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TUBERCLE AND LUNG DISEASE. 1994 Jun; 75(3):163-7.Poor management of tuberculosis (TB) control is responsible for resistance to antituberculosis drugs. It leads to treatment failure, relapse, transmission of resistant TB, and multi-drug resistant TB. In developing countries, where resources are already limited, an epidemic of multi-drug resistant TB would jeopardize TB control. The effect of HIV infection is likely to worsen drug resistance-related problems. Specifically, streptomycin injections pose a risk of HIV transmission. It appears that withdrawal of thiacetazone from HIV infected TB patients causes resistance to more powerful drugs. If these 2 antibiotics cannot be used to treat TB patients, the armamentarium available to control TB in high HIV prevalence countries is reduced, which could foster resistance to the fewer remaining antibiotics. Good management and supervision is needed to prevent resistance to antituberculosis drugs. Surveillance of drug resistance is also needed to monitor the current level and characteristics of the drug resistance problem and to identify effective solutions. Specifically, at the national level, a TB surveillance system can assess the TB control program's performance and assess the need to modify the current treatment policy. It can identify districts or health centers with high levels of drug resistance and determine the risk factors for resistance. WHO will assist developing countries in developing their own surveillance systems. WHO and the International Union Against Tuberculosis and Lung Disease plan on setting up a network of supranational reference laboratories to determine the quality control and standardization of susceptibility testing needed for international comparison. WHO also plans on supporting national reference laboratories in developing countries.
Impact of the 1994 expanded World Health Organization AIDS case definition on AIDS surveillance in university hospitals and tuberculosis centers in Cote d'Ivoire.
AIDS. 1997 Dec; 11(15):1867-72.To assess the impact of the 1994 expanded World Health Organization (WHO) AIDS case definition upon AIDS surveillance in Cote d'Ivoire, passive AIDS case surveillance was conducted from March 1994 through December 1996 at the 3 university hospitals in Abidjan, while active AIDS case surveillance was conducted at the 8 large tuberculosis (TB) centers throughout Cote d'Ivoire. Standardized questionnaires were administered and blood samples for HIV testing were collected from patients evaluated. 3658 of the 8648 hospital patients met the clinical and/or expanded case definition: 744 HIV-seropositive individuals met only the expanded definition, 44 HIV-seropositive individuals met only the clinical definition, 2334 HIV-seropositive individuals met both definitions, and 536 HIV-seronegative persons met only the clinical definition. Of 18,661 TB center patients, 9664 met the clinical and/or expanded case definition: 5685 HIV-seropositive individuals met only the expanded definition, none of the HIV-seropositive individuals met only the clinical definition, 2625 HIV-seropositive individuals met both definitions, and 1354 HIV-seronegative persons met only the clinical definition. The use of the 1994 expanded definition for surveillance purposes should be encouraged in areas of the developing world where HIV serologic testing is available.
Scaling up antiretroviral therapy in resource-limited settings: treatment guidelines for a public health approach. Rev. ed.
Geneva, Switzerland, WHO, 2003. 67 p.Currently, fewer than 5% of people in developing countries who need ART can access the medicines in question. WHO believes that at least 3 million people needing care should be able to get the medicines by 2005. This represents almost a tenfold increase. These treatment guidelines are intended to support and facilitate the proper management and scale-up of ART in the years to come by proposing a public health approach to achieve the goals. The key tenets of this approach are as follows. 1) Scaling-up of antiretroviral treatment programmes with a view to universal access, i.e. all persons requiring treatment as indicated by medical criteria should have access to it. 2) Standardization and simplification of ARV regimens so as to support the efficient implementation of treatment programmes in resource-limited settings. 3) Ensuring that ARV treatment programmes are based on scientific evidence in order to avoid the use of substandard protocols that compromise the outcomes of individual patients and create a potential for the emergence of drug-resistant virus. However, it is also important to consider the realities with respect to the availability of human resources, health system infrastructures and socioeconomic contexts so that clear and realistic recommendations can be made. (excerpt)
Journal of the Indian Medical Association. 2003 Mar; 101(3):150-151.Tuberculosis (TB) remains a serious public health problem in spite of DOTS programme recommended by WHO. One person dies from TB in India every minute. Revised National TB Control Programme (RNTCP) is playing a major role in global DOTS expansion. DOTS coverage has expanded from 2% of the population in mid-1998 to 57% by the end of January, 2003. RNTCP has made a significant contribution to public health capacity. The programme has saved the people of India hundreds of millions of dollars. Monitoring the clinical course using smear microscopy and accurately reporting treatment outcomes is essential in well-functioning DOTS programme. RNTCP has invested heavily and made significant strides in maintaining and improving quality DOTS. State and district level programme reviews are a key component of the process. RNTCP has established guidelines for the involvement of the private sector and medical colleges. A member by ongoing technical activities will improve RNTCP’s surveillance and monitoring systems. However a challenge lies with the programme and a collective effort is welcome. (excerpt)
Impact of external assistance: review of the tuberculosis programme in Karnataka, India (1999-2001).
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)
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)
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005 Oct 27. 19 p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-068; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)Many national TB programs continue to encounter problems in providing quality TB medicines to patients when they need them. While lack of financial resources may be one constraint for procuring all TB medicines needed, national programs experience a host of other problems in pharmaceutical management. Strong pharmaceutical management is one of the key pillars to effective tuberculosis (TB) control; without appropriate selection, effective procurement, distribution, stock management and rational use of TB medicines and related supplies, individuals will not be cured of the disease and countries will not reach global targets. Management Sciences for Health's Rational Pharmaceutical Management Plus (RPM Plus) program funded by USAID in collaboration with Stop TB Partnership's Global TB Drug Facility (GDF) housed at World Health Organization (WHO) Geneva conducted a workshop at the 36th International UNION World Congress on Tuberculosis and Lung Health on October 19th 2005 at Paris, France. This is the fourth year MSH and GDF have collaborated in such an event at the UNION congress due to popular demand by national TB programmes and their partners. (excerpt)
Instructions for applying to the Green Light Committee for access to second-line anti-tuberculosis drugs.
[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)
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)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.Control of tuberculosis (TB), like health care in general, costs money. To sustain TB control at current levels, and to make further progress so that global targets can be achieved, information about funding needs, sources of funding, funding gaps and expenditures is important at global, regional, national and sub-national levels. Such data can be used for resource mobilization efforts; to document how funding requirements and gaps are changing over time; to assess whether increases in funding can be translated into increased expenditures and whether increases in expenditure are producing improvements in programme performance; and to identify which countries or regions have the greatest needs and funding gaps. In this paper, we discuss a global system for financial monitoring of TB control that was established in WHO in 2002. By early 2007, this system had accounted for actual or planned expenditures of more than US$ 7 billion and was systematically reporting financial data for countries that carry more than 90% of the global burden of TB. We illustrate the value of this system by presenting major findings that have been produced for the period 2002-2007, including results that are relevant to the achievement of global targets for TB control set for 2005 and 2015. We also analyse the strengths and limitations of the system and its relevance to other health-care programmes. (author's)
Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response.
Geneva, Switzerland, WHO, 2010.  p.This new report on anti-tuberculosis (TB) drug resistance by the World Health Organization (WHO) updates "Anti-tuberculosis drug resistance in the world: Report No. 4" published by WHO in 2008. It summarizes the latest data and provides latest estimates of the global epidemic of multidrug and extensively drug-resistant tuberculosis (M/XDR-TB). For the first time, this report includes an assessment of the progress countries are making to diagnose and treat MDR-TB cases. (Excerpt)
PloS One. 2010; 5(1):e8796.BACKGROUND: The tight epidemiological coupling between HIV and its associated opportunistic infections leads to challenges and opportunities for disease surveillance. METHODOLOGY/PRINCIPAL FINDINGS: We review efforts of WHO and collaborating agencies to track and fight the TB/HIV co-epidemic, and discuss modeling--via mathematical, statistical, and computational approaches--as a means to identify disease indicators designed to integrate data from linked diseases in order to characterize how co-epidemics change in time and space. We present R(TB/HIV), an index comparing changes in TB incidence relative to HIV prevalence, and use it to identify those sub-Saharan African countries with outlier TB/HIV dynamics. R(TB/HIV) can also be used to predict epidemiological trends, investigate the coherency of reported trends, and cross-check the anticipated impact of public health interventions. Identifying the cause(s) responsible for anomalous R(TB/HIV) values can reveal information crucial to the management of public health. CONCLUSIONS/SIGNIFICANCE: We frame our suggestions for integrating and analyzing co-epidemic data within the context of global disease monitoring. Used routinely, joint disease indicators such as R(TB/HIV) could greatly enhance the monitoring and evaluation of public health programs.