World TB Day: WHO updates guidelines, urges accountability

Tereza Kasaeva, MD, PhD
Tereza Kasaeva

WHO fully released new treatment guidelines for multidrug-resistant tuberculosis, or MDR-TB, and announced a package of actions it said is designed to help countries close gaps in care.

The actions were taken ahead of World TB Day, observed each year on March 24.

“To win the fight against TB, multisectoral accountability, engagement and action is vital,” Tereza Kasaeva, MD, PhD, director of WHO’s Global TB Programme, told Infectious Disease News.

WHO previewed the new MDR-TB guidelines last year. They recommend shifting to a fully oral regimen.

According a news release, a “larger package of actions” meant to increase the progress toward ending TB was designed to help countries address gaps in care, “ensuring no one is left behind.”

WHO described the package as including:

  • an accountability framework to coordinate actions across sectors and to monitor and review progress;
  • a dashboard to help countries know more about their own epidemics through real-time monitoring — by moving to electronic TB surveillance systems;
  • a guide for effective prioritization of planning and implementation of impactful TB interventions based on analyses of patient pathways in accessing care;
  • ·new WHO guidelines on infection control and preventive treatment for latent TB infection;
  • and a civil society task force to ensure effective and meaningful civil society engagement.

“The framework promotes the following key principles to accelerate progress to end TB: 1) All high-level commitments should be urgently translated into national targets with a comprehensive action plan; 2) Regular monitoring and reporting from all sectors should be enabled and ensured; 3) Comprehensive review of all actions of different stakeholders should be provided,” Kasaeva explained.

Additionally, electronic TB surveillance systems will help countries monitor TB cases in real time, allowing public health officials and other experts to learn more about TB epidemics occurring in their country.

“Infectious disease clinicians are a key provider of essential care to people with TB,” Kasaeva said. “Accountability for ID clinicians means providing high-quality care to all patients by ensuring early diagnosis and treatment according to WHO guidelines, adverse drug safety monitoring, mandatory notification and reporting.”

Infectious Disease News compiled a list of recent TB stories to mark World TB Day. – by Marley Ghizzone

TB cases in US hit all-time low; declines insufficient to meet goals

TB cases in the United States in 2018 fell to the lowest level ever reported, according to preliminary surveillance data, but the rate of progress toward the goal of eliminating the disease in the U.S. has slowed. Read more.

MDR-TB: A ‘global public health crisis’

In a recent cover story, Infectious Disease News spoke with experts about the global effort to eliminate MDR-TB and end the TB epidemic. Read more.

Mandatory screening helped stop TB outbreak among Atlanta homeless

A comprehensive public health approach that included mandatory screening helped stop an outbreak of drug-resistant TB in Atlanta homeless shelters. Read more.

Tshepiso study: Preventive TB therapy not associated with poor pregnancy outcomes

Initiating isoniazid preventive therapy for TB during pregnancy is not associated with a higher rate of poor maternal or infant outcomes, according to results of an observational study presented at CROI. A previous randomized trial found that its use in pregnancy led to a higher risk for adverse maternal outcomes. Read more.

FDA accepts NDA for pretomanid in combination TB regimen

TB Alliance announced that the FDA accepted a new drug application for its novel TB drug candidate, pretomanid, as part of a drug regimen used to treat extensively drug-resistant TB; treatment-intolerant, multidrug-resistant TB; and treatment-nonresponsive, multidrug-resistant TB. Read more.

‘Reassured’: Short TB treatment safe in adults with HIV on dolutegravir

A short-course drug regimen to prevent TB was found to be safe in patients with HIV on dolutegravir therapy, while not reducing the HIV drug’s effectiveness. Read more.

Social intervention in Brazil increases rate of TB cure by 7.6%

The Bolsa Familia Programme — a conditional cash transfer program in Brazil — directly affects TB treatment outcomes, demonstrating a 7.6% higher rate of cure. Read more.

Undernutrition a ‘potent accelerant’ of TB epidemic

Undernutrition, which affects nearly 800 million people worldwide, is a “potent accelerant” of the global TB epidemic, impacting disease incidence and treatment outcomes in infected patients. Read more.

Study demonstrates cardiac safety of bedaquiline plus delamanid for MDR-TB

Phase 2 study data presented at CROI demonstrated the cardiac safety of the combined use of bedaquiline and delamanid — two novel TB medications — in patients with multidrug-resistant TB receiving multidrug background treatment. Read more.

Experts suggest urine-based TB screening for all patients with HIV

In resource-limited settings, urine-based TB screening of all hospitalized patients with HIV is a cost-effective strategy that could increase their life expectancy. Read more.

Reference:

WHO. WHO consolidated guidelines on drug-resistant tuberculosis treatment. https://www.who.int/tb/publications/2019/consolidated-guidelines-drug-resistant-TB-treatment/en/. Accessed March 21, 2019.

Disclosure: Kaseva is employed by WHO.

Tereza Kasaeva, MD, PhD
Tereza Kasaeva

WHO fully released new treatment guidelines for multidrug-resistant tuberculosis, or MDR-TB, and announced a package of actions it said is designed to help countries close gaps in care.

The actions were taken ahead of World TB Day, observed each year on March 24.

“To win the fight against TB, multisectoral accountability, engagement and action is vital,” Tereza Kasaeva, MD, PhD, director of WHO’s Global TB Programme, told Infectious Disease News.

WHO previewed the new MDR-TB guidelines last year. They recommend shifting to a fully oral regimen.

According a news release, a “larger package of actions” meant to increase the progress toward ending TB was designed to help countries address gaps in care, “ensuring no one is left behind.”

WHO described the package as including:

  • an accountability framework to coordinate actions across sectors and to monitor and review progress;
  • a dashboard to help countries know more about their own epidemics through real-time monitoring — by moving to electronic TB surveillance systems;
  • a guide for effective prioritization of planning and implementation of impactful TB interventions based on analyses of patient pathways in accessing care;
  • ·new WHO guidelines on infection control and preventive treatment for latent TB infection;
  • and a civil society task force to ensure effective and meaningful civil society engagement.

“The framework promotes the following key principles to accelerate progress to end TB: 1) All high-level commitments should be urgently translated into national targets with a comprehensive action plan; 2) Regular monitoring and reporting from all sectors should be enabled and ensured; 3) Comprehensive review of all actions of different stakeholders should be provided,” Kasaeva explained.

Additionally, electronic TB surveillance systems will help countries monitor TB cases in real time, allowing public health officials and other experts to learn more about TB epidemics occurring in their country.

“Infectious disease clinicians are a key provider of essential care to people with TB,” Kasaeva said. “Accountability for ID clinicians means providing high-quality care to all patients by ensuring early diagnosis and treatment according to WHO guidelines, adverse drug safety monitoring, mandatory notification and reporting.”

Infectious Disease News compiled a list of recent TB stories to mark World TB Day. – by Marley Ghizzone

TB cases in US hit all-time low; declines insufficient to meet goals

TB cases in the United States in 2018 fell to the lowest level ever reported, according to preliminary surveillance data, but the rate of progress toward the goal of eliminating the disease in the U.S. has slowed. Read more.

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MDR-TB: A ‘global public health crisis’

In a recent cover story, Infectious Disease News spoke with experts about the global effort to eliminate MDR-TB and end the TB epidemic. Read more.

Mandatory screening helped stop TB outbreak among Atlanta homeless

A comprehensive public health approach that included mandatory screening helped stop an outbreak of drug-resistant TB in Atlanta homeless shelters. Read more.

Tshepiso study: Preventive TB therapy not associated with poor pregnancy outcomes

Initiating isoniazid preventive therapy for TB during pregnancy is not associated with a higher rate of poor maternal or infant outcomes, according to results of an observational study presented at CROI. A previous randomized trial found that its use in pregnancy led to a higher risk for adverse maternal outcomes. Read more.

FDA accepts NDA for pretomanid in combination TB regimen

TB Alliance announced that the FDA accepted a new drug application for its novel TB drug candidate, pretomanid, as part of a drug regimen used to treat extensively drug-resistant TB; treatment-intolerant, multidrug-resistant TB; and treatment-nonresponsive, multidrug-resistant TB. Read more.

‘Reassured’: Short TB treatment safe in adults with HIV on dolutegravir

A short-course drug regimen to prevent TB was found to be safe in patients with HIV on dolutegravir therapy, while not reducing the HIV drug’s effectiveness. Read more.

Social intervention in Brazil increases rate of TB cure by 7.6%

The Bolsa Familia Programme — a conditional cash transfer program in Brazil — directly affects TB treatment outcomes, demonstrating a 7.6% higher rate of cure. Read more.

Undernutrition a ‘potent accelerant’ of TB epidemic

Undernutrition, which affects nearly 800 million people worldwide, is a “potent accelerant” of the global TB epidemic, impacting disease incidence and treatment outcomes in infected patients. Read more.

Study demonstrates cardiac safety of bedaquiline plus delamanid for MDR-TB

Phase 2 study data presented at CROI demonstrated the cardiac safety of the combined use of bedaquiline and delamanid — two novel TB medications — in patients with multidrug-resistant TB receiving multidrug background treatment. Read more.

Experts suggest urine-based TB screening for all patients with HIV

In resource-limited settings, urine-based TB screening of all hospitalized patients with HIV is a cost-effective strategy that could increase their life expectancy. Read more.

Reference:

WHO. WHO consolidated guidelines on drug-resistant tuberculosis treatment. https://www.who.int/tb/publications/2019/consolidated-guidelines-drug-resistant-TB-treatment/en/. Accessed March 21, 2019.

Disclosure: Kaseva is employed by WHO.