Scaling Up Programmatic Management of Drug-Resistant Tuberculosis A Prioritized Research Agenda 英文参考文献.docVIP

Guidelines and Guidance Scaling Up Programmatic Management of Drug-Resistant Tuberculosis: A Prioritized Research Agenda Frank G. J. Cobelens , Einar Heldal, Michael E. Kimerling, Carole D. Mitnick, Laura J. Podewils, Rajeswari Ramachandran, * Hans L. Rieder, Karin Weyer, and Matteo Zignol, on behalf of the Working Group on MDR-TB of the Stop TB Partnership Background Summary Points Tuberculosis (TB) remains a significant global health problem, responsible for an estimated 1.7 million deaths per year worldwide [1]. Resistance to anti-tuberculosis drugs is an important threat to tuberculosis control. The risk of treatment failure and death with standard short-course chemotherapy is highest with resistance to both isoniazid and rifampicin (multidrug-resistant tuberculosis, or MDR- TB; see Glossary) [2]. Drug-resistant tuberculosis is “human- made”: it results from treatment with inadequate drugs or drug regimens, improper case management, and preventable transmission. Its presence generally reflects weak tuberculosis control in the past or present. Between 1994–2007, resistance to any first-line drugs among new tuberculosis cases was reported from 127 settings included in the Global Project on Anti-Tuberculosis Drug Resistance Surveillance, with a median prevalence of 17% [3]. The total number of MDR- TB cases estimated to have occurred worldwide in 2006 was 489,139, or 4.8% of all TB cases. [3]. sè 4HEè7ORLDè(EALTHè/RGANIZATIONèCALLSèFORèMASSIVEèSCALE UPèOFè programmatic management of drug-resistant tuberculosis in resource-limited settings. sè 3EVERALèTECHNICALèANDèOPERATIONALèBARRIERSèIMPEDEèTHEè achievement of this scale-up. sè !èRESEARCHèAGENDAèDEVELOPEDèBYèTHEè3TOPè4è0ARTNERSHIPè identifies the most important barriers and prioritizes the research questions to be addressed in order to overcome these barriers. sè 2ESEARCHèPRIORITIESèINCLUDEèNEWèANDèIMPROVEDèTOOLSèFORèDRUGè resistance testing; clinical trials of simplified and shorter second-line treatment reg