Controlling TB Requires Improved Detection, Treatment, Education, Lancet Editorial Says
The World Health Organization's Global Tuberculosis Control Report 2009, released last month, makes for "somber reading" because TB is "a preventable and treatable disease that thrives amid poverty and weak health systems," according to an editorial published in the journal Lancet. According to the editorial, HIV/TB coinfection, as well as multi- and extensively drug-resistant TB, can "complicate treatment and threaten to increase fatality rates." In addition, the prevalence of these conditions has increased because "established procedures for HIV/AIDS coinfection and MDR-TB have not been implemented widely," the editorial states. It continues that "testing and treatment for the two infections often occur at separate sites," adding that accurate MDR- and XDR-TB diagnosis "requires drug sensitivity testing in a qualified laboratory." The editorial states, "Testing accelerates diagnosis, improves treatment and protects" HIV-positive people from contracting TB. However, inadequate case-detection, drug regimens and clinical supervision can contribute to a rising prevalence of drug-resistant TB, according to the editorial.
According to the editorial, measures to ensure best practice in TB control "have failed at many levels in several countries because of lack of discipline, infrastructure and resources." In addition, factors such as drug-resistant TB, HIV/TB coinfection, inadequate health systems and the current economic downturn all "create ideal conditions for TB," the editorial states. However, the "same factors also provide targets to improve care through collaboration, strengthened health systems and research," according to the editorial. For example, a recent Lancet study demonstrated that a new drug might shorten TB treatment duration, which potentially could "improve compliance and increase efficiency," the editorial states. It continues, "more developments in diagnosis and treatment are needed" to successfully curb TB.
According to the editorial, "the changing nature of TB epidemiology demands a reassessment and scaling up of control measures." It continues that health officials and advocates at the Ministerial Meeting of High M/XDR-TB Burden Countries in Beijing -- which took place last week -- "will need to build consensus, establish political will and secure sustainable funding" to succeed in curbing drug-resistant TB. In addition, health officials and the public "must change" their attitudes about TB, and clinicians and laboratories "need to follow best practice in diagnosing, reporting and managing the disease -- and they need to have the tools to do so," the editorial states. Finally, TB control efforts "should engage communities to reduce stigma, support care and develop local solutions" to addressing TB, the editorial states. It concludes that last week's meeting in Beijing "must be an inflexion point in our collective response" to curb TB worldwide (Lancet, 4/4).