ABSTRACT
Rapid diagnostics, newer drugs, repurposed medications, and shorter regimens have radically altered the landscape for treating rifampicin-resistant TB (RR-TB) and multidrug-resistant TB (MDR-TB). There are multiple ongoing clinical trials aiming to build a robust evidence base to guide RR/MDR-TB treatment, and both observational studies and programmatic data have contributed to advancing the treatment field. In December 2019, the WHO issued their second 'Rapid Communication´ related to RR-TB management. This reiterated their prior recommendation that a majority of people with RR/MDR-TB receive all-oral treatment regimens, and now allow for specific shorter duration regimens to be used programmatically as well. Many TB programs need clinical advice as they seek to roll out such regimens in their specific setting. In this Perspective, we highlight our early experiences and lessons learned from working with National TB Programs, adult and pediatric clinicians and civil society, in optimizing treatment of RR/MDR-TB, using shorter, highly-effective, oral regimens for the majority of people with RR/MDR-TB.
Subject(s)
Rifampin , Tuberculosis, Multidrug-Resistant , Adult , Antitubercular Agents/therapeutic use , Child , Clinical Protocols , Humans , Rifampin/therapeutic use , Time Factors , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/drug therapyABSTRACT
INTRODUCTION: The 2008 UK National Guidelines for HIV testing were designed in order to decrease the proportion of people living with undiagnosed HIV infection. AIMS: Two audits were conducted. The aim of Audit 1 was to determine the proportion of current medical inpatients with an indicator condition that had been tested for HIV. Audit 2 aimed to identify missed opportunities for testing prior to diagnosis among newly diagnosed individuals with HIV. METHODS: Audit 1 involved a case note review looking for indicator conditions and HIV testing of all inpatients. Audit 2 analysed the hospital case notes of all new Lanarkshire HIV patients in 2010 for previous missed diagnostic opportunities. RESULTS: In Audit 1, 36% (63/174) of medical inpatients had a current indicator condition. Of the total population, 1.7% (3/174) had what would be an AIDS-defining condition if they had a positive HIV test. However, only 11% (7/63) of individuals were appropriately HIV tested. For Audit 2, 64% (9/14) of newly diagnosed individuals had previous missed opportunities for diagnosis. CONCLUSION: Increased education of clinical staff around testing guidelines is needed, as we have demonstrated that the 2008 guidelines are not being adhered to.
