Infection Control for Drug-Resistant Tuberculosis: Early Diagnosis and Treatment Is the Key.
Multidrug-resistant (MDR) tuberculosis, "Ebola with wings," is a significant threat to tuberculosis control efforts. Previous prevailing views that resistance was mainly acquired through poor treatment led to decades of focus on drug-sensitive rather than drug-resistant (DR) tuberculosis, driven by the World Health Organization's directly observed therapy, short course strategy. The paradigm has shifted toward recognition that most DR tuberculosis is transmitted and that there is a need for increased efforts to control DR tuberculosis. Yet most people with DR tuberculosis are untested and untreated, driving transmission in the community and in health systems in high-burden settings. The risk of nosocomial transmission is high for patients and staff alike. Lowering transmission risk for MDR tuberculosis requires a combination approach centered on rapid identification of active tuberculosis disease and tuberculosis drug resistance, followed by rapid initiation of appropriate treatment and adherence support, complemented by universal tuberculosis infection control measures in healthcare facilities. It also requires a second paradigm shift, from the classic infection control hierarchy to a novel, decentralized approach across the continuum from early diagnosis and treatment to community awareness and support. A massive scale-up of rapid diagnosis and treatment is necessary to control the MDR tuberculosis epidemic. This will not be possible without intense efforts toward the implementation of decentralized, ambulatory models of care. Increasing political will and resources need to be accompanied by a paradigm shift. Instead of focusing on diagnosed cases, recognition that transmission is driven largely by undiagnosed, untreated cases, both in the community and in healthcare settings, is necessary. This article discusses this comprehensive approach, strategies available, and associated challenges.
Médecins Sans Frontières Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa.
Gilles
G
van Cutsem
Médecins Sans Frontières, Mumbai, India.
Petros
P
Isaakidis
School of Nursing, Johns Hopkins University, Baltimore, Maryland.
Jason
J
Farley
Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.
Ed
E
Nardell
Department of Tuberculosis Control, Vladimir Oblast Tuberculosis Dispensary, Russian Federation.
Grigory
G
Volchenkov
Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa.
Helen
H
Cox
D000995:Antitubercular Agents / Q000627:therapeutic use; D042241:Early Diagnosis; D006801:Humans; D017053:Infection Control; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control
D000995:Antitubercular Agents
community; diagnosis; infection control; multidrug-resistant tuberculosis; treatment