Updating the International Standards for Tuberculosis Care. Entering the Era of Molecular Diagnostics

Abstract

The International Standards for Tuberculosis Care, first published in 2006 (Lancet Infect Dis 2006;6:710-725.) with a second edition in 2009 ( www.currytbcenter.ucsf.edu/international/istc_report ), was produced by an international coalition of organizations funded by the United States Agency for International Development. Development of the document was led jointly by the World Health Organization and the American Thoracic Society, with the aim of promoting engagement of all care providers, especially those in the private sector in low- and middle-income countries, in delivering high-quality services for tuberculosis. In keeping with World Health Organization recommendations regarding rapid molecular testing, as well as other pertinent new recommendations, the third edition of the Standards has been developed. After decades of dormancy, the technology available for tuberculosis care and control is now rapidly evolving. In particular, rapid molecular testing, using devices with excellent performance characteristics for detecting Mycobacterium tuberculosis and rifampin resistance, and that are practical and affordable for use in decentralized facilities in low-resource settings, is being widely deployed globally. Used appropriately, both within tuberculosis control programs and in private laboratories, these devices have the potential to revolutionize tuberculosis care and control, providing a confirmed diagnosis and a determination of rifampin resistance within a few hours, enabling appropriate treatment to be initiated promptly. Major changes have been made in the standards for diagnosis. Additional important changes include: emphasis on the recognition of groups at increased risk of tuberculosis; updating the standard on antiretroviral treatment in persons with tuberculosis and human immunodeficiency virus infection; and revising the standard on treating multiple drug-resistant tuberculosis.

The within-host population dynamics of Mycobacterium tuberculosis vary with treatment efficacy

“…Treatment guidelines provided by the World Health Organization [46, 47] state that patients should receive a combination of at least four effective antibiotics. Based on these recommendations, we could assign patients to one of two groups: patients 1–8 received four or more (4+) effective drugs, while patients 9–12 received fewer than four effective drugs.…”

Performance of Xpert MTB/Rif Assay for Detection of M.TB in Pulmonary and Extra-Pulmonary Samples in Indian Patients

“…One of these samples should be obtained early morning, because the sample would have the highest yield at that time. 26 One of the reasons for low sensitivity of ZN smear microscopy is due to the fact that 10 5 /ml is required for AFB to be seen using smear microscopy. However it has been reported that multiple sputum tests can give a sensitivity of about 90%.…”

Private Practitioners’ Perspectives on Their Involvement With the Tuberculosis Control Programme in a Southern Indian State

“…One way of achieving it could be through the wider dissemination of International Standards for TB Care (ISTC) among PPs, and through allowing the PPs more freedom to prescribe different regimens that would be confined within the wider guidelines of the ISTC. 84 The RNTCP–IMA led training programmes for allopathic practitioners have adopted the ISTC, 85 however, it was surprising to note that not all allopathic practitioners were members of the IMA. These factors need to be considered when planning future dissemination/training programmes for practitioners.…”