Suchergebnisse

Peter W Shelby, Maria Paola Lia, Amy Israel Lilly Global Health Programs, Geneva, Switzerland Abstract: Since 2003, the Lilly Foundation has supported the noncommercial Lilly MDR-TB Partnership, which involves more than 45 local, national, global, and nongovernmental organizations and governments. The aim of the Lilly MDR-TB Partnership is to achieve significant global impact on multidrug-resistant tuberculosis (MDR-TB) by addressing a series of important local health care needs in highly affected countries: China, India, Russia, and South Africa. The main focus of activities during 2012–2016 was on community needs in primary care. Supported projects seek to make meaningful and measurable progress toward global and national TB objectives. The partnership programs share an overall conceptual approach known as "research, report, advocate", based on the piloting of novel approaches on a small scale, with outcomes assessed at early stages. The results are analyzed and communicated to governments, health-policy experts, and local and national stakeholders, including those in other countries facing similar MDR-TB challenges. For successful, cost-effective initiatives, the analysis is used as support when advocating for the scaling up of initiatives to regional or national levels. This article discusses representative examples of projects supported by the Lilly MDR-TB Partnership in the time period 2012–2016. The examples illustrate the potential for globally informed, locally designed primary-care collaborations to strengthen health care systems and support TB policies and offer observations to inform future health care public–private partnerships. Keywords: public–private partnership, nongovernmental organization, public health, community programs, primary care, prevention

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Despite the lack of reliable information on multidrug-resistant tuberculosis (MDR-TB) epidemiology, research shows an increasing trend of MDR-TB incidence in India. Of several determinants attributable to the rising trend of MDR-TB, health systems and policy (HSP) determinants play a pivotal role. With this article, an attempt has been made to unravel the HSP challenges for the control of MDR-TB and recommend strategies to overcome that. Ten different strategies have been recommended in this article that includes operations research (OR), molecular epidemiological studies, drug susceptibility test (DST), surveillance system, advocacy communication and social mobilisation (ACSM), nutrition and livelihood support, contribution of private practitioners (PPs), human resources for health (HRH), social determinants of health and information systems. Methods of OR with the right technical expertise can help in decision-making and evaluation of the TB control programme. Molecular epidemiological studies further help identify the right strain and can help in institutionalising the right therapeutic regimen. Similarly, the DST allows extended treatment strategies, including second-line drugs. A proper surveillance system can enable the availability of the right information for public health decision-making. Communication enables and empowers the community in accessing health services and helps policymakers take informed decisions. Nutrition and livelihood support are essential in TB control as it mostly affects the poor and people in the productive age group. Further, tapping PPs is equally important as more than 50 per cent of TB patients visit them. Proper orientation of the PPs about the TB control programme is non-negotiable given these facts. The HRH issues are pertinent—staff members lack the required motivation owing to delay in payment of salaries and the lack of job promotion. The HRH form the backbone of any health system, as the mere presence of drugs, technologies and infrastructure do not suffice for the provision of healthcare. Attention on the neglected social determinants of health is required as well. Finally, all these suggestions need to be implemented in coordination with each other to bring down the scourge of MDR-TB in India.

The World Health Organization European Region has one of the highest rates of multidrug-resistant tuberculosis (MDR-TB) in the world, resulting in many vulnerable children being exposed each year. Evidence for preventive therapy following MDR-TB exposure is limited and current guidance is conflicting. An internet-based survey was performed to determine clinical practice in this region. Seventy-two clinicians from 25 countries participated. Practices related to screening and decision-making were highly variable. Just over half provided preventive therapy for children exposed to MDR-TB; the only characteristic associated with provision was practice within the European Union (adjusted OR 4.07, 95%CI 1.33-12.5).

Multi-drug-resistant tuberculosis (MDR-TB) poses a major threat to public health worldwide, particularly in low-income countries. The current long (20 month) and arduous treatment regime uses powerful drugs with side-effects that include mental ill-health. It has a high loss-to-follow-up (25%) and higher case fatality and lower cure-rates than those with drug sensitive tuberculosis (TB). While some national TB programmes provide small financial allowances to patients, other aspects of psychosocial ill-health, including iatrogenic ones, are not routinely assessed or addressed. We aimed to develop an intervention to improve psycho-social well-being for MDR-TB patients in Nepal. To do this we conducted qualitative work with MDR-TB patients, health professionals and the National TB programme (NTP) in Nepal. We conducted semi-structured interviews (SSIs) with 15 patients (10 men and 5 women, aged 21 to 68), four family members and three frontline health workers. In addition, three focus groups were held with MDR-TB patients and three with their family members. We conducted a series of meetings and workshops with key stakeholders to design the intervention, working closely with the NTP to enable government ownership. Our findings highlight the negative impacts of MDR-TB treatment on mental health, with greater impacts felt among those with limited social and financial support, predominantly married women. Michie et al's (2011) framework for behaviour change proved helpful in identifying corresponding practice- and policy-level changes. The findings from this study emphasise the need for tailored psycho-social support. Recent work on simple psychological support packages for the general population can usefully be adapted for use with people with MDR-TB.

Introduction: The increasing number of patients with resistant tuberculosis requires attention and efforts for prevention. Resistance causes more expensive cost of treatment, longer duration of treatment, more severe side effects and decreasing the chance of recovery. The specific purpose of this literature review was to identify modifiable and nonmodifiable factors associated with previous treatment as predisposing factors for MDR-TB.Method: This study applies scoping review method of JBI (Joanna briggs Institute) by using 5 databases: Scopus, Ebscohost, Proquest, Science direct and google scholar publication 2015-2021. keywords for MDR-TB search, predisposing factors, previously treatment and adult.Results: Modifiable factors related to previous tuberculosis treatment include treatment failure or discontinuation, non-adherence, lack of supervision, unclear or inadequate instructions. Meanwhile modifiable factors are side effects and relapse.Conclusion: The cause of MDR-TB which can be modified and cannot be modified is very important to know. The government as a policy maker can use the results of this research to strengthen tuberculosis control programs and prevention of resistant tuberculosis

Background: The incidence of Multiple Drugs Resistance Tuberculosis (TB MDR) is still very high. TB MDR treatments requires a long period care that could lead to an impact on TB MDR patients and their families. This study aims to explore the perceived burden of TB MDR patients and their families. Method: Review literature was conducted through a search of four journal databases which later found 8 articles according to the inclusion criteria which were then identified, evaluated and synthesized. Results: The literature review found four major themes related to the perceived burden by TB MDR patients and their family, namely; physical, psychological, social and financial burden. Discussion: various problems arise due to the illness suffered by MDR TB patients and families. Understanding the difficulties and burdens experienced by MDR TB patients and their families is important in order to be able to intervene according to the problems that might arise due to MDR TB disease. Conclusion: The government needs to provide social protection to patients with MDR TB and families. Health professional workers need to add physical and psychological interventions to relieve the burden felt by MDR TB patients and their families. Keywords: Multiple Drugs Resistance Tuberculosis; Perceived burden; Sufferers; family; literature review

Tuberculosis, in all its forms, poses a serious, demonstrable threat to the health of countless individuals as well as to health as a public good. MDR-TB and, in particular, the emergence of XDR-TB, have re-opened the debate on the importance, and nature, of treatment supervision for basic TB control and the management of drug-resistant TB. Enforcing compulsory measures regarding TB patients raises questions of respect for human rights. Yet, international law provides for rights-limiting principles, which would justify enforcing compulsory measures against TB patients who refuse to have diagnostic procedures or who refuse to be monitored and treated once disease is confirmed. This article analyzes under what circumstances compulsory measures for TB patients may be enforced under international law. Compulsory measures for TB patients may, in fact, be justified on legal grounds provided that these measures are foreseen in the law, that they are used as a last resort, and that safeguards are in place to protect affected individuals. The deadly nature of the disease, its epidemiology, the high case fatality rate, and the speed at which the disease leads to death when associated with HIV are proven. Adapted from the source document.

Tuberculosis (TB) remains a global emergency, with an estimated 9.6 million new TB cases worldwide reported in 2014. Twenty-eight percent of these cases were in the World Health Organization (WHO) Africa Region, where the annual case detection rate was 281 per 100 000 population—more than double the global average of 133 per 100 000. Of the 9.6 million people who developed TB, an estimated 1.2 million (12%) were HIV-positive, and the Africa Region accounted for 74% of these cases. Three million people with TB remain undiagnosed and untreated. Globally, an estimated 480 000 had multidrug-resistant TB (MDR-TB). Whilst of the African countries, only South Africa has reported a high prevalence of MDR-TB, it is likely that all of Sub-Saharan Africa has an unreported high load of drug-resistant TB. Tragically, in 2014, only 48% of individuals diagnosed with MDR-TB had successful treatment and an estimated 190 000 people died of MDR-TB. Of the global TB funding gap of US$ 0.8 billion, the largest funding gap was in the Africa Region, amounting to US$ 0.4 billion in 2015. The MDR-TB pandemic in particular now threatens to devastate entire regions and may fundamentally alter the life-expectancy and demographic profile of many countries in Sub-Saharan Africa. The theme designated for this year's World TB Day, March 24, 2016, is 'Unite to End TB'. From the Africa Region, there is an urgent need to seriously address the political, economic, and social factors that influence host–Mycobacterium tuberculosis interactions and result in disease. Recent political and funder initiatives that provide renewed hope for the alleviation of Africa's TB and TB/HIV problems are discussed.