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Ensuring that the diagnosis of tuberculosis accelerates progress towards the Millennium Development Goals

Hanson, Christy and Sotgiu, Giovanni and Loddenkemper, Robert (2014) Ensuring that the diagnosis of tuberculosis accelerates progress towards the Millennium Development Goals. European Respiratory Journal, Vol. 44 (1), p. 1-4. ISSN 0903-1936. eISSN 1399-3003. Article.

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DOI: 10.1183/09031936.00028514

Abstract

Global tuberculosis control has been riding a wave of progress over the past decade. Mortality and incidence are now falling in all six World Health Organization (WHO) regions and the tuberculosis-related targets of the Millennium Development Goals now seem more reachable. This progress reflects important momentum on many fronts, from more systematic community engagement to increased funding availability. Improvements in tuberculosis case detection have been greatly facilitated by the introduction of new diagnostic technologies and approaches. These novel methods are beginning to address clinical, public health and technological challenges, such as diagnosing tuberculosis in people living with HIV, as well as patient barriers to accessing sophisticated technologies and diagnostic results. Prior to 2007, no new diagnostic technologies had been endorsed by WHO in decades. However, in the past 5 years, WHO has evaluated and endorsed six diagnostic technologies and methods. It has refined its specifications for sputum collection and case identification using smear microscopy, reducing the burden on patients and laboratory technicians. It has proposed diagnostic algorithms to streamline the concurrent availability of various technologies and to improve the sensitivity of screening of people living with HIV. In 2011, WHO went so far as to issue negative recommendations on serodiagnostic tests and interferon-c release assays for high-incidence countries], steering national tuberculosis programmes (NTPs) away from diagnostic technologies not yet refined enough to warrant a change in practice.
Two articles in a recent issue of the European Respiratory Journal focused on the most recently WHOendorsed diagnostic technology, the Xpert MTB/RIF system (Cepheid, Sunnyvale, CA, USA). This automated real-time nucleic acid amplification technology was initially recommended in 2010 as a rapid diagnostic test for tuberculosis and rifampicin resistance, and is suitable for use in peripheral as well as higher level laboratories. In its 2013 report, WHO noted that by end of June 2013, 1402 machines and 3.2 million cartridges had been purchased in 88 countries; 94 000 multidrug-resistant (MDR) TB cases were diagnosed (84 000 were culture confirmed and 10 000 were identified using the rapid technique).The aforementioned articles published in the European Respiratory Journal summarise the rapid roll-out process, and provide one of the most robust cost analyses to date for Xpert MTB/RIF. These timely reviews and economic analyses can inform efforts to retool NTPs as new drugs, diagnostics and vaccines become available.

Item Type:Article
ID Code:10112
Status:Published
Refereed:Yes
Uncontrolled Keywords:Multidrug-resistant (MDR) TB cases, Millennium Development Goals (MDG), TB
Subjects:Area 06 - Scienze mediche > MED/01 Statistica medica
Divisions:002 Altri enti e centri di ricerca del Nord Sardegna > AOU -Azienda Ospedaliero Universitaria, Sassari
001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Scienze Biomediche
Publisher:European Respiratory Society Journals
ISSN:0903-1936
eISSN:1399-3003
Copyright Holders:@ ERS publications
Deposited On:18 Sep 2014 13:20

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