News Article | April 25, 2017
El 14 de marzo de 2017, FluoroType MTBDR se presentó oficialmente a un panel de expertos, incluyendo representantes de la OMS, Stop TB Partnership, el Fondo Mundial y la Foundation for Innovative New Diagnostics (FIND). Para el ponente Prof. Rob Warren, líder del grupo de investigación en mico-bacteriología en la Universidad de Stellenbosch en Sudáfrica, la ventaja radica en la detección de resistencias a isoniazida en particular: "Esto permite la diferenciación entre MDR-TB y rifampicina mono-resistente a TB permitiendo el ajuste en el régimen de tratamiento."
Dowdy D.W.,Johns Hopkins University |
Lotia I.,Interactive Research and Development |
Creswell J.,Stop TB Partnership |
Sahu S.,Stop TB Partnership |
Khan A.J.,Interactive Research and Development
PLoS ONE | Year: 2013
Background:The potential population-level impact of private-sector initiatives for tuberculosis (TB) case finding in Southeast Asia remains uncertain. In 2011, the Indus Hospital TB Control Program in Karachi, Pakistan, undertook an aggressive case-finding campaign that doubled notification rates, providing an opportunity to investigate potential population-level effects.Methods:We constructed an age-structured compartmental model of TB in the intervention area. We fit the model using field and literature data, assuming that TB incidence equaled the estimated nationwide incidence in Pakistan (primary analysis), or 1.5 times greater (high-incidence scenario). We modeled the intervention as an increase in the rate of formal-sector TB diagnosis and evaluated the potential impact of sustaining this rate for five years.Results:In the primary analysis, the five-year intervention averted 24% (95% uncertainty range, UR: 18-30%) of five-year cumulative TB cases and 52% (95% UR: 45-57%) of cumulative TB deaths. Corresponding reductions in the high-incidence scenario were 12% (95% UR: 8-17%) and 27% (95% UR: 21-34%), although the absolute number of lives saved was higher. At the end of five years, TB notification rates in the primary analysis were below their 2010 baseline, incidence had dropped by 45%, and annual mortality had fallen by 72%. About half of the cumulative impact on incidence and mortality could be achieved with a one-year intervention.Conclusions:Sustained, multifaceted, and innovative approaches to TB case-finding in Asian megacities can have substantial community-wide epidemiological impact. © 2013 Dowdy et al.
Creswell J.,Stop TB Partnership |
Pant R.,National TB Control Programme |
Pyakurel S.,Eastern Regional Health Directorate Office |
Uranw D.,Eastern Regional Health Directorate Office |
Codlin A.J.,Stop TB Partnership
International Journal of Tuberculosis and Lung Disease | Year: 2015
SETTING: The Xpert® MTB/RIF assay is a highly sensitive molecular test with the potential to improve tuberculosis (TB) case detection. However, evidence supporting this potential at a programme level is minimal. METHODS: Xpert testing following smear microscopy and chest X-ray was implemented as part of routine case finding in 16 districts of Eastern Nepal. Changes in TB case notification were evaluated based on a pre/post analysis, as were expected notifications based on linear trend. RESULTS: A total of 9723 Xpert tests were performed, resulting in the identification of 1662 Mycobacterium tuberculosis-positive patients. Despite a previous declining trend in notifications, annual bacteriologically positive TB notifications increased by 15.2% during the intervention, from 3390 to 3906. However, annual notifications of pulmonary TB dropped by 8.5% overall, from 5123 to 4688. Both observations were significantly different from expected notifications based on historical trends. Treatment initiation for drug-resistant TB almost doubled. DISCUSSION: Xpert testing significantly increased bacteriologically positive TB notifications, but large reductions in empiric treatment of smear-negative disease reduced the number of pulmonary TB notifications overall. While better diagnostics remain critical, focusing solely on superior test sensitivity may not increase TB case notifications. Additional interventions are required to reach the millions of people with TB who are missed by routine services. © 2015 The Union.
Sandgren A.,Centers for Disease Control and Prevention |
Cuevas L.E.,The World Bank |
Dara M.,World Health Organization |
Gie R.P.,Stellenbosch University |
And 9 more authors.
European Respiratory Journal | Year: 2012
Childhood tuberculosis (TB) is a preventable and curable infectious disease that remains overlooked by public health authorities, health policy makers and TB control programmes. Childhood TB contributes significantly to the burden of disease and represents the failure to control transmission in the community. Furthermore, the pool of infected children constitutes a reservoir of infection for the future burden of TB. It is time to prioritise childhood TB, advocate for addressing the challenges and grasp the opportunities in its prevention and control. Herein, we propose a scientifically informed advocacy agenda developed at the International Childhood TB meeting held in Stockholm, Sweden, from March 17 to 18, 2011, which calls for a renewed effort to improve the situation for children affected by Mycobacterium tuberculosis exposure, infection or disease. The challenges and needs in childhood TB are universal and apply to all settings and must be addressed more effectively by all stakeholders. Copyright©ERS 2012.
Abubakar I.,University College London |
Abubakar I.,Public Health England |
Zignol M.,WHO |
Falzon D.,WHO |
And 32 more authors.
The Lancet Infectious Diseases | Year: 2013
Two decades ago, WHO declared tuberculosis a global emergency, and invested in the highly cost-effective directly observed treatment short-course programme to control the epidemic. At that time, most strains of Mycobacterium tuberculosis were susceptible to first-line tuberculosis drugs, and drug resistance was not a major issue. However, in 2013, tuberculosis remains a major public health concern worldwide, with prevalence of multidrug-resistant (MDR) tuberculosis rising. WHO estimates roughly 630 000 cases of MDR tuberculosis worldwide, with great variation in the frequency of MDR tuberculosis between countries. In the past 8 years, extensively drug-resistant (XDR) tuberculosis has emerged, and has been reported in 84 countries, heralding the possibility of virtually untreatable tuberculosis. Increased population movement, the continuing HIV pandemic, and the rise in MDR tuberculosis pose formidable challenges to the global control of tuberculosis. We provide an overview of the global burden of drug-resistant disease; discuss the social, health service, management, and control issues that fuel and sustain the epidemic; and suggest specific recommendations for important next steps. Visionary political leadership is needed to curb the rise of MDR and XDR tuberculosis worldwide, through sustained funding and the implementation of global and regional action plans. © 2013 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved.
Creswell J.,Stop TB Partnership |
Codlin A.J.,Interactive Research and Development |
Andre E.,Catholic University of Louvain |
Micek M.A.,University of Washington |
And 11 more authors.
BMC Infectious Diseases | Year: 2014
Background: The Xpert MTB/RIF assay has garnered significant interest as a sensitive and rapid diagnostic tool to improve detection of sensitive and drug resistant tuberculosis. However, most existing literature has described the performance of MTB/RIF testing only in study conditions; little information is available on its use in routine case finding. TB REACH is a multi-country initiative focusing on innovative ways to improve case notification.Methods: We selected a convenience sample of nine TB REACH projects for inclusion to cover a range of implementers, regions and approaches. Standard quarterly reports and machine data from the first 12 months of MTB/RIF implementation in each project were utilized to analyze patient yields, rifampicin resistance, and failed tests. Data was collected from September 2011 to March 2013. A questionnaire was implemented and semi-structured interviews with project staff were conducted to gather information on user experiences and challenges.Results: All projects used MTB/RIF testing for people with suspected TB, as opposed to testing for drug resistance among already diagnosed patients. The projects placed 65 machines (196 modules) in a variety of facilities and employed numerous case-finding strategies and testing algorithms. The projects consumed 47,973 MTB/RIF tests. Of valid tests, 7,195 (16.8%) were positive for MTB. A total of 982 rifampicin resistant results were found (13.6% of positive tests). Of all tests conducted, 10.6% failed. The need for continuous power supply was noted by all projects and most used locally procured solutions. There was considerable heterogeneity in how results were reported and recorded, reflecting the lack of standardized guidance in some countries.Conclusions: The findings of this study begin to fill the gaps among guidelines, research findings, and real-world implementation of MTB/RIF testing. Testing with Xpert MTB/RIF detected a large number of people with TB that routine services failed to detect. The study demonstrates the versatility and impact of the technology, but also outlines various surmountable barriers to implementation. The study is not representative of all early implementer experiences with MTB/RIF testing but rather provides an overview of the shared issues as well as the many different approaches to programmatic MTB/RIF implementation. © 2014 Creswell et al.; licensee BioMed Central Ltd.
Creswell J.,Stop TB Partnership |
Sahu S.,Stop TB Partnership |
Blok L.,Royal Tropical Institute KIT |
Bakker M.I.,Royal Tropical Institute KIT Biomedical Research |
And 2 more authors.
PLoS ONE | Year: 2014
Background: Globally, TB notifications have stagnated since 2007, and sputum smear positive notifications have been declining despite policies to improve case detection. We evaluate results of 28 interventions focused on improving TB case detection. Methods: We measured additional sputum smear positive cases treated, defined as the intervention area's increase in case notification during the project compared to the previous year. Projects were encouraged to select control areas and collect historical notification data. We used time series negative binomial regression for over-dispersed cross-sectional data accounting for fixed and random effects to test the individual projects' effects on TB notification while controlling for trend and control populations. Results: Twenty-eight projects, 19 with control populations, completed at least four quarters of case finding activities, covering a population of 89.2 million. Among all projects sputum smear positive (SS+) TB notifications increased 24.9% and annualized notification rates increased from 69.1 to 86.2/100,000 (p = 0.0209) during interventions. Among the 19 projects with control populations, SS+TB case notifications increased 36.9% increase while in the control populations a 3.6% decrease was observed. Fourteen (74%) of the 19 projects' SS+TB notification rates in intervention areas increased from the baseline to intervention period when controlling for historical trends and notifications in control areas. Conclusions: Interventions were associated with large increases in TB notifications across many settings, using an array of interventions. Many people with TB are not reached using current approaches. Different methods and interventions tailored to local realities are urgently needed. © 2014 Creswell et al.
Reducing the price of treatment for multidrug-resistant tuberculosis through the global drug facility [Réduction du prix du traitement pour soigner la tuberculose multirésistante aux médicaments par le biais du Dispositif mondial d’approvisionnement en medicaments] [Reducir el precio del tratamiento para la tuberculosis multirresistente mediante el servicio farmacéutico mundial]
Lunte K.,Stop TB Partnership |
Cordier-Lassalle T.,World Health Organization |
Keravec J.,Stop TB Partnership
Bulletin of the World Health Organization | Year: 2015
Problem Many countries have limited experience of securing the best prices for drugs and have little negotiating power. This is particularly true for the complex, lengthy and expensive regimens used to treat multidrug-resistant tuberculosis. Approach The Stop TB Partnership’s Global Drug Facility is dedicated to improving worldwide access to antituberculosis medicines and diagnostic techniques that meet international quality standards. Local setting The Global Drug Facility is able to secure price reductions through competitive tendering among prequalified drug manufacturers and by consolidating orders to achieve large purchase volumes. Consolidating the market in this way increases the incentives for suppliers of quality-assured medicines. Relevant changes In 2013 the Global Drug Facility reduced the price of the second-line drugs it supplies for multidrug-resistant tuberculosis: the overall cost of the longest and most expensive treatment regimen for a patient decreased by 26% – from 7890 United States dollars (US$) in 2011 to US$ 5822 in 2013. Lessons learnt The price of treatment for multidrug-resistant tuberculosis supplied by the Global Drug Facility was reduced by consolidating orders to achieve large purchase volumes, by international, competitive bidding and by the existence of donor-funded medicine stockpiles. The rise in the number of suppliers of internationally quality-assured drugs was also important. The savings achieved from lower drug costs could be used to increase the number of patients on high-quality treatment. © 2015, World Health Organization. All Rights Reserved.
Khan A.J.,Interactive Research and Development |
Khan A.J.,Indus Hospital Research Center |
Khowaja S.,Indus Hospital Research Center |
Khan F.S.,Indus Hospital Research Center |
And 12 more authors.
The Lancet Infectious Diseases | Year: 2012
Background: In many countries with a high burden of tuberculosis, most patients receive treatment in the private sector. We evaluated a multifaceted case-detection strategy in Karachi, Pakistan, targeting the private sector. Methods: A year-long communications campaign advised people with 2 weeks or more of productive cough to seek care at one of 54 private family medical clinics or a private hospital that was also a national tuberculosis programme (NTP) reporting centre. Community laypeople participated as screeners, using an interactive algorithm on mobile phones to assess patients and visitors in family-clinic waiting areas and the hospital's outpatient department. Screeners received cash incentives for case detection. Patients with suspected tuberculosis also came directly to the hospital's tuberculosis clinic (self-referrals) or were referred there (referrals). The primary outcome was the change (from 2010 to 2011) in tuberculosis notifications to the NTP in the intervention area compared with that in an adjacent control area. Findings: Screeners assessed 388 196 individuals at family clinics and 81 700 at Indus Hospital's outpatient department from January-December, 2011. A total of 2416 tuberculosis cases were detected and notified via the NTP reporting centre at Indus Hospital: 603 through family clinics, 273 through the outpatient department, 1020 from self-referrals, and 520 from referrals. In the intervention area overall, tuberculosis case notification to the NTP increased two times (from 1569 to 3140 cases) from 2010 to 2011-a 2·21 times increase (95% CI 1·93-2·53) relative to the change in number of case notifications in the control area. From 2010 to 2011, pulmonary tuberculosis notifications at Indus Hospital increased by 3·77 times for adults and 7·32 times for children. Interpretation: Novel approaches to tuberculosis case-finding involving the private sector and using laypeople, mobile phone software and incentives, and communication campaigns can substantially increase case notification in dense urban settings. Funding: TB REACH, Stop TB Partnership. © 2012 Elsevier Ltd.
Lienhardt C.,Stop TB Partnership
International Journal of Tuberculosis and Lung Disease | Year: 2010
Studies have shown that when using microbiologically confirmed active TB as a gold standard, the pooled sensitivity is 76% (72-80) across Quanti FERON studies, 78% (73-82) for QFT-G, 70% (63-78) for QFT-GIT, and 90% (86-93) for T-SPOT. This compares to 77% (71-82) for the TST. The pooled specificity for IGRA studies is 98% across the QFT assays and 93% (86-100) for T-SPOT. This compares to 97% for the TST in non-BCG-vaccinated populations and 59% in BCG-vaccinated populations (highly heterogeneous). There is consistently high specificity of IGRAs and they appear to be unaffected by BCG vaccination. What is the added value of IGRAs compared to the TST? The expectations are for better accuracy than with the TST for reliable detection of LTBI, to permit better targeted preventive therapy (contacts of TB cases, HIV-infected individuals, children). The problem though is the lack of a gold standard and the need to use active TB as a proxy for LTBI. A positive IGRA result does not necessarily indicate the presence of active TB and a negative IGRA result would not conclusively rule out active disease in an individual suspected of having TB. IGRAs can be useful as an aid in the diagnostic workup of smear-negative pulmonary or extra-pulmonary TB. Discordance between the TST and IGRAs are frequently reported, but largely unexplained. The significance of conversions and reversions in repeated IGRA testing is not clear. There are insufficient data so far to draw conclusions on the ability of IGRAs to reliably identify individuals with LTBI at greater risk of progression to active TB. Given the multitude of published studies and guidelines on IGRAs and their role in TB control, the WHO anticipates issuing policy guidance in 2010, following due WHO process. For the time being further research is needed, including: 1) better assessment of test accuracy and validity in various epidemiological settings (low vs. medium vs. high-burden countries) and various specific groups (children, immunocompromised individuals, health care workers, etc.); and 2) large-scale prospective studies to address the key issues of test prognostic values in high-risk settings and populations, the definition of appropriate thresholds, and variability of IGRA response in serial testing. All this is needed for the best informed decisions. © 2010 The Union.