The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa
Global and Local Challenges and Solutions
SUMMARY OF A JOINT WORKSHOP by the Institute of Medicine and the Academy of Science of South Africa
Steve Olson, Yeonwoo Lebovitz, and Anne Claiborne, Rapporteurs
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
and
ACADEMY OF SCIENCE OF SOUTH AFRICA
THE NATIONAL ACADEMIES PRESS
Washington D.C.
www.nap.edu
THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W.
Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This study was supported by Department of Health and Human Services (Contract Nos. N01-OD-4-2139 and 223001003T), the U.S. State Department (S-LMAQM-08-GR-071), the American Diabetes Association, the American Society for Microbiology, Amgen Inc., the Association of American Medical Colleges, Bristol-Myers Squibb, the Burroughs Wellcome Fund, Celtic Therapeutics, LLLP, the Critical Path Institute, the Doris Duke Charitable Foundation, Eli Lilly & Co., GlaxoSmithKline, Howard Hughes Medical Institute, Johnson & Johnson, Novartis Pharmaceuticals Corporation, and Pfizer, Inc. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
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Suggested citation: IOM (Institute of Medicine). 2011. The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions: Summary of a Joint Workshop. Washington, DC: The National Academies Press.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.
PLANNING COMMITTEE FOR THE WORKSHOP ON THE EMERGING THREAT OF DRUG-RESISTANT TUBERCULOSIS IN SOUTHERN AFRICA: GLOBAL AND LOCAL CHALLENGES AND SOLUTIONS1
GAIL H. CASSELL (Chair),
Eli Lilly and Company (retired)
DONALD M. BERWICK,2
Centers for Medicare and Medicaid Services
BARRY R. BLOOM,
Harvard School of Public Health
ENRIQUETA C. BOND, QE Philanthropic Advisors
RICHARD E. CHAISSON,
Johns Hopkins University
PAUL FARMER,
Partners In Health, Harvard Medical School
ANTHONY FAUCI,
National Institute of Allergy and Infectious Diseases
GARY FILERMAN,
Atlas Research
GERALD H. FRIEDLAND,
Yale University School of Medicine
ELAINE K. GALLIN,3 QE Philanthropic Advisors
STEPHEN C. GROFT,
Office of Rare Disease Research, National Institutes of Health
VICTORIA MCGOVERN,
Burroughs Wellcome Fund
NANCY SUNG,
Burroughs Wellcome Fund
ROY WIDDUS,
Global Forum for Health Research
IOM Staff
ANNE B. CLAIBORNE, Director
REBECCA A. ENGLISH, Research Associate
YEONWOO LEBOVITZ, Program Associate
GENEA S. VINCENT, Senior Program Assistant (until November 1, 2010)
RONA BRIERE, Consulting Editor
South Africa Liaison Planning Committee Members
GAVIN J. CHURCHYARD,
Aurum Institute for Health Research
HOOSEN COOVADIA,
Nelson Mandela School of Medicine, University of KwaZulu-Natal
SALIM S. ABDOOL KARIM,
University of KwaZulu-Natal, Centre for the AIDS Programme of Research in South Africa
A. WILLEM STURM,
Nelson Mandela School of Medicine, University of KwaZulu-Natal
MARTIE VAN DER WALT,
Medical Research Council of South Africa
PAUL VAN HELDEN,
Stellenbosch University
ROBIN WOOD,
Desmond Tutu HIV Centre, University of Cape Town
Academy of Science of South Africa Staff
ROSEANNE D. DIAB, Executive Officer
PHAKAMILE TRUTH MNGADI, Project Officer
NTHABISENG TAOLE, Project Manager
FORUM ON DRUG DISCOVERY, DEVELOPMENT, AND TRANSLATION1
Gail H. Cassell (Co-Chair),
Eli Lilly and Company (retired), Indiana
Jeffrey M. Drazen (Co-Chair),
New England Journal of Medicine, Massachusetts
Barbara Alving,
National Center for Research Resources, Maryland
Leslie Z. Benet,
University of California-San Francisco
Ann Bonham,
Association of American Medical Colleges, Washington, DC
Linda Brady,
National Institute of Mental Health, Maryland
Robert M. Califf,
Duke University Medical Center, North Carolina
Scott Campbell,
Foundation for the National Institutes of Health, Maryland
C. Thomas Caskey,
University of Texas-Houston Health Science Center
Peter B. Corr,
Celtic Therapeutics, LLLP, New York
James H. Doroshow,
National Cancer Institute, Maryland
Gary L. Filerman,
Atlas Research, Washington, DC
Garret A. FitzGerald,
University of Pennsylvania School of Medicine
Elaine K. Gallin,2 QE Philanthropic Advisors,
Maryland
Steven K. Galson,
Amgen Inc., California
Harry B. Greenberg,
Stanford University School of Medicine, California
Stephen Groft,
National Institutes of Health, Maryland
Annalisa Jenkins,
Bristol-Myers Squibb, New Jersey
Michael Katz,
March of Dimes Foundation, New York
Jack D. Keene,
Duke University Medical Center, North Carolina
Ronald L. Krall,
University of Pennsylvania
Freda Lewis-Hall,
Pfizer, Inc., New York
William D. Matthew,
National Institute of Neurological Disorders and Stroke, Maryland
Mark B. McClellan,
Brookings Institution, Washington, DC
Carol Mimura,
University of California-Berkeley
John Orloff,
Novartis Pharmaceuticals Corporation, New Jersey
Amy P. Patterson,
National Institutes of Health, Maryland
Janet Shoemaker,
American Society for Microbiology, Washington, DC
Ellen V. Sigal,
Friends of Cancer Research, Virginia
Nancy S. Sung,
Burroughs Wellcome Fund, North Carolina
Jorge A. Tavel,
National Institute of Allergy and Infectious Diseases, Maryland
Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report:
Enriqueta C. Bond, QE Philanthropic Advisors
Jerrold J. Ellner, Boston University School of Medicine, Boston Medical Center
Gerald Friedland, Yale School of Medicine
Salim S. Abdool Karim, University of KwaZulu-Natal, Center for the AIDS Programme of Research in South Africa (CAPRISA)
Salmaan Keshavjee, Harvard Medical School, Partners In Health
Although the reviewers listed above have provided many constructive comments and suggestions, they did not endorse the final draft of the report before its release. The review of this report was overseen by Melvin Worth. Appointed by the Institute of Medicine, he was responsible for making
Table, Figure, and Boxes
TABLE
4-1 |
Percentage of Health Care Workers Reporting Various Infection Control Measures, |
FIGURE
2-1 |
More than 75,000 new cases of MDR TB are estimated to have occurred in Africa in 2010, |
BOXES
1-1 |
The Nature of the Threat, |
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2-1 |
Problems of Dealing with Drug-Resistant TB in Mozambique, |
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2-2 |
Estimating the Contribution of TB to Mortality in South Africa, |
|||
5-1 |
Some Diagnostic Methods Currently in Use for TB, |
|||
6-1 |
CD4 Count as a Predictor of Mortality Among MDR and XDR TB Patients, |
|||
7-1 |
A Family Case Study Illustrating Issues in Pediatric MDR TB, |
Acronyms
ACME Automated Classification of Medical Entities
ACR adult clinical record
AIDS acquired immune deficiency syndrome
AIR Airborne Infection Research
ANRS Agency for AIDS Research (France)
ARASA AIDS and Rights Alliance for Southern Africa
ART antiretroviral treatment
ARV antiretroviral
ASADI African Science Academy Development Initiative
ASSAf Academy of Science of South Africa
BCG Bacillus Calmette-Guérin vaccine
C-DOTS Community-based Directly Observed Treatment Short Course
CAPRISA Center for the AIDS Programme of Research in South Africa
CD4 Cluster of Differentiation 4
CDC Centers for Disease Control and Prevention
CoSH Church of Scotland Hospital
CSIR Council for Scientific and Industrial Research
DNA deoxyribonucleic acid
DOTS Directly Observed Treatment Short Course
FIND Foundation for Innovative New Diagnostics
GFP green fluorescent proteins
GLC Green Light Committee
GLI Global Laboratory Initiative
GPS global positioning system
HIV human immunodeficiency virus
ICD-10 International Classification of Diseases, 10th revision
IFNg interferon-gamma
IOM Institute of Medicine
IRIS immune reconstitution inflammatory syndrome
ISTC International Standards for Tuberculosis Care
LAM lipoarabinomannan
LIPHE Laboratory Information for Public Health Excellence
LPA line probe assay
LRP luciferase reporter phage
M.tb. Mycobacterium tuberculosis
MDR TB multidrug-resistant tuberculosis
MGIT mycobacteria growth indicator tube
MRC Medical Research Council
NIAID National Institute of Allergy and Infectious Diseases
NIH National Institutes of Health
PCR polymerase chain reaction
PETTS Preserving Effective Tuberculosis Treatment with Second-line drugs study
QFT-GIT QuantiFERON-TB Gold In-Tube test
RNA ribonucleic acid
SAPiT Starting Antiretroviral therapy at three Points in Tuberculosis therapy study
TB tuberculosis
TCR T cell receptor
TDR TB totally drug-resistant tuberculosis
TF CARES Tugela Ferry Care and Research Collaboration