Infection Control for Drug-Resistant Tuberculosis: Early Diagnosis and Treatment Is the Key: Table 1.

Abstract

Multidrug-resistant (MDR) tuberculosis, "Ebola with wings," is a significant threat to tuberculosis control efforts. Previous prevailing views that resistance was mainly acquired through poor treatment led to decades of focus on drug-sensitive rather than drug-resistant (DR) tuberculosis, driven by the World Health Organization's directly observed therapy, short course strategy. The paradigm has shifted toward recognition that most DR tuberculosis is transmitted and that there is a need for increased efforts to control DR tuberculosis. Yet most people with DR tuberculosis are untested and untreated, driving transmission in the community and in health systems in high-burden settings. The risk of nosocomial transmission is high for patients and staff alike. Lowering transmission risk for MDR tuberculosis requires a combination approach centered on rapid identification of active tuberculosis disease and tuberculosis drug resistance, followed by rapid initiation of appropriate treatment and adherence support, complemented by universal tuberculosis infection control measures in healthcare facilities. It also requires a second paradigm shift, from the classic infection control hierarchy to a novel, decentralized approach across the continuum from early diagnosis and treatment to community awareness and support. A massive scale-up of rapid diagnosis and treatment is necessary to control the MDR tuberculosis epidemic. This will not be possible without intense efforts toward the implementation of decentralized, ambulatory models of care. Increasing political will and resources need to be accompanied by a paradigm shift. Instead of focusing on diagnosed cases, recognition that transmission is driven largely by undiagnosed, untreated cases, both in the community and in healthcare settings, is necessary. This article discusses this comprehensive approach, strategies available, and associated challenges.

Knowledge, attitude and perception of tuberculosis management among tuberculosis-infected patients in resource constraint setting: field experience from Oyo state, South-West, Nigeria

“…13,14 However, studies have shown that poor knowledge of TB could contribute to high burden of TB due to patients' poor health seeking behavior such as looking for inappropriate care. 15,16 Although many patients understand the need to seek care in approved health institutions, it has been shown that they do not fully assimilate the information they are receiving from the health care providers. This could be linked to lack of comprehension on TB information on the part of either the patient or nurse due to insufficient training on TB.…”

High incidence of drug‐resistant Mycobacterium tuberculosis in Hainan Island, China

“…Drug‐resistant tuberculosis has emerged as a major obstacle to gaining control over tuberculosis during recent years in China , and its comprehensive understanding is essential for formulating effective control strategies by local governments . This study shows that Hainan has a serious epidemic of drug‐resistant tuberculosis.…”

Animal Models for Tuberculosis in Translational and Precision Medicine

“…It is necessary to employ methods of quick diagnosis and regimens of shorter and cheaper treatment to achieve fast diagnosis and improve disease prognosis (van Cutsem et al, 2016). Such methods and regimens can be developed and/or optimized based on MDR TB animal models.…”