Drug Resistance in Tuberculosis and Its Public Health Management ...

Drug Resistance in Tuberculosisand Its Public Health ManagementDr. Paul NunnWhy is planning for MDR-TBtreatment programmes important?• MDR-TB treatment is difficult, complex, time-consumingand expensive – much more so than drug sensitive TB• Provision of reliable treatment to hundreds of patientsfor ~2 years on a national scale requires enormouscoordination of multiple players – and is thus a majorplanning exercise25http://www.path.org/publications/detail.php?i=1678Essential principles of care for MDR-TBstrengthen basic TB controlPolitical commitment to implement objectives of the responsewith adequate budget to startMicrobiological diagnosis (culture, drug susceptibility test by a qualityassuredlaboratory) and monitoring of response to treatmentCollaboration with HIV programmePatient-centred approach for direct observation of treatmenton out-patient or hospitalised basisCare under proper infection control conditions26Quality assured second-line anti-TB drugs, meeting at leastWHO-GMP standardsRecording and reporting for monitoring and evaluationEssential elements in planning the strengtheningof basic TB control through MDR-TB managementEstimate burdenMeasure diagnostic capacity in place and define gapsDecide models of care (hospitalisation, outpatient)Ensure infection control measures in place and define gapsEnsure social support networkPlan drug procurement – second-line anti-TB drugs and those for adverse effectsSet up recording and reporting systemEnsure workforce in place and define gapsSet up staff development and trainingWrite national guidelines and manual of operationsConsider operational research agendaBudget and financing27The screen versions of these slides have full details of copyright and acknowledgements9