Control of drug-resistant tuberculosis

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Abstract

Drug-resistant tuberculosis is a global problem, but the necessity and quality of intervention should be assessed by country since the causes of drug resistance, and thus the appropriate intervention strategies, may vary considerably between countries. An analysis of the development and spread of drug-resistant tuberculosis is presented and the respective roles of import of the disease and of HIV are discussed. A definition of inadequate treatment and a systematic approach to the quantitative and qualitative aspects of the drug resistance problem is proposed. The ‘treatment delivery process’ (TDP) is introduced as a diagnostic tool to analyse the causes of secondary (or acquired) resistance in a specific area. Intervention strategies should be based on the evaluation of this TDP. Intervention strategies and general aspects of their implementation are discussed.

Résumé

La tuberculose résistante aux médications est un problème mondial, mais la nécessité et la qualité des interventions devraient être évaluées selon le pays, puisque les causes de résistance, et donc les stratégies d'intervention appropriées, peuvent varier considérablement selon les pays. Une analyse du développement et de l'extension de la tuberculose résistante est présentée et les rôles respectifs de l'importation de la maladie et du virus de l'immunodéficience humaine (VIH) sont discutés. Une définition d'un traitement inadéquat et une approche systématique des aspects quantitatifs et qualitatifs du problème de la résistance aux antibiotiques sont proposées. La ‘procédure de délivrance du traitement’ (TDP) est présentée comme un outil diagnostique afin d'analyser les causes d'une résistance secondaire (ou acquise) dans un domaine spécifique. Les stratégies d'intervention devraient être basées sur l'évaluation de ce TDP. Ces stratégies et les aspects généraux de leur réalisation sont discutés.

Resumen

El problema de la tuberculosis resistente a los medicamentos es mundial, pero la necesidad y el tipo de intervención debe ser evaluado para cada país, dado que las causas de la resistencia y en consecuencia las estrategias de intervención adecuadas pueden variar considerablemente entre los países. Se presenta un análisis del desarrollo y de la extensión de la tuberculosis resistente a los medicamentos y se discute el problema de la resistencia en relación con la importación de la tuberculosis y con la infección VIH. Se propone una definición de tratamiento inadecuado y un enfoque sistemático de los aspectos cuantitativos y cualitativos del problema de la resistencia a los medicamentos. Se introduce el concepto de ‘proceso de entrega de medicamentos’ (TDP) como una herramienta diagnóstica para analizar las causas de la resistencia secundaria (o adquirida) en un área especifica. Las estrategias de intervención deben basarse en la evaluación de este TDP. Se discuten estrategias de intervención y aspectos generales de su aplicación.

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