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dc.contributor.authorvan Cutsem, G
dc.contributor.authorIsaakidis, P
dc.contributor.authorFarley, J
dc.contributor.authorNardell, E
dc.contributor.authorVolchenkov, G
dc.contributor.authorCox, H
dc.date.accessioned2017-03-17T17:01:05Z
dc.date.available2017-03-17T17:01:05Z
dc.date.issued2016-05-15
dc.date.submitted2016-05-13
dc.identifier.citationInfection Control for Drug-Resistant Tuberculosis: Early Diagnosis and Treatment Is the Key. 2016, 62 Suppl 3:S238-43 Clin. Infect. Dis.en
dc.identifier.issn1537-6591
dc.identifier.pmid27118853
dc.identifier.doi10.1093/cid/ciw012
dc.identifier.urihttp://hdl.handle.net/10144/618847
dc.description.abstractMultidrug-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.
dc.language.isoenen
dc.publisherOxford University Press -- We regret that this article is behind a paywall.en
dc.rightsArchived with thanks to Clinical infectious diseases : an official publication of the Infectious Diseases Society of Americaen
dc.titleInfection Control for Drug-Resistant Tuberculosis: Early Diagnosis and Treatment Is the Keyen
dc.identifier.journalClinical Infectious Diseasesen
dc.internal.reviewer-noteClinical Inf Dis - Oxford - Emma Thorntonen
html.description.abstractMultidrug-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.


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