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El. knyga: Addressing the Threat of Drug-Resistant Tuberculosis: A Realistic Assessment of the Challenge: Workshop Summary

  • Formatas: 252 pages
  • Išleidimo metai: 07-Dec-2009
  • Leidėjas: National Academies Press
  • Kalba: eng
  • ISBN-13: 9780309148740
Kitos knygos pagal šią temą:
  • Formatas: 252 pages
  • Išleidimo metai: 07-Dec-2009
  • Leidėjas: National Academies Press
  • Kalba: eng
  • ISBN-13: 9780309148740
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Tuberculosis is one of the leading causes of death in the world today, with 4,500 people dying from the disease every day. Many cases of TB can be cured by available antibiotics, but some TB is resistant to multiple drugsa major and growing threat worldwide. The Institute of Medicine's Forum on Drug Discovery, Development, and Translation hosted a workshop on November 5, 2008, to address the mounting concern of drug-resistant TB. The session brought together a wide range of international experts to discuss what is known and not known about this growing threat, and to explore possible solutions.

Table of Contents



Front Matter Summary 1 Introduction 2 The Global Spread of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis 3 MDR TB Transmission, HIV Coinfection, and Transmission Control 4 Diagnosis 5 Infrastructure and Health Care Delivery Systems 6 Global Systems for the Purchase and Delivery of TB Drugs 7 Research on the Global Control of TB: Understanding the Role of Drugs, Vaccines, and Funding 8 Strategies for Confronting the Global MDR and XDR TB Crisis References Appendix A: Agenda Appendix B: Participant Biographies Appendix C: Partners In Health White Paper - Stemming the Tide of Multidrug-Resistant Tuberculosis: Major Barriers to Addressing the Growing Epidemic
ACRONYMS xv
SUMMARY 1
1 INTRODUCTION 15
Obstacles to Treatment,
16
Workshop Objectives,
17
Organization of This Report,
18
2 THE GLOBAL SPREAD OF MULTIDRUG-RESISTANT AND EXTENSIVELY DRUG-RESISTANT TUBERCULOSIS 19
Scope of the Problem,
19
Underreporting of MDR TB in Africa,
25
The Threat of Totally Drug-Resistant TB,
33
Importance of Better Data,
33
3 MDR TB TRANSMISSION, HIV COINFECTION, AND TRANSMISSION CONTROL 35
Coinfection with HIV,
35
Treatment,
36
Transmission of XDR TB,
37
Perspective from Russia,
43
Mitigating Transmission,
43
Implications for Health Care Workers,
49
4 DIAGNOSIS 51
Actual Need,
51
Diagnostic Quality,
53
Currently Available Diagnostics,
53
Point-of-Care (POC) Diagnostics,
54
5 INFRASTRUCTURE AND HEALTH CARE DELIVERY SYSTEMS 59
Vertical Versus Horizontal Programs,
59
Approaches to Addressing Infrastructure Problems,
62
Role of Information Technology,
63
6 GLOBAL SYSTEMS FOR THE PURCHASE AND DELIVERY OF TB DRUGS 67
Procurement Problems,
68
The Drug Quality Issue,
69
Need for Accurate Demand Forecasting,
73
7 RESEARCH ON THE GLOBAL CONTROL OF TB: UNDERSTANDING THE ROLE OF DRUGS, VACCINES, AND FUNDING 81
The Pipeline for New Drugs,
82
Probability of Success,
85
Economic Incentives for Drug Development,
93
8 STRATEGIES FOR CONFRONTING THE GLOBAL MDR AND XDR TB CRISIS 97
Recommendations Presented by Dr. Keshavjee,
97
Lessons Learned from the President's Emergency Plan for AIDS Relief (PEPFAR),
102
Policy Focus on Drug-Resistant Versus Non-Drug-Resistant TB,
104
The Level of Response,
105
Summary of Key Points,
107
Closing Remarks,
108
REFERENCES 109
APPENDIXES
A Agenda
113
B Participant Biographies
117
C Partners In Health White Paper—Stemming the Tide of Multidrug-Resistant Tuberculosis: Major Barriers to Addressing the Growing Epidemic
139