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    Jan 16, 2021
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    Infection Control for Drug-Resistant Tuberculosis: Early Diagnosis and Treatment Is the Key

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    Authors
    van Cutsem, G
    Isaakidis, P
    Farley, J
    Nardell, E
    Volchenkov, G
    Cox, H
    Issue Date
    2016-05-15
    Submitted date
    2016-05-13
    
    Metadata
    Show full item record
    Journal
    Clinical Infectious Diseases
    Abstract
    Multidrug-resistant (MDR) tuberculosis, "Ebola with wings," is a significant threat to tuberculosis control efforts. Previous prevailing views that resistance was mainly acquired through poor treatment led to decades of focus on drug-sensitive rather than drug-resistant (DR) tuberculosis, driven by the World Health Organization's directly observed therapy, short course strategy. The paradigm has shifted toward recognition that most DR tuberculosis is transmitted and that there is a need for increased efforts to control DR tuberculosis. Yet most people with DR tuberculosis are untested and untreated, driving transmission in the community and in health systems in high-burden settings. The risk of nosocomial transmission is high for patients and staff alike. Lowering transmission risk for MDR tuberculosis requires a combination approach centered on rapid identification of active tuberculosis disease and tuberculosis drug resistance, followed by rapid initiation of appropriate treatment and adherence support, complemented by universal tuberculosis infection control measures in healthcare facilities. It also requires a second paradigm shift, from the classic infection control hierarchy to a novel, decentralized approach across the continuum from early diagnosis and treatment to community awareness and support. A massive scale-up of rapid diagnosis and treatment is necessary to control the MDR tuberculosis epidemic. This will not be possible without intense efforts toward the implementation of decentralized, ambulatory models of care. Increasing political will and resources need to be accompanied by a paradigm shift. Instead of focusing on diagnosed cases, recognition that transmission is driven largely by undiagnosed, untreated cases, both in the community and in healthcare settings, is necessary. This article discusses this comprehensive approach, strategies available, and associated challenges.
    Publisher
    Oxford University Press -- We regret that this article is behind a paywall.
    URI
    http://hdl.handle.net/10144/618847
    DOI
    10.1093/cid/ciw012
    PubMed ID
    27118853
    Language
    en
    ISSN
    1537-6591
    ae974a485f413a2113503eed53cd6c53
    10.1093/cid/ciw012
    Scopus Count
    Collections
    TB

    entitlement

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