Currently Skimming:
1 Introduction and Overview of the Workshop
1 Introduction and Overview of the Workshop
Pages 1-10
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The role of HIV infection in the spread of multidrug-resistant tuberculosis (MDR TB)
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Workshop Chair's Key Messages To underscore her remarks summarizing the themes of the workshop series, Gail Cassell, Visiting Professor, Harvard Medical School; and Vice President of TB Drug Discovery, Infectious Disease Research Institute, exhorted the workshop participants to consider how an accurate and comprehensive understanding of the realities of DR TB could be translated into policies to address the issues that are commensurate with the magnitude and urgency of the challenges. Cassell argued that several common public perceptions about DR TB have been shown in recent years, through the workshop series and other research and international meetings, not to accord with the reality of the disease.
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• Data from certain locations have demonstrated that most new cases of MDR TB result from person-to-person spread and are not caused by inadequate treatment, inappropriate drugs, or lack of patient compli ance. In addition, Cassell noted, many have held a mistaken belief that MDR TB is caused by organisms that have a lack of fitness; this misper ception has focused attention away from addressing transmission and has resulted in infection control receiving less attention than it should.
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Technology for detection of MDR TB and extensively drug-resistant tuberculosis (XDR TB) at the point of care is available but, Cassell noted, requires further development and evaluation.
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TB is resistant to the same drugs as MDR TB (isoniazid and rifampicin) , as well as any fluoroquinolone (levofloxacin, moxifloxacin, or ofloxacin)
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The workshop objectives were to • consider lessons learned from the other three high burden countries; • highlight global challenges to controlling the spread of drug- esistant r strains; • discuss innovative strategies to advance and harmonize local and international efforts to prevent and treat DR TB; • consider urgent themes relating to the problem of MDR TB, XDR TB, and emergent TB strains that are potentially untreatable with drugs available; and • consider the critical leadership role of the BRICS countries in ad dressing the threats and opportunities in DR TB. diseases.
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Chapter 5 examines programs addressing MDR and XDR TB in Russia, South Africa, Cambodia, and Ethiopia, which provide points of both contrast and similarity with programs in China and in the other BRICS countries. Chapter 6 turns to DR TB in children, reviewing the global burden and transmission of pediatric DR TB and the challenges of diagnosis and treatment.
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They resolved to collaborate and cooperate for development of capacity and infrastructure to reduce the prevalence and incidence of tuberculosis through innovation for new drugs/vaccines, diagnostics and promotion of consortia of tuberculosis researchers to collaborate on clinical trials of drugs and vaccines, strengthening access to affordable medicines and delivery of quality care. The Ministers also recognized the need to cooperate for adopt ing and improving systems for notification of tuberculosis patients, availabil ity of anti-tuberculosis drugs at facilities by improving supplier performance, procurement systems and logistics and management of HIV-associated tuberculosis in the primary health care system.a Other aspects of the communiqué related to DR TB include calls to face the continuing challenge of HIV, share existing resources, con duct effective health surveillance, enhance technology transfer, and pro vide universal health insurance.
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Chapter 12 summarizes a talk by Salmaan Keshavjee, Director, Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, that examined what, in his view, will be required to achieve zero deaths from DR TB. Finally, Chapter 13 records discussions and presentations from the penultimate session of the workshop, which considered steps that could be taken to create an evidence-based blueprint for action.
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Key Terms
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