Excerpt

In recognition of the grave threat posed worldwide by drug-resistant tuberculosis (TB), in November 2008 the Institute of Medicine's (IOM's) Forum on Drug Discovery, Development, and Translation held a workshop titled “Addressing the Threat of Drug-Resistant Tuberculosis: A Realistic Assessment of the Challenge,” which brought together experts in drug-resistant TB and public health to speak frankly and openly about the problem. That workshop led to plans for four additional workshops in countries with a high burden of drug-resistant TB. The first of these workshops, summarized in this volume, was held in Pretoria, South Africa, on March 3–4, 2010, with subsequent workshops being planned for Russia, China, and India. The workshop brought together about 65 disease experts, community leaders, policy makers, and patient advocates from South Africa, other countries in southern Africa, and the United States for 2 days of intensive discussions. The workshop was supported in part by the Doris Duke Foundation, by the Howard Hughes Medical Institute, and by the U.S. Department of State.

Contents

• The National Academies
• Planning Committee for the Workshop on the Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions
• Forum on Drug Discovery, Development, and Translation
• Reviewers
• 1. Introduction
  • THE BURDEN OF DRUG-RESISTANT TB
  • WORKSHOP OBJECTIVES
  • THE PROBLEM AND PRIORITIES
  • ORGANIZATION OF THIS REPORT
• 2. The Incidence of Drug-Resistant TB in Southern Africa
  • RELATIONSHIP BETWEEN REPORTED INCIDENCE AND DIAGNOSTIC TOOLS
  • MDR AND XDR TB IN SOUTH AFRICA
  • OUTBREAK OF MDR AND XDR TB IN KWAZULU-NATAL PROVINCE
  • TB AND HIV COINFECTION IN SOUTHERN AFRICA
• 3. Surveillance and Tracking of Drug-Resistant TB
  • GENETIC ANALYSIS OF DRUG-RESISTANT STRAINS
  • INTENSIFIED TB CASE FINDING
  • INFORMATION SYSTEMS TO ENHANCE LABORATORY CAPACITY
• 4. Transmission and Infection Control
  • TRANSMISSIBILITY OF TB
  • INFECTION CONTROL IN HOSPITAL AND OTHER HEALTH CARE SETTINGS
  • CONTACT TRACING AND COMMUNITY-BASED INFECTION CONTROL PRACTICES
  • PARTICULAR CHALLENGES FOR HEALTH CARE WORKERS
  • TRANSMISSION AND INFECTION CONTROL AMONG MINERS AND MIGRANT WORKERS IN LESOTHO
• 5. Diagnosis of Drug-Resistant TB
  • NEED FOR RAPID DIAGNOSTICS
  • PROGRESS ON POINT-OF-CARE DIAGNOSTICS
  • CHALLENGES OF LABORATORY CAPACITY
  • USE OF BIOMARKERS TO DIAGNOSE TB
• 6. Treatment of Drug-Resistant TB
  • TREATMENT OF DRUG-RESISTANT TB
  • COMMUNITY-BASED CARE
  • LIMITATIONS OF HEALTH CARE SYSTEMS AND COST ISSUES
• 7. Drug-Resistant TB in Children
  • EPIDEMIOLOGY OF PEDIATRIC DRUG-RESISTANT TB
  • PROPHYLAXIS AND DIAGNOSIS OF PEDIATRIC DRUG-RESISTANT TB
  • DRUG TREATMENT REGIMENS FOR PEDIATRIC DRUG-RESISTANT TB
  • MANAGEMENT OF PEDIATRIC DRUG-RESISTANT TB
  • OUTCOMES OF PEDIATRIC DRUG-RESISTANT TB
• 8. Convergence of Science and Policy to Create a Blueprint for Action
  • EPIDEMIOLOGY
  • INFECTION CONTROL
  • DIAGNOSTICS
  • TREATMENT
  • PEDIATRIC TB
  • RESEARCH NEEDS
  • THE NEED FOR PARTNERSHIPS
• References
• Acronyms
• Appendixes
  • Appendix A Agenda
  • Appendix B Report from the National Institute of Allergy and Infectious Diseases (NIAID) Workshop
  • Appendix C Participant Biographies

Rapporteurs: Steve Olson, Yeonwoo Lebovitz, and Anne Claiborne

This study was supported by Department of Health and Human Services (Contract Nos. N01-OD-4-2139 and 223001003T), the U.S. State Department (S-LMAQM-08-GR-071), the American Diabetes Association, the American Society for Microbiology, Amgen Inc., the Association of American Medical Colleges, Bristol-Myers Squibb, the Burroughs Wellcome Fund, Celtic Therapeutics, LLLP, the Critical Path Institute, the Doris Duke Charitable Foundation, Eli Lilly & Co., GlaxoSmithKline, Howard Hughes Medical Institute, Johnson & Johnson, Novartis Pharmaceuticals Corporation, and Pfizer, Inc. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Suggested citation:

IOM (Institute of Medicine). 2011. The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions: Summary of a Joint Workshop. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.