Integrating tuberculosis and antimicrobial resistance control programmes

Abstract

Many low- and middle-income countries facing high levels of antimicrobial resistance, and the associated morbidity from ineffective treatment, also have a high burden of tuberculosis. Over recent decades many countries have developed effective laboratory and information systems for tuberculosis control. In this paper we describe how existing tuberculosis laboratory systems can be expanded to accommodate antimicrobial resistance functions. We show how such expansion in services may benefit tuberculosis case-finding and laboratory capacity through integration of laboratory services. We further summarize the synergies between high-level strategies on tuberculosis and antimicrobial resistance control. These provide a potential platform for the integration of programmes and illustrate how integration at the health-service delivery level for diagnostic services could occur in practice in a low- and middle-income setting. Many potential mutual benefits of integration exist, in terms of accelerated scale-up of diagnostic testing towards rational use of antimicrobial drugs as well as optimal use of resources and sharing of experience. Integration of vertical disease programmes with separate funding streams is not without challenges, however, and we also discuss barriers to integration and identify opportunities and incentives to overcome these.

No antimicrobial resistance research agenda without tuberculosis

“…By assuming tuberculosis programmes are inherently separate from research initiatives for other bacteria, both tuberculosis and other pathogens will suffer a lack of shared infrastructure, knowledge, investment, and research overlap. 9 For example, new funding frameworks could be introduced to expand further and jointly develop new antimicrobials and therapies for all bacteria, including and emphasising tuberculosis. The attempt by the Innovative Medicines Initiative to develop an integrated research platform within which tuberculosis is a pillar is an important step forward.…”

Low Diagnostic Performance of Thick Blood Smears of 50 µL in Comparison with Blood Direct Examination of 10 µL and Leukoconcentration Techniques among Loiasis-Suspected Patients with Low Microfilaremia in Gabon, Central Africa, using the STARD-BCLM Guidelines

“…In remote areas of low-and middle-income countries, their implementation is challenging in screening campaigns due to the lack of electrical infrastructure. To overcome this challenge, a thick blood smear (TBS) was proposed as a large campaign survey method by Sasa [13]. In Gabon, national cartography was performed in 2014-2015 for loiasis, onchocerciasis, soiltransmitted helminthiasis, schistosomiasis and human trypanosomiasis in Africa.…”