Journal Article > CommentaryFull Text
Int J Tuberc Lung Dis. 2020 November 1; Volume 24 (Issue 11); 1134-1144.; DOI:10.5588/ijtld.20.0330
Cox V, McKenna L, Acquah R, Reuter A, Wasserman S, et al.
Int J Tuberc Lung Dis. 2020 November 1; Volume 24 (Issue 11); 1134-1144.; DOI:10.5588/ijtld.20.0330
Rapid diagnostics, newer drugs, repurposed medications, and shorter regimens have radically altered the landscape for treating rifampicin-resistant TB (RR-TB) and multidrug-resistant TB (MDR-TB). There are multiple ongoing clinical trials aiming to build a robust evidence base to guide RR/MDR-TB treatment, and both observational studies and programmatic data have contributed to advancing the treatment field. In December 2019, the WHO issued their second ‘Rapid Communication´ related to RR-TB management. This reiterated their prior recommendation that a majority of people with RR/MDR-TB receive all-oral treatment regimens, and now allow for specific shorter duration regimens to be used programmatically as well. Many TB programs need clinical advice as they seek to roll out such regimens in their specific setting. In this Perspective, we highlight our early experiences and lessons learned from working with National TB Programs, adult and pediatric clinicians and civil society, in optimizing treatment of RR/MDR-TB, using shorter, highly-effective, oral regimens for the majority of people with RR/MDR-TB.
Journal Article > LetterSubscription Only
Eur Clin Respir J. 2023 October 1; Volume 62 (Issue 4); 2300556.; DOI:10.1183/13993003.00556-2023
Soares KA, Ehrlich J, Camara MS, Chaloub S, Emeka E, et al.
Eur Clin Respir J. 2023 October 1; Volume 62 (Issue 4); 2300556.; DOI:10.1183/13993003.00556-2023
Journal Article > ResearchFull Text
Bull World Health Organ. 2023 November 1; Volume 101 (Issue 11); 730-737.; DOI:10.2471/BLT.23.290901
Gupta-Wright A, den Boon S, MacLean E, Cirillo DM, Cobelens F, et al.
Bull World Health Organ. 2023 November 1; Volume 101 (Issue 11); 730-737.; DOI:10.2471/BLT.23.290901
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The World Health Organization has developed target product profiles containing minimum and optimum targets for key characteristics for tests for tuberculosis treatment monitoring and optimization. Tuberculosis treatment optimization refers to initiating or switching to an effective tuberculosis treatment regimen that results in a high likelihood of a good treatment outcome. The target product profiles also cover tests of cure conducted at the end of treatment. The development of the target product profiles was informed by a stakeholder survey, a cost-effectiveness analysis and a patient-care pathway analysis. Additional feedback from stakeholders was obtained by means of a Delphi-like process, a technical consultation and a call for public comment on a draft document. A scientific development group agreed on the final targets in a consensus meeting. For characteristics rated of highest importance, the document lists: (i) high diagnostic accuracy (sensitivity and specificity); (ii) time to result of optimally ≤ 2 hours and no more than 1 day; (iii) required sample type to be minimally invasive, easily obtainable, such as urine, breath, or capillary blood, or a respiratory sample that goes beyond sputum; (iv) ideally the test could be placed at a peripheral-level health facility without a laboratory; and (v) the test should be affordable to low- and middle-income countries, and allow wide and equitable access and scale-up. Use of these target product profiles should facilitate the development of new tuberculosis treatment monitoring and optimization tests that are accurate and accessible for all people being treated for tuberculosis.