TB and MDR/XDR-TB in European Union and European Economic Area countries: managed or mismanaged?

Abstract

In spite of the growing awareness of emerging drug-resistant Mycobacterium tuberculosis, the extent of inappropriate tuberculosis (TB) case management may be underestimated, even in Europe. We evaluated TB case management in the European Union/ European Economic Area countries, with special focus on multidrug-resistant (MDR) and extensively drug-resistant (XDR)-TB, using a purposely developed, standardised survey tool.National reference centres in five countries representing different geographical, socioeconomic and epidemiological patterns of TB in Europe were surveyed. 40 consecutive, original clinical TB case records (30 MDR/XDR-TB cases) were reviewed in each of the five countries. The findings were recorded and, through the survey tool, compared with previously agreed and identified international standards.Deviations from international standards of TB care were observed in the following areas: surveillance (no information available on patient outcomes); infection control (lack of respiratory isolation rooms/procedures and negative-pressure ventilation rooms); clinical management of TB, MDR-TB and HIV co-infection (inadequate bacteriological diagnosis, regimen selection and treatment duration); laboratory support; and diagnostic/treatment algorithms.Gaps between present international standards of care and the management of MDR/XDR-TB patients were identified. Training, increased awareness, promotion of standards and allocation of appropriate resources are necessary to ensure appropriate care and management as well as to prevent further emergence of drug resistance.

TB financing in East Europe promotes unnecessary hospital admissions: the case of Armenia

“…Established clinical traditions which are prevalent in FSU countries, such as hospitalising non-infectious TB cases for the intensive phase of treatment (2 months) and admitting TB suspects for further investigations, do not comply with international recommendations, and pose infection control problems on top of generating unnecessary costs [1,2,3,4]. In addition, unnecessary hospital admission imposes financial and psychosocial burdens for TB patients.…”

“…The economic savings that such a change will generate could be directed to strengthen human resources at the primary health-care level, with improved quality of life for patients and reduced risk of nosocomial transmission [1,2,3,4].…”

“…Based on cost-effectiveness considerations and on the risk of nosocomial transmission of Mycobacterium tuberculosis strains, the World Health Organization (WHO) and other international institutions recommend to minimize unnecessary hospitalization of tuberculosis (TB) cases [1,2,3,4].…”

Pulmonary Tuberculosis Management: 2015 Update

“…Re-treatment patients need special attention because of the risk of inducing drug resistance. Rapid tests for DST should be used whenever available to ensure an appropriate treatment regimen from the beginning as well as adequate infection control management in a specialized MDR-TB Centre 18,19 . While awaiting DST results, these patients could be initially treated with an empiric regimen (i.e.…”

Tuberculosis: are we making it incurable?

“…addition of only one to two drugs to a failing regimen, or irrational use of available effective anti-TB drugs) or programmatic (no social support, no good approach to potential adverse drug reactions, no good adherence supporting initiatives, etc.) errors [26,27]. If this trend is not reversed, the chances of cure for TB patients will remain low, and the high costs of treating MDR-or XDR-TB may become unaffordable in low-income countries [28].…”