Multidrug-resistant tuberculosis management in resource-limited settings.
Evidence of successful management of multidrug-resistant tuberculosis (MDRTB) is mainly generated from referral hospitals in high-income countries. We evaluate the management of MDRTB in 5 resource-limited countries: Estonia, Latvia, Peru, the Philippines, and the Russian Federation. All projects were approved by the Green Light Committee for access to quality-assured second-line drugs provided at reduced price for MDRTB management. Of 1047 MDRTB patients evaluated, 119 (11%) were new, and 928 (89%) had received treatment previously. More than 50% of previously treated patients had received both first- and second-line drugs, and 65% of all patients had infections that were resistant to both first- and second-line drugs. Treatment was successful in 70% of all patients, but success rate was higher among new (77%) than among previously treated patients (69%). In resource-limited settings, treatment of MDRTB provided through, or in collaboration with, national TB programs can yield results similar to those from wealthier settings.
Nathanson
Eva
E
Stop TB Department, World Health Organization, Geneva, Switzerland. nathansone@who.int
Lambregts-van Weezenbeek
Catharina
C
Rich
Michael L
ML
Gupta
Rajesh
R
Bayona
Jaime
J
Blöndal
Kai
K
Caminero
José A
JA
Cegielski
J Peter
JP
Danilovits
Manfred
M
Espinal
Marcos A
MA
Hollo
Vahur
V
Jaramillo
Ernesto
E
Leimane
Vaira
V
Mitnick
Carole D
CD
Mukherjee
Joia S
JS
Nunn
Paul
P
Pasechnikov
Alexander
A
Tupasi
Thelma
T
Wells
Charles
C
Raviglione
Mario C
MC
D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003140:Communicable Disease Control / Q000379:methods; D003906:Developing Countries; D004334:Drug Administration Schedule; D004957:Estonia / Q000453:epidemiology; D006078:Government Programs; D006801:Humans; D007844:Latvia / Q000453:epidemiology; D010568:Peru / Q000453:epidemiology; D010679:Philippines / Q000453:epidemiology; D015397:Program Evaluation; D012426:Russia / Q000453:epidemiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control*
D000995:Antitubercular Agents