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This report was prepared as part of a World Health Organization (WHO) project funded by the Bill & Melinda Gates Foundation to review the history of tuberculosis (TB) control in India, to assess the impact of the TB programme on the epidemiology of tuberculosis in India, and to outline directions for future progress.
The challenge is now to sustain the existing DOTS-based programme while introducing all components of the new Stop TB strategy, including services to address TB/HIV, treatment for multidrug-resistant TB, strengthening laboratory services, and integrating TB services in all health facilities of both the public and private health-care sectors.
The present WHO Consolidated Guidelines on Tuberculosis, Module 4: Treatment - Drug-Resistant Tuberculosis Treatment includes a comprehensive set of WHO recommendations for the treatment and care of DR-TB. The document includes two new recommendations, one on the composition of shorter regimens and one on the use of the BPaL regimen. In addition, the consolidated guidelines include existing recommendations on treatment regimens for isoniazid-resistant TB and MDR/RR-TB, including longer regimens, culture monitoring of patients on treatment, the timing of antiretroviral therapy (ART) in MDR/RR-TB patients infected with the human immunodeficiency virus (HIV), the use of surgery for patients receiving MDR-TB treatment, and optimal models of patient support and care.
The operational handbook provides practical information and tools that complement the recommendations in the guidelines. The strategies described in the operational handbook are based on the latest WHO recommendations which were formulated by Guideline Development Groups using the GRADE approach. In many cases however, the recommendations in their current form lacked sufficient clinical and programmatic detail, which is important for implementation. This operational handbook complements the guidelines with practical advice based on best practices and knowledge from the fields such as pharmacokinetics, pharmacodynamics, microbiology, pharmacovigilance and clinical and programmatic management.
The present Consolidated guidelines include a comprehensive set of WHO recommendations for the treatment and care of DR-TB, derived from these WHO guidelines documents. The consolidated guidelines include policy recommendations on treatment regimens for isoniazid-resistant TB (Hr-TB) and MDR/RR-TB, including longer and shorter regimens, culture monitoring of patients on treatment, the timing of antiretroviral therapy (ART) in MDR/RR-TB patients infected with the human immunodeficiency virus (HIV), use of surgery for patients receiving MDR-TB treatment, and optimal models of patient support and care.
Keywords: TB, HIV, drug-resistant, treatment, support and care
Recognizing that the promotion and protection of the human rights of people affected by tuberculosis is a legal, ethical and moral imperative, as well as of crucial importance for the effectiveness of the response to the epidemic and the relief of suffering among affected individuals and communitie.
Most countries are not on track and too many people living with HIV are still dying from TB which is preventable and curable. The most vulnerable and the marginalized are still out of reach of HIV and TB services and in around 40 countries the number of TB deaths among people living with HIV is increasing. This is unacceptable.
TAG’s latest report on global funding for TB research and development (R&D), published in collaboration with the Stop TB Partnership, presents new data on TB R&D funding in 2018 and analyzes trends in funding since 2005. The report—Tuberculosis Research Funding Trends, 2005–2018—is a critical accountability tool and serves as a barometer of progress in raising support for the scientific innovation needed to eliminate TB.
In November 2017, 117 national delegations adopted the Moscow Declaration to End TB at the first WHO Global Ministerial Conference on Ending TB: A Multisectoral Response. They committed to “supporting the development of a multisectoral accountability framework” to accelerate progress to end TB. They called on WHO to develop the framework, working in close cooperation with relevant partners.
At the 71st World Health Assembly (WHA) in May 2018, Member States welcomed the WHO draft multisectoral accountability framework (hereafter referred to as the MAF-TB). The WHA also requested the Director-General to continue to develop the MAF-TB, in consultation with Member States, and working in close collaboration with partners, as well as to provide technical support for national adaptation and use of the MAF-TB.
Keywords: SDG, TB, development, funding, monitoring and reporting
Key informant semi-structured interview and focus group discussion guides.