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12 What Will Be Required to Achieve Zero Deaths from TB?
12 What Will Be Required to Achieve Zero Deaths from TB?
Pages 129-136
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From page 129... ...
• Moving from a minimalist approach to an "optimalist" approach, in which TB cases are identified rapidly, active case finding is performed, infection control is implemented to reduce transmission, and patients are treated based on the results of rapid DST, could yield dramatic progress. • The BRICS countries have a unique opportunity to take a leadership role and scale up diagnosis and treatment of TB and MDR TB, in addition to the socioeconomic interventions that reduce poverty and enhance TB control efforts.
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From page 130... ...
During this same period, however, death rates for TB have been nearly static, declining only about 1 percent per year. The only reason TB mortality may appear to be declining is that HIV-infected patients dying from TB are sometimes classified as "non-TB deaths." This is a classification artifact and does not represent the true impact of the disease or the unmet need for treatment, said Keshavjee, who noted that, although effective treatment regimens for TB have been available since the early 1950s, 1.5 million to 2 million people still die annually from the disease.
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From page 131... ...
Keshavjee noted further that standardized recording and reporting have led to much greater accountability in TB control worldwide. However, the systems used have been unable to capture complex data, such as those related to MDR TB, coinfection with HIV, and diabetes as a comorbidity.
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From page 132... ...
For example, Keshavjee described a project funded by the Stop TB Partnership's TB Reach initiative in which Pakistani health care workers at private general practitioner clinics screened patients for TB and referred them for sputum smear microscopy and X-rays. During the course of just 1 year, the case notification rate for all forms of TB almost quadrupled.
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From page 133... ...
In addition, prophylaxis for contacts of MDR TB patients -- an area of inquiry that remains to be sufficiently explored -- can be important, especially for children, for people infected with HIV, or for contacts. Keshavjee suggested that preventive therapy should begin by focusing on those at highest risk of developing active TB, such as individuals exposed to silica dust, patients treated with immune modulators such as steroids, diabetics, and smokers.
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From page 134... ...
Reflecting on a white paper developed to support the first workshop in the IOM series, Keshavjee indicated that the system for providing international technical assistance is currently inadequate. The system needs to be transformed to do better at drawing on the experience of successful regional MDR TB treatment programs; to include the provision of onsite, long-term technical assistance; and where necessary, to involve onsite implementation teams (Keshavjee and Seung, 2008)
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From page 135... ...
This should convince us that we have to think about having some component that invests in the social aspects of TB for our patients as an integral part of every program." The BRICS countries could provide leadership for TB treatment and control, Keshavjee said, echoing comments made throughout the workshop. He reiterated the commitments made in the Delhi Ministerial Communiqué, in which the BRICS health ministers recognized that MDR TB is a major public health problem for their countries.
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