if current efforts are intensified. Among the important interventions required to reach these goals would be a systematic involvement of all relevant health care providers in delivering effective TB services to all segments of the population. Therefore, engaging all health care providers in TB control is an essential component of WHO's new Stop TB strategy¹ and the Stop TB Partnership's Global Plan to Stop TB 2006-2015. (excerpt)
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  9. 9
    312460

    The Stop TB Strategy: building on and enhancing DOTS to meet the TB-related Millennium Development Goals.

    Uplekar M; Figueroa-Munoz J; Floyd K; Getahun H; Jaramillo E

    Geneva, Switzerland, World Health Organization [WHO], 2006. 22 p. (WHO/HTM/STB/2006.37)

    Since the development of the DOTS strategy, WHO and partners have worked on complementary policies and strategies to address the remaining major constraints to achievement of global TB control targets. These include expanding access to diagnosis and treatment through community TB care, and public--private mix (PPM) approaches aimed at engaging all care providers -- state and non-state -- in DOTS implementation. Innovative mechanisms such as the Global Drug Facility and the Green Light Committee have been developed to improve access to quality-assured and affordable drugs in resource-poor settings. The collaborative activities that need to be implemented by TB and HIV/AIDS control programmes have been defined, and strategies for managing multidrug-resistant TB (MDR-TB) have been developed and tested. Impact assessment is being pursued as a means of evaluating progress towards the MDGs. New partnerships and academic research initiatives for development of new tools are beginning to produce results and several new diagnostics, drugs and candidate vaccines are in the pipeline. (excerpt)
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  10. 10
    312306

    3...2...1... gone? Failure to call Global Fund Round 6 risks the whole 2010 AIDS treatment target.

    Wright S

    [London, England], ActionAid, 2006 Apr 11. 5 p.

    Global Fund funding rounds are becoming further and further apart due to the failure of donors to commit enough resources for the Fund to do its job. At the April Board meeting, donors will decide whether Round 6 can be held this year. If it is delayed until 2007 or even later, the G8's treatment target will not be helped by one of the main sources of funding. ActionAid calls on the UK Government to continue its leadership on AIDS from 2005 and put pressure on other donors to launch Round 6 and to pay their fair share to the Fund. (excerpt)
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  11. 11
    312299

    Stop TB Partnership -- annual report 2005.

    World Health Organization [WHO]. Stop TB Partnership

    Geneva, Switzerland, WHO, 2006. [52] p. (WHO/HTM/STB/2006.36)

    During 2005, the Stop TB Partnership continued to work towards the goal of eliminating tuberculosis (TB) as a public health problem and obtaining a world free of TB. Through a dynamic network of international organizations, national governments, donors and nongovernmental organizations that share this goal, the Partnership strengthened its reputation as an effective force in global TB control. The major achievement of the Stop TB Partnership in 2005 was the development of the Global Plan to Stop TB, 2006--2015, a blueprint for TB control over the coming decade. This landmark achievement was the result of intense work by the Partnership's Working Groups and all of its partners, and is underpinned by the new Stop TB Strategy of WHO. The Global Plan and the new Stop TB Strategy were both endorsed by the Coordinating Board (CB) of the Partnership. The CB met twice in 2005, first in Addis Ababa (Ethiopia) and then in Assisi (Italy), and took major decisions on governance, business processes and technical issues. The CB delegations undertook a number of important advocacy missions on behalf of the Stop TB Partnership including Gaborone (Botswana), Ottawa (Canada), Jakarta (Indonesia), Rome (Italy) and Maputo (Mozambique). (excerpt)
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  12. 12
    312298

    Strengthening the teaching of tuberculosis control in basic training programmes. A manual for instructors of nurses and other health-care workers.

    Engstrom K

    Geneva, Switzerland, World Health Organization [WHO], 2006. 95 p. (WHO/HTM/TB/2006.367)

    Approximately one third of the world's population is infected with Mycobacterium tuberculosis and at risk of developing the disease. Every year, more than 8 million people develop active tuberculosis (TB) and approximately 1.9 million people die. More than 90% of global TB cases and deaths occur in the developing world, where 75% of cases are in the most economically productive age group (15--54 years). Once infected with M. tuberculosis, a person is infected for life. While only 1 in 10 of infected people with healthy immune systems will develop TB symptoms during their lifetimes, infected people with weakened immune systems, such as those with the human immunodeficiency virus (HIV), are at much greater risk of becoming ill with TB. At the same time, multidrug resistance, which is caused by poorly managed TB treatment, is a growing problem of serious concern in many countries throughout the world. (excerpt)
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  13. 13
    312290

    Guidance for national tuberculosis programmes on the management of tuberculosis in children.

    Bjune G; Cotton M; El Sony A; Gie R; Graham S

    Geneva, Switzerland, World Health Organization [WHO], 2006. [49] p. (WHO/HTM/ TB/2006.371; WHO/FCH/CAH/2006.7)

    This document complements existing national and international guidelines and standards for managing TB, many of which include guidance on children. It fills the gaps in the existing materials and provides current recommendations based on the best available evidence. National and regional TB control programmes may wish to revise and adapt this guidance according to local circumstances. This document reflects two important recent policy changes. Firstly, NTPs should record and report two age groups for children (0--4 years and 5--14 years) using the quarterly reporting form. Routine reporting of these two age groups has considerable benefits. Enumerating children with TB is a key step in bringing their management into the mainstream of the Stop TB Strategy as part of routine NTP activities. This age breakdown is crucial in ordering drugs (since child-friendly formulations are particularly important in children aged 0--4 years) and in monitoring of trends in these two distinct age groups (since children aged 0--4 years are the most vulnerable and infection at these early ages indicates recent transmission). In addition, routine NTP data collection will provide valuable and sustainable information on market needs concerning child-friendly formulations of anti-TB drugs. Secondly, the revised recommended dose of ethambutol is now 20 mg/kg (range 15--25 mg/kg) daily. Although ethambutol was previously often omitted from treatment regimens for children, due in part to concerns about toxicity (particularly optic neuritis), a literature review indicates that it is safe in children at this dose. (excerpt)
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  14. 14
    311779

    Instructions for applying to the Green Light Committee for access to second-line anti-tuberculosis drugs.

    Blondal K; Caminero JA; Cegielski P; Espinal MA; Jaramillo E

    [Geneva, Switzerland], World Health Organization [WHO], 2006. 15 p. (WHO/HTM/TB/2006.369)

    Controlling multi-drug resistant tuberculosis (MDR-TB) is one of the six components of the WHO Stop TB strategy. Although prevention must be the highest priority for TB control programmes, many countries have patients with drug-resistant TB who must be treated too. Such countries should take specific measures to gradually incorporate appropriate strategies for treatment of this form of tuberculosis into their programmes and prevent propagation of drug-resistant TB. Misuse of second-line anti-TB drugs results in further resistance to these same second-line drugs, creating incurable forms of tuberculosis. It is imperative that second-line anti-TB drugs are used wisely. The WHO Guidelines For The Programmatic Management of Drug Resistant Tuberculosis (herein after referred to as the Guidelines) provide recommendations for appropriate management of drug-resistant TB so as not to generate further drug resistance. To help programmes develop and implement develop and implement strategies for the management of drug resistant TB, the Green Light Committee for Access to Second-line Anti-tuberculosis Drugs (GLC) was created by WHO and its partners in January 2000. (excerpt)
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  15. 15
    311948
    Peer Reviewed

    Incorporating a rapid-impact package for neglected tropical diseases with programs for HIV / AIDS, tuberculosis, and malaria: A comprehensive pro-poor health policy and strategy for the developing world.

    Hotez PJ; Molyneux DH; Fenwick A; Ottesen E; Sachs SE

    PLoS Medicine. 2006 May; 3(5):e102.

    The last five years have witnessed increased efforts by G8 nations and United Nations agencies to improve the health of the world's 3 billion people living on less than US$2 a day. Most of this attention has focused on efforts to intensify resources for fighting the three most devastating diseases: HIV/AIDS, tuberculosis, and malaria. Together, these "big three" account for a staggering 5.6 million deaths and the loss of 166 million disability-adjusted life years (DALYs) annually (see annex tables 2 and 3 in). Prominent partnerships and initiatives are now devoted to the big three, and increased global attention to these diseases (and to the risks posed by avian influenza and other emerging viral infections) culminated in the November 2005 TIME Global Health Summit, branded by Bono as the "Woodstock of Global Health". These new initiatives and "Woodstock" Global Health have done much to raise funds and elevate public awareness in order to launch a serious war on the big three. Conspicuously absent from these activities, however, has been commensurate advocacy for a group of diseases that exclusively affect the poor and the powerless in rural and impoverished urban areas of developing countries. An increasing body of evidence indicates that this group of "neglected tropical diseases" may not only threaten the health of the poor as much as HIV/ AIDS, tuberculosis, or malaria, but even more importantly, may have effective treatment and prevention strategies that can be delivered for less than US$1 per capita per year. Furthermore, new evidence points to substantial geographic overlap between the neglected tropical diseases and the big three, with emerging data suggesting that control of the neglected tropical diseases could actually become a powerful tool for combating HIV/AIDS, tuberculosis, and malaria. (excerpt)
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  16. 16
    310966
    Peer Reviewed

    Epidemiology of antituberculosis drug resistance (the Global Project on Anti-tuberculosis Drug Resistance Surveillance): an updated analysis.

    Aziz MA; Wright A; Laszlo A; De Muynck A; Portaels F

    Lancet. 2006 Dec 16; 368(9553):2142-2154.

    The burden of tuberculosis is compounded by drug-resistant forms of the disease. This study aimed to analyse data on antituberculosis drug resistance gathered by the WHO and International Union Against Tuberculosis and Lung Disease Global Project on Anti-tuberculosis Drug Resistance Surveillance. Data on drug susceptibility testing for four antituberculosis drugs--isoniazid, rifampicin, ethambutol, and streptomycin--were gathered in the third round of the Global Project (1999-2002) from surveys or ongoing surveillance in 79 countries or geographical settings. These data were combined with those from the first two rounds of the project and analyses were done. Countries that participated followed a standardised set of guidelines to ensure comparability both between and within countries. The median prevalence of resistance to any of the four antituberculosis drugs in new cases of tuberculosis identified in 76 countries or geographical settings was 10.2% (range 0.0-57.1). The median prevalence of multidrug resistance in new cases was 1.0% (range 0.0-14.2). Kazakhstan, Tomsk Oblast (Russia), Karakalpakstan (Uzbekistan), Estonia, Israel, the Chinese provinces Liaoning and Henan, Lithuania, and Latvia reported prevalence of multidrug resistance above 6.5%. Trend analysis showed a significant increase in the prevalence of multidrug resistance in new cases in Tomsk Oblast (p < 0.0001). Hong Kong (p = 0.01) and the USA (p = 0.0002) reported significant decreasing trends in multidrug resistance in new cases of tuberculosis. Multidrug resistance represents a serious challenge for tuberculosis control in countries of the former Soviet Union and in some provinces of China. Gaps in coverage of the Global Project are substantial, and baseline information is urgently required from several countries with high tuberculosis burden to develop appropriate control interventions. (author's)
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  17. 17
    310512

    Intersecting epidemics: tuberculosis and HIV.

    Worley H

    Washington, D.C., Population Reference Bureau [PRB], 2006 Apr. 5 p.

    As if the global AIDS pandemic alone were not enough, developing countries are beset with converging epidemics of HIV and tuberculosis (TB)--increasing the likelihood of premature death in these countries. Worldwide, 14 million people are coinfected with TB and HIV--70 percent of those in sub-Saharan Africa (see figure for five countries with particularly high coinfection rates). TB is the leading cause of death for those infected with HIV and is implicated in up to one-half of all AIDS deaths. And because HIV compromises the immune system, HIV-positive people are 50 times more likely to develop active TB than those who are HIV-negative. (excerpt)
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  18. 18
    310193
    Peer Reviewed

    Tuberculosis control in Bolivia, Chile, Colombia and Peru: Why does incidence vary so much between neighbors?

    Sobero RA; Peabody JW

    International Journal of Tuberculosis and Lung Disease. 2006 Nov; 10(11):1292-1295.

    In 2003, Peru and Bolivia reported the highest annual tuberculosis (TB) incidence rates in the Americas. Neighboring Colombia and Chile had lower annual incidence rates despite their proximity. The objective was to determine what factors contribute to differences in TB incidence rates among Chile, Colombia, Bolivia and Peru. Multiple sources of literature dating between 1990 and 2005 were used and World Health Organization TB control guidelines were consulted for policy level comparisons. Comprehensive implementation of the DOTS strategy is the main factor explaining the differences in TB incidence rates, even after considering socio-economic factors. Cross-national comparisons suggest ways to improve regional DOTS implementation. (author's)
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  19. 19
    310198
    Peer Reviewed

    Ten-year experiences of the tuberculosis control programme in the southern region of Ethiopia.

    Yassin MA; Datiko DG; Shargie EB

    International Journal of Tuberculosis and Lung Disease. 2006 Oct; 10(10):1166-1171.

    The setting used was a tuberculosis control programme, southern region of Ethiopia. The objective was to assess the impact of the expansion of the DOTS strategy on tuberculosis (TB) case finding and treatment outcome. Reports of TB patients treated since the introduction of DOTS in the region were reviewed. Patients were diagnosed and treated according to World Health Organization (WHO) recommendations. Case notification and treatment outcome reports were compiled quarterly at district level and submitted to the regional programme. Of 136 572 cases registered between 1995 and 2004, 47% were smear-positive, 25% were smear-negative and 28% had extra-pulmonary tuberculosis (EPTB). In 2004, 94% of the health institutions were covered by DOTS. Between 1995 and 2004, the smear-positive case notification rate increased from 45 to 143 per 100 000 population, the case detection rate from 22% to 45%, and the treatment success rate from 53% to 85%. The default and failure rates decreased from 26% to 6% and from 7% to 1%, respectively. There was a steady increase in the treatment success rate with the decentralisation of DOTS. Although 94% coverage was achieved after 10 years, the stepwise scale-up was important in securing resources and dealing with challenges. The programme achieved 85% treatment success; however, with the current low case detection rate (45%), the 70% WHO target seems unachievable in the absence of alternative case-finding mechanisms. (author's)
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  20. 20
    307809

    Tuberculosis in children [editorial]

    Mehnaz A

    Journal of the Pakistan Medical Association. 2006 Sep; 56(9):390-391.

    Tuberculosis, one of the oldest and deadliest infectious diseases had a dramatic comeback in the last quarter of the century. WHO declared Tuberculosis (TB) as a global emergency in 1993. Though no nation was immune from the disease, the main brunt of the disease was found in the developing countries. The escalating incidence of tuberculosis in Pakistan is due to persistence of poor socio-political conditions, inadequate health care infrastructure, undernutrition, overcrowded living conditions, influx of refugees, rising incidence of HIV/AIDS, and a general apathy towards health and related problems. Pakistan is identified as sixth among the 22 countries of the EMRO region with the highest burden of TB. In 2001, the Government of Pakistan declared Tuberculosis as a National Emergency. In 2002 the National Tuberculosis Control Programme (NTP) a project of Ministry of Health (MoH), Government of Pakistan, adopted and initiated the implementation of DOTS programme. The objective of the NTP was to provide 100 percent DOTS coverage by 2005, detecting 70% of all cases and successfully treating 85% of them by 2005 and reducing the prevalence and deaths due to tuberculosis by 50% by 2010. (excerpt)
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  21. 21
    307507

    XDR-TB -- a global threat [editorial]

    Lancet. 2006 Sep 16; 368(9540):964.

    Following an emergency consultation in Johannesburg on Sept 7 and 8, global health agencies have developed a seven-point plan to combat extensively (or extremely) drug-resistant tuberculosis (XDR-TB). Representatives from several southern African countries have agreed to implement the plan within 3 months. Multidrug-resistant TB (MDR-TB), defined as resistance to at least isoniazid and rifampicin, requires the use of second-line drugs that are less effective, more expensive, and more toxic than first-line regimens based on isoniazid and rifampicin. Recognised earlier this year, XDR-TB is MDR-TB that is also resistant to three or more of the six classes of second-line drugs. Of 17 690 TB isolates taken between 2000 and 2004, 20% were MDR and 2% were XDR. XDR-TB has now been identified in all regions of the world but is most prevalent in Asia and in eastern Europe. (excerpt)
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  22. 22
    306613
    Peer Reviewed

    The impact of tuberculosis on Zambia and the Zambian nursing workforce.

    Chanda D; Gosnell DJ

    Online Journal of Issues in Nursing. 2006 Jan 31; 11(1):[21] p..

    In Zambia, the incidence of tuberculosis (TB) has greatly increased in the last 10 years. This article describes Zambia and highlights the country's use of the United Nations Millennium Development Goals as a framework to guide TB treatment programmes. An overview of TB in Zambia is provided. Data related to TB cases at the county's main referral hospital, the University Teaching Hospital (UTH), is discussed. Treatment policies and barriers are described. Zambian nurses have been greatly affected by the rise in the morbidity and mortality of nurses with TB. This article explains the impact of TB on the Zambian nursing workforce. Review of Zambian government programmes designed to address this health crisis and targeted interventions to reduce TB among nurses are offered. (author's)
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  23. 23
    306528
    Peer Reviewed

    Multidrug-resistant tuberculosis management in resource-limited settings.

    Nathanson E; Lambregts-van Weezenbeek C; Rich ML; Gupta R; Bayona J

    Emerging Infectious Diseases. 2006 Sep; 12(9):1389-1397.

    Evidence of successful management of multidrugresistant tuberculosis (MDRTB) is mainly generated from referral hospitals in high-income countries. We evaluate the management of MDRTB in 5 resource-limited countries: Estonia, Latvia, Peru, the Philippines, and the Russian Federation. All projects were approved by the Green Light Committee for access to quality-assured second-line drugs provided at reduced price for MDRTB management. Of 1,047 MDRTB patients evaluated, 119 (11%) were new, and 928 (89%) had received treatment previously. More than 50% of previously treated patients had received both first- and second-line drugs, and 65% of all patients had infections that were resistant to both first- and second-line drugs. Treatment was successful in 70% of all patients, but success rate was higher among new (77%) than among previously treated patients (69%). In resource-limited settings, treatment of MDRTB provided through, or in collaboration with, national TB programs can yield results similar to those from wealthier settings. (author's)
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  24. 24
    306526
    Peer Reviewed

    Nosocomial tuberculosis in India.

    Pai M; Kalantri S; Aggarwal AN; Menzies D; Blumberg HM

    Emerging Infectious Diseases. 2006 Sep; 12(9):1311-1318.

    Most high-income countries implement tuberculosis (TB) infection control programs to reduce the risk for nosocomial transmission. However, such control programs are not routinely implemented in India, the country that accounts for the largest number of TB cases in the world. Despite the high prevalence of TB in India and the expected high probability of nosocomial transmission, little is known about nosocomial and occupational TB there. The few available studies suggest that nosocomial TB may be a problem. We review the available data on this topic, describe factors that may facilitate nosocomial transmission in Indian healthcare settings, and consider the feasibility and applicability of various recommended infection control interventions in these settings. Finally, we outline the critical information needed to effectively address the problem of nosocomial transmission of TB in India. (author's)
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  25. 25
    293690

    Fifth round of funding adds $729 to fight against diseases.

    Mera. 2006 Jan; (21):3-4.

    The Global Fund is a unique global public-private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV/AIDS, tuberculosis and malaria. This partnership between governments, civil society, the private sector and affected communities represents a new approach to international health financing. The Fund works in close collaboration with other bilateral and multilateral organisations to supplement existing efforts dealing with the three diseases. Apart from a high standard of technical quality, the Global Fund attaches no conditions to any of its grants. It is not an implementing agency, instead relying on local ownership and planning to ensure that new resources are directed to programmes on the frontline of this global effort to reach those most in need. Its performance-based approach to grant-making is designed to ensure that funds are used efficiently and create real change for people and communities. (excerpt)
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