Drug-Resistant Tuberculosis--Current dilemmas, unanswered questions, challenges, and priority needs

Hdl Handle:
http://hdl.handle.net/10144/303524
Title:
Drug-Resistant Tuberculosis--Current dilemmas, unanswered questions, challenges, and priority needs
Authors:
Zumla, Alimuddin; Abubakar, Ibrahim; Raviglione, Mario; Hoelscher, Michael; Ditiu, Lucica; McHugh, Timothy D; Squire, S Bertel; Cox, Helen; Ford, Nathan; McNerney, Ruth; Marais, Ben; Grobusch, Martin; Lawn, Stephen D; Migliori, Giovanni-Battista; Mwaba, Peter; O'Grady, Justin; Pletschette, Michel; Ramsay, Andrew; Chakaya, Jeremiah; Schito, Marco; Swaminathan, Soumya; Memish, Ziad; Maeurer, Markus; Atun, Rifat
Journal:
The Journal of Infectious Diseases
Abstract:
Tuberculosis was declared a global emergency by the World Health Organization (WHO) in 1993. Following the declaration and the promotion in 1995 of directly observed treatment short course (DOTS), a cost-effective strategy to contain the tuberculosis epidemic, nearly 7 million lives have been saved compared with the pre-DOTS era, high cure rates have been achieved in most countries worldwide, and the global incidence of tuberculosis has been in a slow decline since the early 2000s. However, the emergence and spread of multidrug-resistant (MDR) tuberculosis, extensively drug-resistant (XDR) tuberculosis, and more recently, totally drug-resistant tuberculosis pose a threat to global tuberculosis control. Multidrug-resistant tuberculosis is a man-made problem. Laboratory facilities for drug susceptibility testing are inadequate in most tuberculosis-endemic countries, especially in Africa; thus diagnosis is missed, routine surveillance is not implemented, and the actual numbers of global drug-resistant tuberculosis cases have yet to be estimated. This exposes an ominous situation and reveals an urgent need for commitment by national programs to health system improvement because the response to MDR tuberculosis requires strong health services in general. Multidrug-resistant tuberculosis and XDR tuberculosis greatly complicate patient management within resource-poor national tuberculosis programs, reducing treatment efficacy and increasing the cost of treatment to the extent that it could bankrupt healthcare financing in tuberculosis-endemic areas. Why, despite nearly 20 years of WHO-promoted activity and >12 years of MDR tuberculosis-specific activity, has the country response to the drug-resistant tuberculosis epidemic been so ineffectual? The current dilemmas, unanswered questions, operational issues, challenges, and priority needs for global drug resistance screening and surveillance, improved treatment regimens, and management of outcomes and prevention of DR tuberculosis are discussed.
Affiliation:
University College London, Centre for Clinical Microbiology, Division of Infection and Immunity, London, UK. a.zumla@ucl.ac.uk
Publisher:
Oxford University Press
Issue Date:
3-Apr-2012
URI:
http://hdl.handle.net/10144/303524
DOI:
10.1093/infdis/jir858
PubMed ID:
22476720
Additional Links:
http://jid.oxfordjournals.org//cgi/reprint/205/suppl_2/S228?ijkey=o10CCvFYKn7TI&keytype=ref&siteid=jinfdis
Language:
en
Description:
To access this article, click on "Additional Links"
ISSN:
1537-6613
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorZumla, Alimuddinen_GB
dc.contributor.authorAbubakar, Ibrahimen_GB
dc.contributor.authorRaviglione, Marioen_GB
dc.contributor.authorHoelscher, Michaelen_GB
dc.contributor.authorDitiu, Lucicaen_GB
dc.contributor.authorMcHugh, Timothy Den_GB
dc.contributor.authorSquire, S Bertelen_GB
dc.contributor.authorCox, Helenen_GB
dc.contributor.authorFord, Nathanen_GB
dc.contributor.authorMcNerney, Ruthen_GB
dc.contributor.authorMarais, Benen_GB
dc.contributor.authorGrobusch, Martinen_GB
dc.contributor.authorLawn, Stephen Den_GB
dc.contributor.authorMigliori, Giovanni-Battistaen_GB
dc.contributor.authorMwaba, Peteren_GB
dc.contributor.authorO'Grady, Justinen_GB
dc.contributor.authorPletschette, Michelen_GB
dc.contributor.authorRamsay, Andrewen_GB
dc.contributor.authorChakaya, Jeremiahen_GB
dc.contributor.authorSchito, Marcoen_GB
dc.contributor.authorSwaminathan, Soumyaen_GB
dc.contributor.authorMemish, Ziaden_GB
dc.contributor.authorMaeurer, Markusen_GB
dc.contributor.authorAtun, Rifaten_GB
dc.date.accessioned2013-10-16T20:22:32Z-
dc.date.available2013-10-16T20:22:32Z-
dc.date.issued2012-04-03-
dc.identifier.citationDrug-resistant tuberculosis--current dilemmas, unanswered questions, challenges, and priority needs. 2012, 205 Suppl 2:S228-40 J. Infect. Dis.en_GB
dc.identifier.issn1537-6613-
dc.identifier.pmid22476720-
dc.identifier.doi10.1093/infdis/jir858-
dc.identifier.urihttp://hdl.handle.net/10144/303524-
dc.descriptionTo access this article, click on "Additional Links"en_GB
dc.description.abstractTuberculosis was declared a global emergency by the World Health Organization (WHO) in 1993. Following the declaration and the promotion in 1995 of directly observed treatment short course (DOTS), a cost-effective strategy to contain the tuberculosis epidemic, nearly 7 million lives have been saved compared with the pre-DOTS era, high cure rates have been achieved in most countries worldwide, and the global incidence of tuberculosis has been in a slow decline since the early 2000s. However, the emergence and spread of multidrug-resistant (MDR) tuberculosis, extensively drug-resistant (XDR) tuberculosis, and more recently, totally drug-resistant tuberculosis pose a threat to global tuberculosis control. Multidrug-resistant tuberculosis is a man-made problem. Laboratory facilities for drug susceptibility testing are inadequate in most tuberculosis-endemic countries, especially in Africa; thus diagnosis is missed, routine surveillance is not implemented, and the actual numbers of global drug-resistant tuberculosis cases have yet to be estimated. This exposes an ominous situation and reveals an urgent need for commitment by national programs to health system improvement because the response to MDR tuberculosis requires strong health services in general. Multidrug-resistant tuberculosis and XDR tuberculosis greatly complicate patient management within resource-poor national tuberculosis programs, reducing treatment efficacy and increasing the cost of treatment to the extent that it could bankrupt healthcare financing in tuberculosis-endemic areas. Why, despite nearly 20 years of WHO-promoted activity and >12 years of MDR tuberculosis-specific activity, has the country response to the drug-resistant tuberculosis epidemic been so ineffectual? The current dilemmas, unanswered questions, operational issues, challenges, and priority needs for global drug resistance screening and surveillance, improved treatment regimens, and management of outcomes and prevention of DR tuberculosis are discussed.en_GB
dc.language.isoenen
dc.publisherOxford University Pressen_GB
dc.relation.urlhttp://jid.oxfordjournals.org//cgi/reprint/205/suppl_2/S228?ijkey=o10CCvFYKn7TI&keytype=ref&siteid=jinfdisen_GB
dc.rightsPublished by Infectious Diseases Society of America Archived on this site with permission and copyright 2012 by the Infectious Diseases Society of America, [url] and Oxford University Pressen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAfricaen_GB
dc.subject.meshAntitubercular Agentsen_GB
dc.subject.meshChilden_GB
dc.subject.meshCommunicable Disease Controlen_GB
dc.subject.meshDirectly Observed Therapyen_GB
dc.subject.meshDrug Administration Scheduleen_GB
dc.subject.meshDrug Resistance, Multiple, Bacterialen_GB
dc.subject.meshEndemic Diseasesen_GB
dc.subject.meshHealth Policyen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMycobacterium tuberculosisen_GB
dc.subject.meshPatient Rightsen_GB
dc.subject.meshTime Factorsen_GB
dc.subject.meshTuberculosis, Multidrug-Resistanten_GB
dc.subject.meshWorld Healthen_GB
dc.titleDrug-Resistant Tuberculosis--Current dilemmas, unanswered questions, challenges, and priority needsen
dc.contributor.departmentUniversity College London, Centre for Clinical Microbiology, Division of Infection and Immunity, London, UK. a.zumla@ucl.ac.uken_GB
dc.identifier.journalThe Journal of Infectious Diseasesen_GB

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