World Health Organization : Year 2000 ; Communicable Diseases and Emerging Infectious Diseases ; Tuberculosis, No. 2000.279: Guidelines for Establishing Dots-Plus Pilot Projects for the Management of Multidrug-Resistant Tuberculosis (MDR-TB)

By Nancy Binkin, Dr.

Book Id: WPLBN0000172286
Format Type: PDF eBook:
File Size: 0.1 MB
Reproduction Date: 2005

Title:	World Health Organization : Year 2000 ; Communicable Diseases and Emerging Infectious Diseases ; Tuberculosis, No. 2000.279: Guidelines for Establishing Dots-Plus Pilot Projects for the Management of Multidrug-Resistant Tuberculosis (MDR-TB)
Author:	Nancy Binkin, Dr.
Volume:
Language:	English
Subject:	Health., Public health, Wellness programs
Collections:	Medical Library Collection, World Health Collection
Historic Publication Date:
Publisher:	World Health Organization


Citation APA MLA Chicago Binkin, B. N. (n.d.). World Health Organization : Year 2000 ; Communicable Diseases and Emerging Infectious Diseases ; Tuberculosis, No. 2000.279. Retrieved from http://gutenberg.cc/

Description
Medical Reference Publication

Excerpt
INTRODUCTION Objectives of the Guidelines A high prevalence of MDR-TB is mostly due to poor TB case management under inappropriate programme conditions. Any intervention to treat and/or control MDRTB must place highest priority in correcting such errors within the national TB programme (NTP) or corresponding entity. As there is not yet a standardised DOTS-Plus strategy, projects currently being implemented or in the planning stages should be considered pilot projects and should be subject to rigorous quality assurance, monitoring and evaluation. Setting minimum standards for these pilot projects should ensure the following: protection of individual patients and communities; prevention of increasing trends of MDR-TB; and systematic collection of comparable data in order to develop an evidence-based approach for global policy recommendations for the management of MDR-TB. The Scientific Panel of the Working Group has prepared these Guidelines with two objectives. The first is to set criteria and technical standards before launching a DOTS-Plus pilot project to manage MDR-TB. The second is to provide an international standard for the structure and function of pilot projects. Adherence to these standards will enable such pilot projects to participate in a global pooled procurement of second-line anti-TB drugs. In addition, conformity with these standards will enable outcomes to be compared across pilot projects so that empirical evidence can guide the expansion of efforts to control MDR-TB. The overall aim is to preserve the integrity of TB control through an evidence-based approach to reduce the burden of MDR-TB.

Table of Contents
CONTENTS PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.1. Objectives of the Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.2. Magnitude of the MDR-TB Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.3. Prevention of MDR-TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 1.4. Basic Principles for the Management of MDR-TB . . . . . . . . . . . . . . . . . . . . . .10 1.5. Concept of DOTS-Plus for MDR-TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 1.6. Green Light Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 2. POLITICAL COMMITMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 3. COORDINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 3.1. Community Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 3.2. Local Health Systems/Services Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 3.3. National TB Programme Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 3.4. International Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 4. LABORATORY ASPECTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 5. TREATMENT STRATEGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 5.1. Provisos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 5.2. Individualised Treatment Regimen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 5.3. Standardised Treatment Regimen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 5.4. Management of Adverse Reactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 5.5. Outcome Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 6. INFORMATION SYSTEM AND DATA MANAGEMENT . . . . . . . . . . . . . . . . .27 6.1. Programme Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 6.2. Case Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 6.3. Programme Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 6.4. Programme Monitoring and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 6.5. Data Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Annex 1 Treatment Regimens Proposed by Harvard Medical School/Partners in Health in Three Districts of Lima, Peru . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Annex 2 Gene