International Union Against Tuberculosis and Lung Disease

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International Union Against Tuberculosis and Lung Disease

Paris, France
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Kapoor S.K.,Harrow Medical Center | Raman A.V.,University of Delhi | Sachdeva K.S.,Directorate General of Health Services | Satyanarayana S.,International Union Against Tuberculosis and Lung Disease
PLoS ONE | Year: 2012

Setting: Revised National Tuberculosis Control Programme (RNTCP), Delhi, India. Objective: To ascertain the number and sequence of providers visited by TB patients before availing treatment services from DOTS; to describe the duration between onset of symptoms to treatment. Study design: A cross sectional, qualitative study. Information was gathered through in-depth interviews of TB patients registered during the month of Oct, 2012 for availing TB treatment under the Revised National TB Control Programme from four tuberculosis diagnosis and treatment centers in Delhi. Results: Out of the 114 patients who registered, 108 participated in the study. The study showed that informal providers and retail chemists were the first point of contact and source of clinical advice for two-third of the patients, while the rest sought medical care from qualified providers directly. Most patients sought medical care from more than two providers, before being diagnosed as TB. Female TB patients and patients with extra-pulmonary TB had long mean duration between onset of symptoms to initiation of treatment (6.3 months and 8.4 months respectively). Conclusion: The pathways followed by TB patients, illustrated in this study, provide valuable lessons on the importance of different types of providers (both formal and informal) in the health system in a society like India and the delays in the diagnosis and treatment of tuberculosis. © 2012 Kapoor et al.

Chiang C.-Y.,International Union Against Tuberculosis and Lung Disease | Schaaf H.S.,Stellenbosch University
International Journal of Tuberculosis and Lung Disease | Year: 2010

Drug-resistant tuberculosis (DR-TB) in adults is either acquired due to poor treatment management or transmitted from infectious DR-TB cases, while children mainly have transmitted disease. Diagnosis of DR-TB relies on drug susceptibility testing (DST), which is not routinely performed in high tuberculosis (TB) burden settings. The Category II retreatment regimen is inadequate for Category I failures if multidrug-resistant TB (MDR-TB) is present. Where possible, DST should be performed for Category I failures and other patients with a high risk of DR-TB. Fluoroquinolones (FQs) should be used with caution in the treatment of mono- and polyresistant TB. Modification of regimens for mono- and polyresistance is prone to error if DST results are not reliable or if there is possible additional drug resistance due to further drug exposure. While standardised treatment is feasible for MDR-TB patients never previously treated with second-line drugs, a different strategy is required for those MDRTB patients who have previously been treated with second-line drugs. Sputum conversion, adverse effects and adherence to MDR-TB treatment should be monitored closely. The presence of FQ resistance prior to MDR-TB treatment poses a serious challenge. To prevent the development of extensively drug-resistant TB, strategies to protect the FQs, the most important second-line agents, need to be developed. Clinical trials assessing MDR-TB treatment regimens are urgently needed. © 2010 The Union.

Lin Y.,International Union Against Tuberculosis and Lung Disease | Fraser T.,The Union
International Journal of Tuberculosis and Lung Disease | Year: 2011

BACKGROUND: Male doctors in China have a high rate of smoking (41%). Smoke-free policies and help in quitting smoking in health care facilities would improve the health of staff and patients, and reduce smoking among doctors. METHODS: A review of smoke-free activity in the health care sector was undertaken by conducting a search of PubMed, Google Scholar, Google and Globalink on smoke-free health care in China and by scanning the print media. Relevant published and unpublished documents were also reviewed. RESULTS: It is not mandatory for health care facilities to be smoke free. However, a Ministerial Decision issued in May 2009 requires all medical and health institutions to be smoke free by the end of 2011, and in Beijing, Shanghai and Guangzhou, legislation requires hospital buildings to be smoke free. A range of initiatives have been implemented to ensure the goal of smoke-free health care is met by the end of 2011. DISCUSSION: A limitation of this review is that it may understate the amount of smoke-free activity that is taking place in China. There was considerable media coverage on clusters of hospitals planning to go smoke free and other smoke-free health care initiatives, but coverage was often vague and it was therefore excluded from this review. CONCLUSIONS: Many provinces, municipalities and cities are working towards meeting the 2011 deadline imposed by the Ministry of Health and other health authorities for all health care facilities and organisations to be smoke free. Government and non-government funding is supporting this initiative. © 2011 The Union.

Leung C.C.,Grantham Hospital | Rieder H.L.,International Union Against Tuberculosis and Lung Disease | Rieder H.L.,University of Zürich | Lange C.,Research Center Borstel | Yew W.W.,Grantham Hospital
European Respiratory Journal | Year: 2011

Much remains unknown about latent infection with Mycobacterium tuberculosis. Existing immunodiagnostic tools for this condition have various limitations, most importantly in their ability to predict disease. Randomised controlled trials have established protective efficacy of isoniazid therapy for 6-12 months among non-HIV-infected and HIV-infected subjects. While efficacy may reach 90%, acceptance and adherence to prolonged therapy are less than desired. Rifampicin plus pyrazinamide for 2 months, though efficacious, has been associated with excess hepatotoxicity in non-HIV-infected persons. Isoniazid plus rifampicin for 3 months has proven efficacy, but adverse effects may be more frequent than isoniazid or rifampicin monotherapy. Rifampicin monotherapy for 3-4 months is well tolerated, but efficacy data are currently limited, and concerns remain over possible selection of rifampicin-resistant mutants. For contacts of patients with multidrug-resistant tuberculosis, expert opinions differ on whether to treat with at least two drugs or just a fluoroquinolone, and for how long. With the existing diagnostic and treatment tools, efficacy of preventive therapy does not necessarily translate into field effectiveness. A targeted approach is required to maximise cost-effectiveness. Each geographic region needs to set its own priority after taking into account available scientific data and local circumstances. Copyright©ERS 2011.

Chiang C.-Y.,International Union Against Tuberculosis and Lung Disease | Centis R.,Care Network | Migliori G.B.,Care Network
Respirology | Year: 2010

In a population of Mycobacterium tuberculosis, random chromosomal mutation that results in genetic resistance to anti-tuberculosis (TB) drugs occurs at a relatively low frequency. Anti-TB drugs impose selection pressure so that mycobacterial mutants gradually outnumber susceptible bacilli and emerge as the dominant strains. Resistance to two or more anti-TB drugs represents cumulative results of sequential mutation. The fourth report on global anti-TB drug resistance provides the latest data on the extent of such problem in the world. The median prevalence of multi-drug-resistant TB (MDR-TB) in new TB cases was 1.6%, and in previously treated TB cases 11.7%. Of the half a million MDR-TB cases estimated to have emerged in 2006, 50% were in China and India. The optimal duration of any given combination of anti-TB drugs for treatment of MDR- and extensively drug-resistant TB (XDR-TB) has not been defined in controlled clinical trials. Standardized treatment may be feasible for MDR-TB patients not previously treated with second-line drugs, but a different strategy needs to be applied in the treatment of MDR-TB patients who have received second-line drugs before. Unfortunately, the reliability of drug susceptibility testing of most second-line anti-TB drugs is still questionable. Drug-resistant TB is not necessarily less virulent. Findings from modelling exercise warned that if MDR-TB case detection and treatment rates increase to the World Health Organization target of 70%, without simultaneously increasing MDR-TB cure rates, XDR-TB prevalence could increase exponentially. Prevention of development of drug resistance must be accorded the top priority in the era of MDR-/XDR-TB. © 2010 Asian Pacific Society of Respirology.

Nunn A.J.,Medical Research Council Clinical Trials Unit | Jindani A.,St George's, University of London | Enarson D.A.,International Union Against Tuberculosis and Lung Disease
International Journal of Tuberculosis and Lung Disease | Year: 2011

SETTING: An 8-month isoniazid (INH, H) and ethambutol (EMB, E) based regimen recommended by the World Health Organization (WHO) had never been evaluated in a randomised controlled multicentre trial. OBJECTIVE: To compare, in a non-inferiority study design, two 8-month INH+EMB-based regimens with a standard INH and rifampicin (RMP, R) based regimen. DESIGN: A total of 1355 patients with newly diagnosed smear-positive pulmonary tuberculosis were randomly allocated to receive 1) daily EMB, INH, RMP and pyrazinamide (PZA, Z) for 2 months, followed by EMB+INH for 6 months (2EHRZ/6HE); 2) the same drugs in the intensive phase but given three times weekly, followed by the same continuation phase of daily EMB+INH (2(EHRZ)3/6HE); or 3) a control regimen with the same intensive phase as in regimen 1, followed by 4 months of daily RMP+INH (2EHRZ/4HR). All patients were to be seen and sputum examinations for microscopy and culture carried out at regular intervals up to 30 months after randomisation. RESULTS: At 30 months, failure/relapse rates were 11.7% of 281 2EHRZ/6HE, 15.3% of 301 2(EHRZ) 3/ 6HE and 6.0% of 282 2EHRZ/4HR patients (χ 2, 2 degrees of freedom = 12.8, P = 0.002). CONCLUSION: These results confirm earlier findings demonstrating the inferiority of the INH+EMB-based regimens to the standard 6-month regimen. The WHO has withdrawn its recommendation of these regimens. © 2011 The Union.

Jackson-Morris A.,International Union Against Tuberculosis and Lung Disease | Latif E.,International Union Against Tuberculosis and Lung Disease
International Journal of Tuberculosis and Lung Disease | Year: 2013

Tobacco control in low- and middle-income countries (LMICs) must gather pace in the coming decade to reverse the increasing prevalence of tobacco use and counter the intensive development of LMIC markets by the tobacco industry. If unchecked, this could undermine wider developments and gains in lung health, for example for people with tuberculosis (TB), TB and human immunodeficiency virus co-infection, asthma and chronic obstructive pulmonary disease. The issue of sustainability for tobacco control in LMICs is also pressing. This perspective article proposes that greater engagement with governments at the national and sub-national levels to strengthen their capacity for effective tobacco control, scale up action and sustain tobacco control is critical. There is also considerable scope to widen effort and impact by building tobacco control into broader initiatives, particularly into those relating to lung health. This paper draws on examples from the tobacco control technical support and capacity building in LMICs of the International Union Against Tuberculosis and Lung Disease, outlines the rationale for such an approach and addresses perceived disadvantages, limitations and barriers. Priority actions and suggestions for how these can best be applied in practice are proposed. © 2013 The Union.

Singh R.J.,International Union against Tuberculosis and Lung Disease
Indian journal of public health | Year: 2011

Exposure to secondhand smoke (SHS) causes an estimated 5% of the global burden of disease, slightly higher than the burden from direct use of tobacco. This review highlights the urgent need to address this ignored public health issue by presenting the evidence and impact of SHS on those exposed using global studies including those from the South-East Asia Region. The burden of morbidity from SHS exposure is higher in low-income countries in Southeast Asia region compared to the rest of the world. SHS exposure affects those most vulnerable, especially women and children. While several countries in the region have enacted legislation which offer protection to those exposed to SHS, most measures are partial and inadequate. As a result, implementation and compliance at national and sub-national level within the countries of the Southeast Asia region is variable. Governments must ensure that legislation mandates comprehensive smoke-free environments in order to provide public health benefit which offers universal protection to everyone and everywhere. Where comprehensive legislation exists, stringent implementation and enforcement, along with awareness building, education and monitoring through regular compliance studies must be done to sustain smokefree status of public places within jurisdictions.

Chiang C.-Y.,International Union Against Tuberculosis and Lung Disease | Van Weezenbeek C.,World Health Organization | Mori T.,Research Institute of Tuberculosis | Enarson D.A.,International Union Against Tuberculosis and Lung Disease
Respirology | Year: 2013

Diagnosis and treatment of tuberculosis (TB) will likely navigate a historical turning point in the 2010s with a new management paradigm emerging. However, global control of TB remains a formidable challenge for the decades to come. The estimated case detection rate of TB globally was 66%, and there were 310 000 estimated multidrug-resistant TB (MDR-TB) cases among the 6.2 million TB patients notified in 2011. Although new tools are being introduced for the diagnosis of MDR-TB, there are operational and cost issues related to their use that require urgent attention, so that the poor and vulnerable can benefit. World Health Organization (WHO) estimated that globally, 3.7% of new cases and 20% of previously treated cases have MDR-TB. However, the scale-up of programmatic management of drug-resistant TB is slow, with only 60 000 MDR-TB cases notified to WHO in 2011. The overall proportion of treatment success of MDR-TB notified globally in 2009 was 48%, far below the global target of 75% success rate. Although new tools and drugs have the potential to significantly improve both case detection and treatment outcome, adequate health systems and human resources are needed for rapid uptake and proper implementation to have the impact required to eliminate TB. Hence, the global TB community should broaden its scope, seek intersectoral collaboration and advocate for cost reduction of new tools, while ensuring that the basics of TB control are implemented to reduce the TB burden through the current 'prevention through case management' paradigm. © 2013 Asian Pacific Society of Respirology.

News Article | October 26, 2016

Once dubbed “Ebola with wings”, tuberculosis resistant to standard antibiotics could finally be on the run. A new regime of seven antibiotics has been shown to vanquish multidrug-resistant tuberculosis (MDR-TB) within just nine months, less than half the time it takes with current treatments. One of the antibiotics – clofazimine – was until recently used mainly to treat leprosy. In all, 821 of the 1006 people with MDR-TB treated with the new course of drugs across nine African countries were cured in a two-year study. “That’s 82 per cent, which is excellent, and with treatments lasting just nine months,” says Valérie Schwoebel at the International Union Against Tuberculosis and Lung Disease, which unveiled the results this week at an international conference on lung health in Liverpool, UK. The standard treatment that it could now replace cures only 55 per cent of people, with many dying because they abandon the prolonged treatment of 20 months or more. The new regime is also cheaper: Schwoebel estimates that it costs less than $1000 per person, compared with at least $3000 for the current treatment. The results replicate those of earlier, smaller studies, providing extra reassurance that the treatment works. Preliminary results from the trial released in December prompted the World Health Organization in May to recommended replacing the old treatment with the new regime. “With strong evidence now showing that this regimen is the most effective available for treating multidrug-resistant forms of TB, the next step is for countries to begin widely implementing this new approach,” said Arnaud Trebucq, who presented the results in Liverpool. “The new regime is nice, because it’s less toxic and much shorter,” says Mario Raviglione, director of the WHO’s global TB programme. But he cautions that it can only be given to around a third to half of all cases worldwide, because it will not work if people are already resistant to certain “second-line” drugs used to treat tuberculosis if standard treatments fail. Provided that people are only resistant to the classic antibiotics rifampacin or isoniazid, the regime can be used. Raviglione says that in most African countries, resistance to second-line drugs remains rare, so the regime can be widely used. However, such resistance is common in the former Soviet Union, so the regime will be less applicable there. For now, the disease remains a global threat. MDR-TB continues to spread, with many people not receiving any treatment, according to the WHO in its Global Tuberculosis Report published this month. “The crisis of MDR-TB detection and treatment continues,” it warns. Of 580,000 people newly diagnosed with MDR-TB in 2015, only a fifth received the existing therapy, and 250,000 died. Three countries – India, China and Russia – account for almost half of all cases. Schwoebel says the main reason for the continued spread is the failure of people with ordinary TB to complete their six-month treatment regime. The result is that the bacteria survive and develop resistance, then spread to others. “This crisis is created through countries with badly functioning programmes,” says Schwoebel. “So the population with MDR-TB is growing despite the fact we have good tests, good diagnosis and now improved treatments.”

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