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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Drug-Resistant tuberculosis-current dilemmas, unanswered questions, challenges, and priority needs
Journal of Infectious Diseases, Volume 205, No. SUPPL. 2, Year 2012
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Description
Tuberculosis was declared a global emergency by the World Health Organization (WHO) in 1993. Following the declaration and the promotion in 1995 of directly observed treatment short course (DOTS), a cost-effective strategy to contain the tuberculosis epidemic, nearly 7 million lives have been saved compared with the pre-DOTS era, high cure rates have been achieved in most countries worldwide, and the global incidence of tuberculosis has been in a slow decline since the early 2000s. However, the emergence and spread of multidrug-resistant (MDR) tuberculosis, extensively drug-resistant (XDR) tuberculosis, and more recently, totally drug-resistant tuberculosis pose a threat to global tuberculosis control. Multidrug-resistant tuberculosis is a man-made problem. Laboratory facilities for drug susceptibility testing are inadequate in most tuberculosis-endemic countries, especially in Africa; thus diagnosis is missed, routine surveillance is not implemented, and the actual numbers of global drug-resistant tuberculosis cases have yet to be estimated. This exposes an ominous situation and reveals an urgent need for commitment by national programs to health system improvement because the response to MDR tuberculosis requires strong health services in general. Multidrug-resistant tuberculosis and XDR tuberculosis greatly complicate patient management within resource-poor national tuberculosis programs, reducing treatment efficacy and increasing the cost of treatment to the extent that it could bankrupt healthcare financing in tuberculosis-endemic areas. Why, despite nearly 20 years of WHO-promoted activity and >12 years of MDR tuberculosis-specific activity, has the country response to the drug-resistant tuberculosis epidemic been so ineffectual? The current dilemmas, unanswered questions, operational issues, challenges, and priority needs for global drug resistance screening and surveillance, improved treatment regimens, and management of outcomes and prevention of DR tuberculosis are discussed. © 2012 The Author.
Authors & Co-Authors
Zumla, A. I.
Unknown Affiliation
Abubakar, Ibrahim I.
Unknown Affiliation
Raviglione, Mario C.
Unknown Affiliation
Höelscher, Michael
Unknown Affiliation
Ditiu, Lucica
Unknown Affiliation
McHugh, Timothy Daniel
Unknown Affiliation
Squire, S. Bertel
Unknown Affiliation
Cox, Helen S.
Unknown Affiliation
Ford, Nathan P.
Unknown Affiliation
McNerney, R.
Unknown Affiliation
Marais, Ben J.
Unknown Affiliation
Grobusch, Martín Peter
Unknown Affiliation
Lawn, Stephen D.
Unknown Affiliation
Migliori, Giovanni Battista
Unknown Affiliation
Mwaba, Peter B.
Unknown Affiliation
O'Grady, Justin
Unknown Affiliation
Pletschette, Michel
Unknown Affiliation
Ramsay, Andrew R.C.
Unknown Affiliation
Chakaya, Jeremiah Muhwa
Unknown Affiliation
Schito, Marco L.
Unknown Affiliation
Swaminathan, Soumya
Unknown Affiliation
Al Memish, Ziad Ahmed
Unknown Affiliation
Maeurer, Markus
Unknown Affiliation
Atun, Rifat Ali
Unknown Affiliation
Statistics
Citations: 171
Authors: 24
Affiliations: 23
Identifiers
Doi:
10.1093/infdis/jir858
ISSN:
00221899
Research Areas
Health System And Policy
Study Design
Cohort Study