Guidelines for treatment of drug-susceptible tuberculosis and patient care
Uptsate 2017
Guidelines for treatment of drug-susceptible tuberculosisand patient care
2017 Update
A practical tool to help health workers in the clinical and operational management of multidrug-resistant tuberculosis with special focus on the introduction, implementation and management of the nine-month treatment regimen.
Las recomendaciones contenidas en este módulo son un componente de las directrices unificadas de la OMS sobre la tuberculosis (TB) y están destinadas principalmente para el uso de los programas nacionales de control de la tuberculosis, los organismos de salud pública y otros interesados clave que... participan en la planificación, ejecución y seguimiento de las actividades de gestión programática de la TB farmacorresistente. El objetivo esta actualización es proporcionar información basada en la evidencia sobre determinadas áreas críticas que ayude a fundamentar el uso de nuevos esquemas totalmente orales y la posible ampliación de la ficha técnica de los nuevos medicamentos contra la TB. Los interesados directos podrán distinguir entre las recomendaciones anteriores que siguen siendo válidas, las que se han actualizado y las que se han elaborado recientemente sobre la base de estudios adicionales, teniendo en cuenta la gama de beneficios conocidos y posibles daños, los ejercicios de modelización y otros datos para fundamentar el proceso de toma de decisiones.
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Considerando los cambios estratégicos en el abordaje de la salud pública y de la atención primaria de la salud, la prevención y el control de la tuberculosis en Ecuador genera un cambio en la parte organizacional y en la prestación de servicios con enfoque en grupos vulnerables y/o con factores... de riesgo acorde a los ciclos de vida. Esta documento contempla una orientación apoyada en evidencia científica y otras recomendaciones en la práctica médica, basadas en el buen juicio clínico de quien la emplea como referencia, en las necesidades del afectado y en los recursos disponibles al momento de la atención, dando prioridad a la prevención, diagnóstico, tratamiento y control de la TB.
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Los pueblos indígenas presentan tasas más altas de morbilidad y mortalidad por tuberculosis (tb) que los demás grupos étnicos. El acceso limitado a servicios de salud debido a la ubicación geográfica y a problemas del conflicto armado los mantiene aislados. En este estudio se pr...esenta un análisis de la situación epidemiológica de la tb en pueblos indígenas, y se identifican factores socioculturales que pueden ayudar a mejorar el control de la enfermedad.
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La publicación describe el método aplicado en los laboratorios que han realizado la validación, como un método rápido de tamizaje para la detección de resistencia a isoniacida y rifampicina en muestras de esputo de pacientes con tuberculosis pulmonar que aún no hayan iniciado tratamiento anti...tuberculosis, pacientes nunca tratados, recaídas o abandonos recuperados con frotis positivo o negativo.
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Ministry of Public Health Tuberculosis Control Programme.
Manual of Standards and procedures for the control of Tuberculosis in Ecuador, second edition.
Public Health Surveillance Protocol Tuberculosis
Los Módulos de autoaprendizaje sobre tuberculosis son una serie de módulos educativos diseñados para proporcionar información sobre la tuberculosis en un formato de autoaprendizaje. El módulo 6 (“Manejo de pacientes con tuberculosis y mejora de la adherencia al tratamiento”) y el módulo 8 ...(“Investigaciones de contactos de tuberculosis”) están disponibles en español. Los módulos 1-9 están disponibles en inglés.
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The Updated guidelines on Management of tuberculosis in children and adolescents include new recommendations that cover diagnostic approaches for TB, shorter treatment for children with non-severe drug-susceptible TB, a new option for the treatment of TB meningitis, the use of bedaquiline and delama...nid in young children with multidrug- and rifampicin-resistant TB and decentralized and family-centred, integrated models of care for TB case detection and prevention in children and adolescents.
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Se estima que unos 10 millones de personas contrajeron tuberculosis (TB) en el 2019 y que a unos 3 millones de ellas no se les diagnosticó ni se les notificó la enfermedad. Con el propósito de poner fin a la epidemia mundial de la tuberculosis para el 2030, sigue siendo necesario ampliar la capac...idad para analizar un gran número de muestras.
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El objetivo de este artículo es analizar las condiciones de acceso a servicios de salud de las personas con tuberculosis en América
Latina y el Caribe (ALC), reflexionando desde la bioética sobre los aspectos de salud pública implicados. Se realizó una revisión
documental del contexto de la ...tuberculosis en ALC con base en datos epidemiológicos. Los resultados se analizaron a partir de su
relación con los determinantes sociales de la salud, los principios éticos que pautan la práctica médica y la responsabilidad social
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Tuberculosis continues to represent a severe public health problem in the Region of the Americas, even more so in the case of indigenous peoples, whose TB incidence is much higher than that of the general population. To achieve tuberculosis control in these communities, it is necessary to respond t...o communities’ diverse needs from an intercultural perspective that allows the application of a holistic approach—from a standpoint of equality and mutual respect—and considers the value of their cultural practices. In the Region of the Americas, although there has been progress toward recognizing the need for an intercultural approach to health services, obstacles rooted in discrimination, racism, and the exclusion of indigenous peoples and other ethnic groups persist. To respond to this situation, the Pan American Health Organization (PAHO) prepared this guidance which––based on an intercultural approach in accordance with the priority lines of the current PAHO Policy on Ethnicity and Health and its practical development in the Region’s indigenous populations––represent a support tool for implementing the End TB Strategy. This publication integrates PAHO’s accumulated experience and best practices developed by its Member States in recent years, including discussions and experiences shared in regional meetings on the issue, and emphasizes innovation and social inclusion. This requires an urgent shift away from traditional paradigms, taking specific actions that gradually reduce TB incidence and moving toward effective multisectoral actions that have proven effective in quickly containing the epidemic. This publication integrates PAHO’s accumulated experience and best practices developed by its Member States in recent years, including discussions and experiences shared in regional meetings on the issue, and emphasizes innovation and social inclusion. This requires an urgent shift away from traditional paradigms, taking specific actions that gradually reduce TB incidence and moving toward effective multisectoral actions that have proven effective in quickly containing the epidemic.
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The Practical manual on laboratory strengthening, 2022 update provides practical guidance on implementation of WHO recommendations and best practices for TB laboratory strengthening. It is an updated version of the GLI Practical Guide to Laboratory Strengthening published in 2017 and provides the la...test practical guidance on use of newly recommended diagnostics as well as guidance in key technical areas, including quality assurance and quality management systems, specimen collection and registration, procurement and supply-chain management, diagnostic connectivity, biosafety, data management, human resources, strategic planning, and model algorithms. The key changes are:
inclusion of recent or updated WHO recommendations for tests to diagnose TB and detect drug resistance;
alignment with the latest WHO critical concentrations for phenotypic drug-susceptibility testing (DST) and the new definitions of pre-XDR-TB and XDR-TB;
updated information on building quality-assured TB testing and management capacity using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) approach (Score-TB package1);
updated information on assessing, analysing and optimising TB diagnostic networks; and
updated information on the use of next-generation sequencing (NGS) to detect mutations associated with drug resistance for surveillance purposes.
The document also provides references to resources and tools relevant for work on laboratory strengthening.
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The Democratic Republic of Timor-Leste has the highest TB incidence rate in the South East Asian Region - 498 per 100,000, which is the seventh highest in the world. In Timor-Leste TB is the eighth most common cause of death.
The salient observations are as follows:
In 2018, 487 (12.5%) of the... 3906 notified TB patients were tested for RR-TB and only 12 lab confirmed RR-TB patients were initiated on standard MDR-TB treatment of 20-months duration, (a 3-fold increase in RR-TB detection compared with 2017). This amounts to treatment coverage of only 17% of 72 estimated MDR/RR-TB among notified TB patients (3906) and 5% of 240 estimated incident MDR-TB patients as compared to 62% treatment coverage of 6300 incident drug sensitive TB patients estimated in TLS. The treatment success in the 2016 annual cohort of 6 MDR-TB patients has been reported at 83%. 80% of TB patients know their HIV Status with around 1% TB-HIV co-infection, 37/ 77 (48%) TB-HIV Co-infection Detected. Of the 387 PLHIV currently alive on ART, exact status on TB screening and testing is unknown. % of PLHIV newly enrolled in HIV care who received IPT is not known.
In 2018, the mortality rate for TB was 94 deaths per 100,000 people (1200 per annum) in TL with an increasing mortality trend (Figure 1), despite TB services being available for nearly two decades.
A survey of catastrophic costs due to TB (2016) highlights that 83% of TB patients are reported to be facing catastrophic costs due to the disease. This is the highest rate in the world.
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