its large population and socioeconomic disparities. With regard to leprosy, there was not only success in reducing the numbers of affected people, but also a reduction and near elimination of drug resistance through implementation of a regimented program.

Conclusions and recommendations offered by individual workshop participants regarding drug-resistant TB in India included the following:

  • The overall public health care system in India needs to be strengthened to support a strong anti-TB program. (K. Srinath Reddy, Public Health Foundation of India)
  • All TB patients should have equitable access to care, and their interests and needs should be protected. (Reddy)
  • The basic TB program in India needs to reach out to unnotified and missed cases and to poor and highly vulnerable populations. (Reddy)
  • TB medicines should be sold by prescription only and should be prescribed and dispensed by accredited public and private providers. (Reddy)
  • A catalog of TB-related activities in India should be undertaken to take stock of the quality and quantity of these activities. Unproductive or ineffective activities should be rejected to make room for innovative new approaches. (Several workshop participants)

PREVENTING TRANSMISSION OF DRUG-RESISTANT TB

As long as people with drug-resistant TB remain untreated or inadequately treated, they have the potential to transmit the disease to others. Infection control in health care facilities and in the community is essential to stop the spread of the epidemic.

Much remains unknown about both the evolution of drug resistance in M.tb. and the transmission of drug-resistant strains among individuals. Certain strains of MDR TB predominate in different countries and regions. An interesting question, said Keshavjee, is whether these strains are more or less fit than other strains in these regions.

Conclusions and recommendations offered by individual workshop participants in the area of preventing transmission of drug-resistant TB included the following:

  • Infection control and patient management remain inadequate in many countries. (Keshavjee)
  • Treatment should start as early as possible to reduce transmission. (Edward Nardell, Harvard Medical School)


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