Treatment as prevention and other interventions to reduce transmission of multidrug-resistant tuberculosis

Abstract

Summary Drug resistant tuberculosis (DR-TB) represents a major programmatic challenge at the national and global level. Only ~30% of patients with multidrug-resistant (MDR) TB were diagnosed and ~25% were initiated on therapy for MDR-TB in 2016. Increasing evidence now points towards primary transmission of DR-TB rather than inadequate treatment as the major driver of the DR-TB epidemic. The cornerstone of DR-TB transmission prevention should be earlier diagnosis and prompt initiation of effective treatment for all patients with DR-TB. Despite the extensive scale up of Xpert MTB/RIF testing, major implementation barriers continue to limit its impact. Although there is longstanding evidence in support of the rapid impact of treatment on patient infectiousness, delays in the initiation of effective DR-TB treatment persist, resulting in ongoing transmission. However, it is also imperative to address the burden of latent DR-TB infection, since it is estimated that many DR-TB patients will become infectious prior to seeking care and encounter various diagnostic delays before treatment. Addressing latent DR-TB primarily consists of identifying, treating and following contacts of patients with MDR-TB, typically through household contact evaluation. Adjunctive measures such as improved ventilation and use of germicidal ultraviolet (GUV) technology can further decrease TB transmission in high-risk congregate settings. Although many gaps remain in our biological understanding of TB transmission, implementation barriers to early diagnosis and rapid initiation of effective DR-TB treatment can and must be overcome if we are to impact DR-TB incidence in the short and long-term.

New Developments and Insights in the Improvement of Mycobacterium tuberculosis Vaccines and Diagnostics Within the End TB Strategy

“…Moreover, implementation of molecular diagnostic tests for DR-TB is challenging in resource-constrained settings due to high costs, need for laboratory infrastructure and mainteinance, and low availability of trained/specialized personnel [17,18]. Although the End TB strategy recommends drug susceptibility testing (DST) in all TB cases, routine access to molecular or phenotypic DST in high TB burden areas remains limited [19]. Current evidences suggest that DR-TB could be uncontrolable without applying effective measures, such as the widespread introduction of point-ofcare (POC) DR-TB diagnosis testing methods, affordable second-line drugs, treatment of latent MDR-TB, and active monitoring of drug susceptible-and DR-TB cases in highrisk groups and crowded settings [20].…”

“…Current public health efforts and resources are shifting towards controlling the coronavirus disease 2019 (COVID- 19) pandemic. This deviation of resources is undermining TB prevention and control, and is estimated to worsen TB transmission dynamics, treatment outcomes, and diagnosis.…”

‘It has become everybody’s business and nobody’s business’: Policy actor perspectives on the implementation of TB infection prevention and control (IPC) policies in South African public sector primary care health facilities

“…with respirators and ventilation), typically leaving those working in TB diagnosis and treatment and in other parts of the clinic out of the prevention frame. Several participants argued that the treatment-as-prevention paradigm (Nathavitharana et al, 2019) was much more firmly established in the field of HIV as compared to TB, and that this was a critical missed opportunity. Finally, a common theme among participants with programme management experience was the need to broaden the framing of TB-IPC and understand it as part of 'respiratory hygiene' or 'airborne infection control' (without at the same time letting it get lost amid all infection control issues).…”

Model Tatalaksana Komprehensif Tuberculosis Multidrug-Resistant (TB-MDR) Melalui Pendekatan Provider Pelayanan Kesehatan

“…Menurut penelitian dari Nathavitharana et al (2019) menunjukkan bahwa salah satu hal yang mempengaruhi terjadinya transmisi adalah terbatasnya ventilasi. 28 Kegiatan promotif dan preventif yang dapat dilakukan oleh tenaga kesehatan adalah memberikan penyuluhan untuk selalu membuka jendela. Penelitian lain oleh Sayidah et al (2018) mengungkapkan bahwa kepadatan hunian juga berpengaruh signifikan terhadap transmisi TB dan TB MDR.…”