MSF, PIH, TAG Report (2011): An evaluation of drug-resistant TB treatment scale-up

The report points out that despite international calls to reach universal access to TB treatment by 2015, scale-up has been minimal. Substantial funding and implementation gaps remain at both national and international levels The report aims to provide an assessment of the effectiveness of some key structures within the global response for MDR-TB, to provide recommendations on how the global response to DR-TB scale-up can be improved, and to examine the results of scale-up activities to date in three key countries.

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Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response

A new report on anti-tuberculosis resistance published by the WHO, updating its 2008 report with new and improved data. For the first time, the report includes an assessment of the progress countries are making to diagnose and treat MDR-TB cases. It urges greater investment in infrastructure, diagnostics, and provision of care in order to reach the 2015 target of diagnosing and treating 80% of the estimated M/XDR-TB cases.

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Multidrug-resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients.

Ahuja SD, Ashkin D, Avendano M, Banerjee R, Bauer M, et al. PLoS Med 2012; 9(8): e1001300.

An individual patient data meta-analysis was conducted by this collaborative group to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB. They used three recent systematic reviews to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. The authors of those studies were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. The collaborative group concludes that improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are needed to optimize MDR-TB treatment.

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Pediatric Tuberculosis: New Guidelines and Recommendations.

Perez-Velez, C.M. Curr Op Ped 2012; 24(3): 319-28.

This study discussed the recommendations pertaining to infants, children, and adolescents in new and updated TB guidelines that have been published since 2010 – with emphasis on those from supranational organizations. The main developments in the guidelines covered in this article are related to: novel diagnostics for TB infection, disease, and drug resistance; updated treatment regimens for childhood and drug-resistant TB (DR-TB); and primary and secondary prevention of TB disease in HIV-infected children and adolescents.

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Prevalence of and risk factors for resistance to second-line drugs in people with multidrug-resistant tuberculosis in eight countries: a prospective cohort study.

Dalton T, Cegielski P, Akksilp S, et al. Lancet 2012 [epub ahead of print].

The prevalence of extensively drug-resistant (XDR) TB is increasing owing to the expanded use of second-line drugs in people with multidrug-resistant (MDR) TB. The authors prospectively assessed resistance to second-line anti-TB drugs in eight countries. Among 1,278 patients, 43·7% showed resistance to at least one second-line drug, 20·0% to at least one second-line injectable drug, and 12·9% to at least one fluoroquinolone; 6·7% of patients had XDR TB (range across study sites 0·8-15·2%). Previous treatment with second-line drugs was consistently the strongest risk factor for resistance to these drugs, which increased the risk of XDR TB by more than 4 times.

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Report: Rational use of moxifloxacin for tuberculosis treatment

Cox H, Ford N, Keshavjee S, McDermid C, Von Schoen-Angerer T, Mitnick C, Goermaere E. Lancet 2011; 11(4): 259-60.

This article outlines the potential risks of incorporating moxifloxacin into the existing first-line regimen, as it could compromise the efficacy of FQs in DR-TB treatment. The authors recommend reserving moxifloxacin as a second-line drug for the treatment of DR-TB, until potent partner drugs have been developed to make it efficacious as a first-line regimen.

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Scaling up interventions to achieve global tuberculosis control: progress and new developments.

Raviglione M, Marais B, Floyd K, et al. Lancet 2012;379(9829):1902-13.

Tuberculosis is still one of the most important causes of death worldwide. In this update we review recent progress. With improved control efforts, the world and most regions are on track to achieve the Millennium Development Goal of decreasing tuberculosis incidence by 2015, and the Stop TB Partnership target of halving 1990 mortality rates by 2015; the exception is Africa. Despite these advances, full scale-up of tuberculosis and HIV collaborative activities remains challenging and emerging drug-resistant tuberculosis is a major threat. Achievement of international tuberculosis control targets and maintenance of these gains needs optimum national health policies and services, with ongoing investment into new approaches and strategies. Despite growing funding in recent years, a serious shortfall persists. International and national financial uncertainty places gains at serious risk. Perseverance and renewed commitment are needed to achieve global control of tuberculosis, and ultimately, its elimination.

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Stop TB, The Global Fund, and WHO 2011 Report: Priorities in operational research to improve tuberculosis care and control

In 2010, the Stop TB Partnership, the GF, and the WHO organized and expert meeting and workshop on operational research, the outcome of which formed the basis of the publication. They identify 5 key areas that need to be addressed: 1) access, screening, and diagnosis of TB; 2) sustainable collaboration with all care-providers for TB control; 3) prevention of TB in people living with HIV, and joint treatment of HIV and TB; 4) access to and delivery of treatment for drug-susceptible and M/XDR-TB; 5) capacity-building for operational research.

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Survival of civilian and prisoner drug-sensitive, multi- and extensive drug-resistant tuberculosis cohorts prospectively followed in Russia.

Balabanova Y, Nikolayevskyy V, Ignatyeva O, et al. PLoS One 2011; 6(6): e20531.

A long-term observational study to assess the survival and risk factors for death of a cohort of non-MDRTB and MDRTB civilian and prison patients and a civilian XDRTB cohort. They concluded that alarmingly high rates of XDRTB exist and that previous TB treatment cycles and MDR were significant risk factors for mortality – survival is short especially for HIV-infected patients.

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Totally drug-resistant tuberculosis in India

Udwadia Z, Amale R, Ajbani K, Rodrigues C. CID 2011; 10.1093/cid/cir889.

The article emphasizes the growing complexity of resistant tuberculosis strains in India, particularly the cases of TDR. The vast majority of DR-TB patients seek care from private physicians, who are unregulated and often unqualified – further amplifying resistance. The authors urge patients with MDR TB to seek treatment within the confines of government-sanctioned DOTS-plus programs.

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