Drug-Resistant tuberculosis-current dilemmas, unanswered questions, challenges, and priority needs

Alimuddin Zumla; Ibrahim Abubakar; Mario Raviglione; Michael Hoelscher; Lucica Ditiu; Timothy D. McHugh; S. Bertel Squire; Helen Cox; Nathan Ford; Ruth McNerney; Ben Marais; Martin Grobusch; Stephen D. Lawn; Giovanni Battista Migliori; Peter Mwaba; Justin O'Grady; Michel Pletschette; Andrew Ramsay; Jeremiah Chakaya; Marco Schito; Soumya Swaminathan; Ziad Memish; Markus Maeurer; Rifat Atun

doi:10.1093/infdis/jir858

Drug-Resistant tuberculosis-current dilemmas, unanswered questions, challenges, and priority needs

Alimuddin Zumla^*, Ibrahim Abubakar, Mario Raviglione, Michael Hoelscher, Lucica Ditiu, Timothy D. McHugh, S. Bertel Squire, Helen Cox, Nathan Ford, Ruth McNerney, Ben Marais, Martin Grobusch, Stephen D. Lawn, Giovanni Battista Migliori, Peter Mwaba, Justin O'Grady, Michel Pletschette, Andrew Ramsay, Jeremiah Chakaya, Marco SchitoSoumya Swaminathan, Ziad Memish, Markus Maeurer, Rifat Atun

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

142 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	S228-S240
Journal	Journal of Infectious Diseases
Volume	205
Issue number	SUPPL. 2
DOIs	https://doi.org/10.1093/infdis/jir858
Publication status	Published - 15 May 2012

Bibliographical note

Funding Information:
Finanacial support. This work was supported by the European Commission (EuropeAid), Belgium; European and Developing Countries Clinical Trials Partnership (EDCTP), Netherlands; and Union Bank of Switzerland (UBS) Optimus Foundation, Switzerland. A. Z is supported by the University College London Hospitals (UCLH) National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre (CBRC) and the UCLH National Health Service (NHS) Foundation Trust. Potential conflicts of interests. All authors: No reported conflicts.

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10.1093/infdis/jir858

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Zumla, A., Abubakar, I., Raviglione, M., Hoelscher, M., Ditiu, L., McHugh, T. D., Squire, S. B., Cox, H., Ford, N., McNerney, R., Marais, B., Grobusch, M., Lawn, S. D., Migliori, G. B., Mwaba, P., O'Grady, J., Pletschette, M., Ramsay, A., Chakaya, J., ... Atun, R. (2012). Drug-Resistant tuberculosis-current dilemmas, unanswered questions, challenges, and priority needs. Journal of Infectious Diseases, 205(SUPPL. 2), S228-S240. https://doi.org/10.1093/infdis/jir858

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title = "Drug-Resistant tuberculosis-current dilemmas, unanswered questions, challenges, and priority needs",

abstract = "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.",

author = "Alimuddin Zumla and Ibrahim Abubakar and Mario Raviglione and Michael Hoelscher and Lucica Ditiu and McHugh, {Timothy D.} and Squire, {S. Bertel} and Helen Cox and Nathan Ford and Ruth McNerney and Ben Marais and Martin Grobusch and Lawn, {Stephen D.} and Migliori, {Giovanni Battista} and Peter Mwaba and Justin O'Grady and Michel Pletschette and Andrew Ramsay and Jeremiah Chakaya and Marco Schito and Soumya Swaminathan and Ziad Memish and Markus Maeurer and Rifat Atun",

note = "Funding Information: Finanacial support. This work was supported by the European Commission (EuropeAid), Belgium; European and Developing Countries Clinical Trials Partnership (EDCTP), Netherlands; and Union Bank of Switzerland (UBS) Optimus Foundation, Switzerland. A. Z is supported by the University College London Hospitals (UCLH) National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre (CBRC) and the UCLH National Health Service (NHS) Foundation Trust. Potential conflicts of interests. All authors: No reported conflicts.",

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doi = "10.1093/infdis/jir858",

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Zumla, A, Abubakar, I, Raviglione, M, Hoelscher, M, Ditiu, L, McHugh, TD, Squire, SB, Cox, H, Ford, N, McNerney, R, Marais, B, Grobusch, M, Lawn, SD, Migliori, GB, Mwaba, P, O'Grady, J, Pletschette, M, Ramsay, A, Chakaya, J, Schito, M, Swaminathan, S, Memish, Z, Maeurer, M & Atun, R 2012, 'Drug-Resistant tuberculosis-current dilemmas, unanswered questions, challenges, and priority needs', Journal of Infectious Diseases, vol. 205, no. SUPPL. 2, pp. S228-S240. https://doi.org/10.1093/infdis/jir858

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T1 - Drug-Resistant tuberculosis-current dilemmas, unanswered questions, challenges, and priority needs

AU - Zumla, Alimuddin

AU - Abubakar, Ibrahim

AU - Raviglione, Mario

AU - Hoelscher, Michael

AU - Ditiu, Lucica

AU - McHugh, Timothy D.

AU - Squire, S. Bertel

AU - Cox, Helen

AU - Ford, Nathan

AU - McNerney, Ruth

AU - Marais, Ben

AU - Grobusch, Martin

AU - Lawn, Stephen D.

AU - Migliori, Giovanni Battista

AU - Mwaba, Peter

AU - O'Grady, Justin

AU - Pletschette, Michel

AU - Ramsay, Andrew

AU - Chakaya, Jeremiah

AU - Schito, Marco

AU - Swaminathan, Soumya

AU - Memish, Ziad

AU - Maeurer, Markus

AU - Atun, Rifat

N1 - Funding Information: Finanacial support. This work was supported by the European Commission (EuropeAid), Belgium; European and Developing Countries Clinical Trials Partnership (EDCTP), Netherlands; and Union Bank of Switzerland (UBS) Optimus Foundation, Switzerland. A. Z is supported by the University College London Hospitals (UCLH) National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre (CBRC) and the UCLH National Health Service (NHS) Foundation Trust. Potential conflicts of interests. All authors: No reported conflicts.

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N2 - 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.

AB - 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.

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SP - S228-S240

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

IS - SUPPL. 2

ER -

Drug-Resistant tuberculosis-current dilemmas, unanswered questions, challenges, and priority needs

Abstract

Bibliographical note

UN SDGs

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