Current thinking on the management of tuberculosis.
High-income countries are moving toward tuberculosis (TB) elimination. Sophisticated diagnostic tests and effective treatment regimens are readily available. The range of available resources even makes effective treatment of multidrug-resistant tuberculosis (MDRTB) possible. The introduction of highly active antiretroviral therapy and specific TB control measures has reduced the incidence of HIV-associated TB disease. Unfortunately, the situation in low-income countries that carry 95% of the global TB burden is less positive. TB diagnosis still relies upon sputum smear microscopy. The management of MDRTB remains problematic though guidelines for DOTS-plus programs have been developed, and cheaper second-line drugs are becoming available. The HIV epidemic continues to confound TB control efforts, particularly in sub-Saharan Africa. The appropriate package of interventions for controlling HIV/TB disease remains undefined and unimplemented. The international community must provide the funding and technical support to address the alarming dichotomy in TB control that exists between rich and poor countries.
Bastian
Ivan
I
Institute of Medical & Veterinary Science, Adelaide, Australia. ivan.bastian@imvs.sa.gov.au
Stapledon
Rick
R
Colebunders
Robert
R
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D000995:Antitubercular Agents / Q000008:administration & dosage*; D001530:Belgium / Q000453:epidemiology; D003140:Communicable Disease Control / Q000458:organization & administration*; D023801:Directly Observed Therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006295:Health Resources; D006801:Humans; D015994:Incidence; D008297:Male; D011203:Poverty; D012307:Risk Factors; D012959:Socioeconomic Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D014944:World Health Organization
D000995:Antitubercular Agents