Currently Skimming:
3 Surveillance and Tracking of Drug-Resistant TB
3 Surveillance and Tracking of Drug-Resistant TB
Pages 21-30
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From page 21... ...
The first section reviews the use of genetic fingerprinting methodologies to understand the genotype and physiology of the various drug-resistant TB strains found in South Africa. The second section describes a clinical screening tool that has been developed to intensify TB case finding.
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From page 22... ...
, the increase in drugresistant TB in the Western Cape Province was driven by a small number of specific strains. The implication is that the current TB control program is unable to prevent ongoing transmission of these highly resistant strains.
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From page 23... ...
The discriminatory power of the DNA fingerprinting method can be improved by sequencing of the target genes conferring drug resistance. Using this approach, Warren and his colleagues showed that MDR TB strains with associated pyrazinamide and ethambutol resistance are spreading and that most XDR TB is acquired.
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From page 24... ...
Finally, Warren showed that pre-XDR and XDR TB strains are moving between provinces, emphasizing the need for rigorous TB control in both the Eastern and Western Capes. INTENSIFIED TB CASE FINDING3 According to Verkuijl, the South African national guidelines recommend a three-tiered approach to establishing collaborative TB−HIV activities.
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From page 25... ...
This feature helps prompt the clinician to monitor the clinical response to TB treatment and can assist in identifying patients not responding to first-line treatment. This integrated screening tool provides for quality and continuity of care through • screening for active TB at every visit for patients enrolled in HIV care (who are not yet eligible for antiretroviral therapy)
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From page 26... ...
According to Verkuijl, lessons learned include the following: • A TB screening questionnaire integrated into a comprehensive HIV clinical record reminds clinicians to "think TB" at all times. • The ACR facilitates effective monitoring of TB screening among HIV patients at enrollment and subsequent visits.
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From page 27... ...
. More specifically, it has stated that "the critical lack of TB laboratory capacity constitutes a global crisis, requiring a paradigm shift in providing laboratory policy guidance, quality assurance, and knowledge creation within a global and integrated laboratory network." Nordenberg identified some of the issues related to the urgent information needs of TB laboratories: • Laboratory capacity is desperately insufficient.
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From page 28... ...
Nordenberg noted that, although WHO's New Diagnostics Working Group of the Stop TB Partnership has developed an effective workflow model for the development of new diagnostic tests to support TB control programs globally, this model lacks reference to the necessary data and information supply chains that are critical to optimize the public health impact of emerging TB diagnostics (WHO, 2009b)
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From page 29... ...
Once TB information supply chains have been designed and implemented, it will be possible to develop models that can quantify the public health impact of suboptimal information supply chains (e.g., data on missed diagnoses,
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From page 30... ...
. These data should help make the development of effective TB information supply chains a priority along with the development of new therapeutics, new diagnostics, improved infection control practices, and other critical components of an effective TB control program.
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