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Arakelyan S, Karat AS, Jones ASK, Vidal N, Stagg HR, Darvell M, Horne R, Lipman MCI, Kielmann K. Relational Dynamics of Treatment Behavior Among Individuals with Tuberculosis in High-Income Countries: A Scoping Review. Patient Prefer Adherence 2021; 15:2137-2154. [PMID: 34584407 PMCID: PMC8464367 DOI: 10.2147/ppa.s313633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/18/2021] [Indexed: 12/28/2022] Open
Abstract
Although tuberculosis (TB) incidence has significantly declined in high-income, low-incidence (HILI) countries, challenges remain in managing TB in vulnerable populations who may struggle to stay on anti-TB treatment (ATT). Factors associated with non-adherence to ATT are well documented; however, adherence is often narrowly conceived as a fixed binary variable that places emphasis on individual agency and the act of taking medicines, rather than on the demands of being on treatment more broadly. Further, the mechanisms through which documented factors act upon the experience of being on treatment are poorly understood. Adopting a relational approach that emphasizes the embeddedness of individuals within dynamic social, structural, and health systems contexts, this scoping review aims to synthesize qualitative evidence on experiences of being on ATT and mechanisms through which socio-ecological factors influence adherence in HILI countries. Six electronic databases were searched for peer-reviewed literature published in English between January 1990 and May 2020. Additional studies were obtained by searching references of included studies. Narrative synthesis was used to analyze qualitative data extracted from included studies. Of 28 included studies, the majority (86%) reported on health systems factors, followed by personal characteristics (82%), structural influences (61%), social factors (57%), and treatment-related factors (50%). Included studies highlighted three points that underpin a relational approach to ATT behavior: 1) individual motivation and capacity to take ATT is dynamic and intertwined with, rather than separate from, social, health systems, and structural factors; 2) individuals' pre-existing experiences of health-seeking influence their views on treatment and their ability to commit to long-term regular medicine-taking; and 3) social, cultural, and political contexts play an important role in mediating how specific factors work to support or hinder ATT adherence behavior in different settings. Based on our analysis, we suggest that person-centered clinical management of tuberculosis should 1) acknowledge the ways in which ATT both disrupts and is managed within the everyday lives of individuals with TB; 2) appreciate that individuals' circumstances and the support and resources they can access may change over the course of treatment; and 3) display sensitivity towards context-specific social and cultural norms affecting individual and collective experiences of being on ATT.
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Affiliation(s)
- Stella Arakelyan
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Aaron S Karat
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Annie S K Jones
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Nicole Vidal
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Helen R Stagg
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Marcia Darvell
- UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Robert Horne
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Marc C I Lipman
- UCL Respiratory, Division of Medicine, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- Correspondence: Karina Kielmann Queen Margaret University, Queen Margaret University Way, Edinburgh, EH216UU, UKTel +44 131 474 0000 Email
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AlMatar M, Makky EA, AlMandeal H, Eker E, Kayar B, Var I, Köksal F. Does the Development of Vaccines Advance Solutions for Tuberculosis? Curr Mol Pharmacol 2018; 12:83-104. [PMID: 30474542 DOI: 10.2174/1874467212666181126151948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/06/2018] [Accepted: 10/17/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mycobacterium tuberculosis (Mtb) is considered as one of the most efficacious human pathogens. The global mortality rate of TB stands at approximately 2 million, while about 8 to 10 million active new cases are documented yearly. It is, therefore, a priority to develop vaccines that will prevent active TB. The vaccines currently used for the management of TB can only proffer a certain level of protection against meningitis, TB, and other forms of disseminated TB in children; however, their effectiveness against pulmonary TB varies and cannot provide life-long protective immunity. Based on these reasons, more efforts are channeled towards the development of new TB vaccines. During the development of TB vaccines, a major challenge has always been the lack of diversity in both the antigens contained in TB vaccines and the immune responses of the TB sufferers. Current efforts are channeled on widening both the range of antigens selection and the range of immune response elicited by the vaccines. The past two decades witnessed a significant progress in the development of TB vaccines; some of the discovered TB vaccines have recently even completed the third phase (phase III) of a clinical trial. OBJECTIVE The objectives of this article are to discuss the recent progress in the development of new vaccines against TB; to provide an insight on the mechanism of vaccine-mediated specific immune response stimulation, and to debate on the interaction between vaccines and global interventions to end TB.
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Affiliation(s)
- Manaf AlMatar
- Department of Biotechnology, Institute of Natural and Applied Sciences (Fen Bilimleri Enstitusu) Cukurova University, Adana, Turkey
| | - Essam A Makky
- Department of Biotechnology, Faculty of Industrial Sciences and Technology, Universiti Malaysia Pahang (UMP), Kuantan, Malaysia
| | - Husam AlMandeal
- Freiburg Universität, Moltkestraße 90, 76133 karlsruhe Augenklinik, Germany
| | - Emel Eker
- Department of Medical Microbiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Begüm Kayar
- Department of Medical Microbiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Işıl Var
- Department of Food Engineering, Agricultural Faculty, Cukurova University, Adana, Turkey
| | - Fatih Köksal
- Department of Medical Microbiology, Faculty of Medicine, Cukurova University, Adana, Turkey
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New 1-hydroxy-2-thiopyridine derivatives active against both replicating and dormant Mycobacterium tuberculosis. J Infect Chemother 2017; 23:794-797. [PMID: 28527650 DOI: 10.1016/j.jiac.2017.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/19/2017] [Accepted: 04/22/2017] [Indexed: 11/23/2022]
Abstract
Tuberculosis (TB) treatment is confounded by the range of metabolic states displayed by Mycobacterium tuberculosis, by the long duration required and by the increasing prevalence of drug-resistant strains. Latent TB infection is especially difficult to treat due to the phenotypic antibiotic resistance of non-replicating M. tuberculosis. Therefore, the development of new drugs effective against both active and latent TB infection is needed. New 1-hydroxy-2-thiopyridine derivatives were synthesized and found to be highly effective in vitro against both actively growing and dormant non-culturable M. tuberculosis. Such compounds are leads for the development of new drugs for all forms of TB including latent infection.
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de Vries SG, Cremers AL, Heuvelings CC, Greve PF, Visser BJ, Bélard S, Janssen S, Spijker R, Shaw B, Hill RA, Zumla A, van der Werf MJ, Sandgren A, Grobusch MP. Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature. THE LANCET. INFECTIOUS DISEASES 2017; 17:e128-e143. [PMID: 28291721 DOI: 10.1016/s1473-3099(16)30531-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 10/11/2016] [Accepted: 11/03/2016] [Indexed: 01/25/2023]
Abstract
Tuberculosis disproportionately affects hard-to-reach populations, such as homeless people, migrants, refugees, prisoners, or drug users. These people often face challenges in accessing quality health care. We did a systematic review of the qualitative literature to identify barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by people from hard-to-reach populations in all European Union (EU), European Economic Area, EU candidate, and Organisation for Economic Co-operation and Development countries. The 12 studies included in this review mainly focused on migrants. Views on perceived susceptibility to and severity of tuberculosis varied widely and included many misconceptions. Stigma and challenges regarding access to health care were identified as barriers to tuberculosis diagnosis and treatment uptake, whereas support from nurses, family, and friends was a facilitator for treatment adherence. Further studies are required to identify barriers and facilitators to the improved identification and management of tuberculosis in hard-to-reach populations to inform recommendations for more effective tuberculosis control programmes.
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Affiliation(s)
- Sophia G de Vries
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anne L Cremers
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Charlotte C Heuvelings
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Patrick F Greve
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Benjamin J Visser
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Sabine Bélard
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Saskia Janssen
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - René Spijker
- Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Beth Shaw
- National Institute for Health and Care Excellence, Piccadilly Plaza, Manchester, UK
| | - Ruaraidh A Hill
- National Institute for Health and Care Excellence, Piccadilly Plaza, Manchester, UK; Health Services Research, University of Liverpool, Liverpool, UK
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | | | - Andreas Sandgren
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Vecchio AL, Bocchino M, Lancella L, Gabiano C, Garazzino S, Scotto R, Raffaldi I, Assante LR, Villani A, Esposito S, Guarino A. Indications to Hospital Admission and Isolation of Children With Possible or Defined Tuberculosis: Systematic Review and Proposed Recommendations for Pediatric Patients Living in Developed Countries. [Corrected]. Medicine (Baltimore) 2015; 94:e2045. [PMID: 26683914 PMCID: PMC5058886 DOI: 10.1097/md.0000000000002045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Tuberculosis (TB) is a re-emerging health problem in developed countries. This paper is part of large guidelines on the global management of TB in children, by a group of scientific societies. It describes the indications to hospitalization of children with suspected or diagnosed TB, the isolation measures, hospital discharge, and re-admission into the community. Using the Consensus Conference method, relevant publications in English were identified by means of a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception until 31 December 2014. Available data on indications to hospitalization were mainly indirect and largely derived from observational studies. They include: (1) host-related risk factors, the main being age <12 months, immune deficiencies, and malnutrition; (2) TB-related clinical conditions that resemble those of pneumonia but also include drug-resistance; and (3) social and logistic conditions. The latter are based on opinion and depend on local conditions. Analysis of the literature showed that patients hospitalized with suspected pulmonary TB should be put in precautionary respiratory isolation regardless of their age while they await diagnosis. The general conditions for re-admission into the community are at least 14 days of effective treatment and negative microscopic tests of 3 consecutive samples in previously microscopically positive patients. This is the first paper that provides indications to hospitalization of children with TB. Most recommendations are generally applicable in all developed countries. Some might need an adaptation to local setting, epidemiological, parameters, and availability of specific health-care facilities.
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Affiliation(s)
- Andrea Lo Vecchio
- From the Section of Pediatrics, Department of Translational Medical Science, Federico II University of Naples, Naples, Italy (ALV, RS, AG); Pneumology Unit, Federico II University of Naples, Naples, Italy (MB, LRA); Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy (LL, AV); Pediatric Infectious Diseases Unit, Regina Margherita Hospital, University of Turin, Turin, Italy (CG, SG, IR); and Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (SE)
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Lönnroth K, Migliori GB, Abubakar I, D'Ambrosio L, de Vries G, Diel R, Douglas P, Falzon D, Gaudreau MA, Goletti D, González Ochoa ER, LoBue P, Matteelli A, Njoo H, Solovic I, Story A, Tayeb T, van der Werf MJ, Weil D, Zellweger JP, Abdel Aziz M, Al Lawati MR, Aliberti S, Arrazola de Oñate W, Barreira D, Bhatia V, Blasi F, Bloom A, Bruchfeld J, Castelli F, Centis R, Chemtob D, Cirillo DM, Colorado A, Dadu A, Dahle UR, De Paoli L, Dias HM, Duarte R, Fattorini L, Gaga M, Getahun H, Glaziou P, Goguadze L, del Granado M, Haas W, Järvinen A, Kwon GY, Mosca D, Nahid P, Nishikiori N, Noguer I, O'Donnell J, Pace-Asciak A, Pompa MG, Popescu GG, Robalo Cordeiro C, Rønning K, Ruhwald M, Sculier JP, Simunović A, Smith-Palmer A, Sotgiu G, Sulis G, Torres-Duque CA, Umeki K, Uplekar M, van Weezenbeek C, Vasankari T, Vitillo RJ, Voniatis C, Wanlin M, Raviglione MC. Towards tuberculosis elimination: an action framework for low-incidence countries. Eur Respir J 2015; 45:928-52. [PMID: 25792630 PMCID: PMC4391660 DOI: 10.1183/09031936.00214014] [Citation(s) in RCA: 530] [Impact Index Per Article: 58.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/02/2015] [Indexed: 12/31/2022]
Abstract
This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.
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Affiliation(s)
- Knut Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland
- Both authors contributed equally
| | - Giovanni Battista Migliori
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy
- Both authors contributed equally
| | - Ibrahim Abubakar
- TB Section, University College London and Public Health England, London, UK
| | - Lia D'Ambrosio
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy
| | | | - Roland Diel
- University Hospital Schleswig Holstein, Institute for Epidemiology, Kiel, Germany
| | - Paul Douglas
- Global Health Borders Refugee and Onshore Services, Dept of Immigration and Border Protection, Sydney, Australia
| | - Dennis Falzon
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Marc-Andre Gaudreau
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Montreal, QC, Canada
| | - Delia Goletti
- National Institute for Infectious Diseases, Rome, Italy
| | - Edilberto R. González Ochoa
- Research and Surveillance Group on TB, Leprosy and ARI, Epidemiology Board, Institute of Tropical Medicine “Pedro Kourí”, Havana, Cuba
| | - Philip LoBue
- Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Howard Njoo
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Montreal, QC, Canada
| | - Ivan Solovic
- TB Dept, National Institute for TB, Respiratory Diseases and Thoracic Surgery, Vysne Hagy, Catholic University, Ružomberok, Slovakia
| | | | - Tamara Tayeb
- National TB Control Programme, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Diana Weil
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | - Stefano Aliberti
- Università degli Studi di Milano – Bicocca, UO Clinica Pneumologica, AO San Gerardo, Monza, Italy
| | | | | | - Vineet Bhatia
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Francesco Blasi
- Dipartimento Fisiopatologia Medico-Chirurgica e dei Trapianti, University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy
| | - Amy Bloom
- US Agency for International Development, Washington, DC, USA
| | - Judith Bruchfeld
- Unit of Infectious Diseases, Institution of Medicine, Karolinska Institute Solna and Karolinska University Hospital, Stockholm, Sweden
| | | | - Rosella Centis
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy
| | | | | | | | - Andrei Dadu
- TB and M/XDR-TB Control Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Ulf R. Dahle
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Hannah M. Dias
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Mina Gaga
- National Referral Centre for Mycobacteria, Athens Chest Hospital, Ministry of Health, Athens, Greece
| | | | - Philippe Glaziou
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Lasha Goguadze
- International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | | | - Walter Haas
- Dept of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Asko Järvinen
- Finnish Lung Health Association, Helsinki, Finland
- Helsinki University Central Hospital, Division of Infectious Diseases, Helsinki, Finland
| | - Geun-Yong Kwon
- Korea Centers for Disease Control and Prevention (KCDC), Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Davide Mosca
- International Organization for Migration, Geneva, Switzerland
| | - Payam Nahid
- University of California, San Francisco, CA, USA
- American Thoracic Society (ATS), New York, NY, USA
| | - Nobuyuki Nishikiori
- Stop TB and Leprosy Elimination, WHO Regional Office for the Western Pacific, Manila, Philippines
| | | | - Joan O'Donnell
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | | | | | | | | | | | | | | | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy
| | - Giorgia Sulis
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Carlos A. Torres-Duque
- Asociacion Latinoamericana de Torax (ALAT) - Fundacion Neumologica Colombiana, Bogota, Colombia
| | | | - Mukund Uplekar
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Maryse Wanlin
- Fonds des Affections Respiratoires (FARES), Brussels, Belgium
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Glass BD. Counterfeit drugs and medical devices in developing countries. Res Rep Trop Med 2014; 5:11-22. [PMID: 32669888 PMCID: PMC7337201 DOI: 10.2147/rrtm.s39354] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/23/2014] [Indexed: 11/24/2022] Open
Abstract
The World Health Organization has reported that counterfeit medicines potentially make up more than 50% of the global drug market, with a significant proportion of these fake products being encountered in developing countries. This occurrence is attributed to a lack of effective regulation and a weak enforcement capacity existing in these countries, with an increase in this trade resulting from the growing size and sophistication of drug counterfeiters. In addition, due to both cost and lack of availability of medicines, consumers in developing countries are more likely to seek out these inexpensive options. The World Health Organization is mindful of the impact of counterfeit drugs on consumer confidence in health care systems, health professionals, the supply chain, and genuine suppliers of medicines and medical devices. Antibiotics, antituberculosis drugs, and antimalarial and antiretroviral drugs are frequently targeted, with reports of 60% of the anti-infective drugs in Asia and Africa containing active pharmaceutical ingredients outside their pharmacopoeial limits. This has obvious public health implications of increasing drug resistance and negating all the efforts that have already gone into the provision of medicines to treat these life threatening conditions in the developing world. This review, while focusing on counterfeit medicines and medical devices in developing countries, will present information on their impact and how these issues can be addressed by regulation and control of the supply chain using technology appropriate to the developing world. The complexity of the problem will also be highlighted in terms of the definition of counterfeit and substandard medicines, including gray pharmaceuticals. Although this issue presents as a global public health problem, outcomes in developing countries where counterfeit drugs to treat malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome not only result in drug resistance, but a number of deaths from the untreated disease, is in stark contrast with the developed world, where lifestyle drugs such as sildenafil (Viagra®) are most commonly counterfeited.
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Affiliation(s)
- Beverley D Glass
- School of Pharmacy and Molecular Sciences, James Cook University, Townsville, QLD, Australia
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Rüütel K, Parker RD, Sobolev I, Loit HM. Tuberculosis knowledge among injecting drug users visiting syringe exchange programme in Tallinn, Estonia. Cent Eur J Public Health 2013; 20:248-51. [PMID: 23441387 DOI: 10.21101/cejph.a3802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of the current study was to describe tuberculosis (TB) knowledge, beliefs, and experience with TB services among injecting drug users. METHODS Participants for this anonymous, cross-sectional study were recruited from a community based syringe exchange programme in Tallinn, Estonia. A structured questionnaire was completed and included information on socio-demographics, health history, drug use, and knowledge about TB and HIV. RESULTS The study included 407 people (79% male, mean age 27.9 years, mean injection drug use 9.4 years). 32.9% of participants reported HIV infection and 1.7% lifetime history of TB. 26.4% participants (n=106) reported symptoms suggestive of TB. 93% of participants recognized correctly that TB is air-borne infection and 91% that HIV is a risk factor for TB. Only 40% of the participants knew that TB diagnostics and treatment in Estonia are free of charge for everybody and 58% reported they knew where to get health care services in case they suspected that they had TB. TB transmission and treatment adherence knowledge was better among those in contact with either health care or harm reduction services, e.g the community based syringe exchange programme. CONCLUSION Similar to HIV services, TB prevention and education should be integrated into harm reduction and drug treatment programmes to facilitate early diagnosis and treatment of TB among injecting drug users.
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Affiliation(s)
- Kristi Rüütel
- National Institute for Health Development, Tallinn, Estonia.
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Importance of the genetic diversity within the Mycobacterium tuberculosis complex for the development of novel antibiotics and diagnostic tests of drug resistance. Antimicrob Agents Chemother 2012; 56:6080-7. [PMID: 23006760 DOI: 10.1128/aac.01641-12] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite being genetically monomorphic, the limited genetic diversity within the Mycobacterium tuberculosis complex (MTBC) has practical consequences for molecular methods for drug susceptibility testing and for the use of current antibiotics and those in clinical trials. It renders some representatives of MTBC intrinsically resistant against one or multiple antibiotics and affects the spectrum and consequences of resistance mutations selected for during treatment. Moreover, neutral or silent changes within genes responsible for drug resistance can cause false-positive results with hybridization-based assays, which have been recently introduced to replace slower phenotypic methods. We discuss the consequences of these findings and propose concrete steps to rigorously assess the genetic diversity of MTBC to support ongoing clinical trials.
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Affiliation(s)
- Ibrahim Abubakar
- Tuberculosis Section, Health Protection Agency, London NW9 5EQ, UK.
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11
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Quinonoid and phenazine compounds: Synthesis and evaluation against H37Rv, rifampicin and isoniazid-resistance strains of Mycobacterium tuberculosis. Eur J Med Chem 2011; 46:4521-9. [DOI: 10.1016/j.ejmech.2011.07.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/06/2011] [Accepted: 07/15/2011] [Indexed: 01/12/2023]
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Abstract
PURPOSE OF REVIEW Tuberculosis (TB) remains a global emergency and continues to kill 1.7 million people globally each year. Drug-resistant TB is now well established throughout the world and most TB patients are not being screened for drug resistance due to lack of laboratory resources and rapid accurate point-of-care tests. Accurate and rapid diagnosis of TB and drug-resistant TB is of paramount importance in establishing appropriate clinical management and infection control measures. During the past decade, there have been significant advances in diagnostic technologies for TB and drug-resistant TB. The purpose of this article is to review the current data, recommendations and evidence base for these tests. RECENT FINDINGS Second-line drug susceptibility testing (DST) is complex and expensive. Automated liquid culture systems and molecular line probe assays are recommended by the WHO as the current 'gold standard' for first-line DST. Liquid culture DST for aminoglycosides, polypeptides and fluoroquinolones has been shown to have relatively good reliability and reproducibility for diagnosis of extensively drug-resistant TB; however, DST for other second-line drugs (ethionamide, prothionamide, cycloserine, terizidone, para-aminosalicylic acid, clofazimine, amoxicillin-clavulanate, clarithromycin, linezolid) is not recommended. Automated liquid culture systems are currently recommended by the WHO as the 'gold standard' for second-line DST. SUMMARY In this review, we describe the phenotypic and genotypic methods currently available for the diagnosis of TB and drug-resistant forms of Mycobacterium tuberculosis and discuss future prospects for TB diagnostics. Current technologies for the detection of drug resistant M. tuberculosis vary greatly in terms of turnaround time, cost and complexity. Ultimately, the 'holy grail' diagnostic for TB must fulfil all technical specifications for a good point-of-care test, screen for drug resistance concurrently and be adaptable to the various health system levels and to countries with diverse economic status and TB burden.
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Wisterowicz K, Gobis K, Foks H, Augustynowicz-Kopeć E. The synthesis and tuberculostatic activity of benzenesulfonohydrazide derivatives. HETEROATOM CHEMISTRY 2011. [DOI: 10.1002/hc.20743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kontsevaya IS, Nikolayevsky VV, Balabanova YM. Molecular epidemiology of tuberculosis: Objectives, methods, and prospects. MOLECULAR GENETICS MICROBIOLOGY AND VIROLOGY 2011. [DOI: 10.3103/s0891416811010034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pandit P, Tiwari S. Recent advances in the chemotherapy of tuberculosis. INDIAN JOURNAL OF RHEUMATOLOGY 2011. [DOI: 10.1016/s0973-3698(11)60039-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Fernandez Fabrellas E, Lucas Ramos PD. III Foro Nacional de Neumologos en Formacion. La formacion desde la participacion. Arch Bronconeumol 2011; 47 Suppl 8:1-2. [DOI: 10.1016/s0300-2896(11)70058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Reliable and relevant research can help to improve tuberculosis control worldwide. In recent years, various organisations have assessed research needs and proposed priorities for tuberculosis. We summarise existing priority statements and assess the rigour of the methods used to generate them. We found 33 documents that specifically outline priorities in tuberculosis research. The top priority areas were drug development (28 articles), diagnosis and diagnostic tests (27), epidemiology (20), health services research (16), basic research (13), and vaccine development and use (13). The most focused questions were on the treatment and prevention of multidrug-resistant tuberculosis in people co-infected with HIV. Methods used to identify these priorities were varied. Improvements can be made to ensure the process is more rigorous and transparent, and to use existing research or systematic reviews more often. WHO, Stop TB Partnership, and other organisations could adopt an incremental process of priority development, building on the existing knowledge base.
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