TB-and-DOTS肺结核与点共46张课件

TBandDOTS肺结核与点31、别人笑我太疯癫，我笑他人看不穿。(名言网)32、我不想听失意者的哭泣，抱怨者的牢骚，这是羊群中的瘟疫，我不能被它传染。我要尽量避免绝望，辛勤耕耘，忍受苦楚。我一试再试，争取每天的成功，避免以失败收常在别人停滞不前时，我继续拼搏。33、如果惧怕前面跌宕的山岩，生命就永远只能是死水一潭。34、当你眼泪忍不住要流出来的时候，睁大眼睛，千万别眨眼!你会看到世界由清晰变模糊的全过程，心会在你泪水落下的那一刻变得清澈明晰。盐。注定要融化的，也许是用眼泪的方式。35、不要以为自己成功一次就可以了，也不要以为过去的光荣可以被永远肯定。TBandDOTS肺结核与点TBandDOTS肺结核与点31、别人笑我太疯癫，我笑他人看不穿。(名言网)32、我不想听失意者的哭泣，抱怨者的牢骚，这是羊群中的瘟疫，我不能被它传染。我要尽量避免绝望，辛勤耕耘，忍受苦楚。我一试再试，争取每天的成功，避免以失败收常在别人停滞不前时，我继续拼搏。33、如果惧怕前面跌宕的山岩，生命就永远只能是死水一潭。34、当你眼泪忍不住要流出来的时候，睁大眼睛，千万别眨眼!你会看到世界由清晰变模糊的全过程，心会在你泪水落下的那一刻变得清澈明晰。盐。注定要融化的，也许是用眼泪的方式。35、不要以为自己成功一次就可以了，也不要以为过去的光荣可以被永远肯定。TB:AGlobalEmergency1/3oftheworld(2billionpeople)infected1personinfected/secondresultingin>30millionnewinfections,8millionnewcasesLeftuntreated1/3die,1/3self-cure,1/3remaininfectiousTBkills1personevery10seconds=5000/day=2-3millioneachyear22HighBurdenCountriesIndiaChinaIndonesiaBangladeshPakistanNigeriaPhilippinesSouthAfricaEthiopiaVietnamRussianFederationCongoBrazilTanzaniaKenyaThailandMyanmarAfghanistanUgandaPeruZimbabweCambodiaTBandDOTS肺结核与点31、别人笑我太疯癫，我笑他1TB-and-DOTS肺结核与点共46张课件2TB-and-DOTS肺结核与点共46张课件3TB-and-DOTS肺结核与点共46张课件4TB-and-DOTS肺结核与点共46张课件5WhendoesTBinfection

becomedisease?MostlikelytooccurinfirsttwoyearsafterinfectionIfpersonbecomesimmunocompromisedHIVCancerChemotherapyPoorlycontrolleddiabetesmalnutritionWhendoesTBinfection

become6The5EssentialComponentsoftheDOTSStrategy

GovernmentcommitmenttoaNationalTBProgramPrioritytodetectinfectiouscasesbysputumsmearmicroscopyStandardizedregimensofshort-coursechemotherapy,givenunderdirectobservationfor,atleast,theintensivephaseRegular,uninterruptedsupplyofanti-TBmedsMonitoringsystemforprogramsupervisionandevaluationThe5EssentialComponentsof71.Political/AdministrativeCommitmentPerceptionofTBasapriorityproblemwithrealsolutionGovernmentacknowledgesimportanceofdiseasePubliccommitmenttoNationalTBProgram(NTP)Supportforpersonnel,training,transportation,drugs1.Political/AdministrativeCo82.AccurateDiagnosis=SputumMicroscopyIdentification/cureofinfectiouscases(smear+)ishighestpriorityofTBcontrolSmear+s4-20timesmoreinfectious;mayinfect10-15/year;morelikelytodieifuntreatedTimelyresultstoreducepotentialfortransmissionQualityassurance/training--nationalreferencelabiskey2.AccurateDiagnosis=SputumM9DiagnosisofpulmonaryTBCough3weeksAFBX3Broad-spectrumantibiotic10-14daysIfsymptomspersist,repeatAFBsmears,X-rayIfconsistentwithTBAnti-TBTreatmentIf1positive,X-rayandevaluation

If2/3positive:Anti-TBRxIf

negative:DiagnosisofpulmonaryTBCough10ChestX-ray(CXR)asDiagnosticToolNoCXRpatternistypicalManyTBcasesaremissed(10-15%culture+s)Manynon-TBcasesmisdiagnosed(40%diagnosedbyCXRalonedonothaveactiveTBPreviousMDtrainingemphasizedCXRasbestdiagnostictoolOftenreactiontopoor,inaccurate,orunavailablelabservicesChestX-ray(CXR)asDiagnosti11X-ray-basedevaluationcausesover-diagnosisofTBNTI,IndJTuberc,1974Over-diagnosisX-ray-basedevaluationcauses12MicroscopyisamorespecifictestthanX-rayforTBdiagnosisSpecificityMicroscopyisamorespecific133.AdequateSupplyofDrugsTreatmentrequiresregulardosesofcombinationregimensfor>6monthsIdentificationofanadequatesupplyofappropriatedrugsforpatientspriortoinitiationoftreatmentessentialIfregimensincomplete,realchanceofdevelopmentofdrug-resistantstrainswhicharehardorimpossibletocureRequirescontinuumofdrugmanagementservices:selection,

procurement,distribution,use.3.AdequateSupplyofDrugsTre144.DirectlyObservedTreatmentWhy?Manypatientsdon’ttakemedicinesregularly,evenifexcellenthealtheducationprovidedWho?Allpatients...impossibletopredictwhichpatientwilltakemedicine(1/3notadherent)What?ObserverwatchesandhelpspatientswallowtabletsWhere?Anywhere!(home,clinic,work,school,etc)Whodoesit?HCW,communityliaisons,teachers,Directobservationensurestreatmentforentirecoursewiththerightdrugs,intherightdoses,attherightintervals4.DirectlyObservedTreatment15DOTisnecessaryevenwhendrugsupplyensured

ChaulkCP.JAMA1998;279:943-8TreatmentSuccessDOTNoDOTDOTisnecessaryevenwhenChau16DOTprolongssurvivalofHIV-infectedTBpatients

SCCwithDOTSCCwithoutDOTDOTprolongssurvivalofSCCwi175.SystematicMonitoring/AccountabilityRecordingsystemissimpletouse,essential,integratedcomponentofDOTSenablingMonitoringofpatientoutcomesEvaluationofprogramperformanceAnalysisofepidemiologicdataIdentificationofareasforOREverylevelofhealthsystemaccountableforpatientdiagnosisandcure;“reportcard”TBRegister5.SystematicMonitoring/Accou18TBandHIV/AIDSHIVnegativelyimpactsTBandTBnegativelyimpactsHIVHIV+individualsinfectedwithTBare30xmorelikelytodevelopTBdiseaseTBisleadingcauseofdeathamongHIV+,accountingfor~40%ofAIDSdeathsHIVincreasestheprevalenceofactiveTBinHIV-andHIV+populationsTBandHIV/AIDSHIVnegatively19Multidrug-ResistantTB(MDRTB)DefinedasresistancetoINHandRIFCausedbyinconsistentorpartialtreatmentofsusceptibleTB(primary)Curerates<70%causetheepidemicanddrugresistancetoincreaseDrugsaremoretoxicandexpensive,andlesseffective;treatmentmoredifficult/expensive,andmorelikelyfatalindevelopingworldPoorlysupervised,incompletetreatmentisworsethannotreatmentatall:PreventionofMDRTBistheprimarystrategytoaddressMDRTBMultidrug-ResistantTB(MDRTB)20USAIDTBStrategySupportfortheSTOPTBInitiativeEstablishmentoffieldsites/programstoserveasmodelsforinnovativewide-scaleTBcontrolInvestigation/implementationofpotentialtechnologiesandmethodologiesforTBprophylaxis,diagnosis,andtreatmentSupportforsurveillancetomonitorTBtrendsandidentifyMDRTB

strainsbeforetheybecomewidespreadUSAIDTBStrategySupportfort21USAIDExpandedResponseContinuedinvestmentsinglobalandregionalpartnerships:supportfortheStopTBinitiativecontinuedworkwithotherUSGagenciesGlobalpartnershiptodevelopnewanti-TBdrugsGlobalDrugFacilityNewInternationalcoalitionoforganizationsandagenciesincludingKNCV,IUATLD,WHO,CDC,ALA/ATStoprovideTA/developTBexpertiseContinuedsupportforcoordinatedresearchtooptimizediagnosticsandtreatmentregimensUSAIDExpandedResponseContinu22USAIDExpandedResponseExpandedresearchinvestmentsrapidandsensitiveTBdiagnostictestsincreasefunding,workwithourpartnerstomobilizeeffortsandexpertiseofPHworkers,industry,academicresearchers,donors,otherpartnersinlab/ORcomponentsTargetcollaborativeeffortstodevelopcost-effectiveTBdrugsandcombinationtherapiesPotentialexpansiontovaccinedevelopmentUSAIDExpandedResponseExpande23USAIDExpandedResponseFocused,expandedprogramsinkeycountries,targetingcountriesofgreatestneed,definedbyTBburdencountrieswithhighHIV/AIDSprevalencecountriesatriskofescalatingMDRepidemicsUSAIDExpandedResponseFocused24TB-and-DOTS肺结核与点共46张课件25Partners/ImplementersCurrentWHO,CDC,Fogarty/NIH,IUATLD,GorgasInstitute,MSH/RPM,PATH,QAP,FHITBCTA(TBCoalitionforTechnicalAssistance)PotentialNGOs(MSF,DOW,MERLIN)Foundations,WorldBank,USModelCentersPartners/ImplementersCurrent26GlobalPrograms/MechanismsGlobal/BureauumbrellaagreementswithWHOandCDCMultipleagreementstoaddresstechnicalareas:RPM,PATH,TBCTANewinteragencyalliancesunderdevelopmentfordrugprocurement/management/developmentStandardindicatorsalreadydevelopedGlobalPrograms/MechanismsGlob27CommonHealthAssumptionsnotapplicabletoTBAccessisnecessarybutNOTsufficientDrugsServicesNoteveryhealthcenter/NGOsiteappropriateasTBcarecenterPoorprogramisworsethannoprogramatallCommonHealthAssumptionsnot28PrioritiesofTBControlMakesurethepersoncompletesTBtreatment!Donotcausedrugresistance;apoorTBprogramisworsethannoTBprogram!Treatingnon-pulmonarycasesandthoseinfectedwithoutactivediseaseareoflesserpublichealthimportancePrioritiesofTBControlMakes29WithTB,treatmentismorethantreatment,treatmentispreventionWithTB,treatmentismoretha30RoleofRifampicinNecessaryforshort-coursetreatmentEssentialforatleastfirst2monthsofregimensBactericidalforrapidlydividingandslow-growingorganismsPreventsemergenceofresistancetootherdrugsIntermittenttreatmentmoreeffectivethandailytreatmentinanimalmodel;equallyeffectiveinclinicaltrialsRoleofRifampicinNecessaryfo31RoleofIsoniazidMainstayofanti-TBtreatmentLifesavinginTBmeningitisBactericidalforrapidlydividingorganismsPreventsemergenceofresistancetootherdrugsIntermittenttreatmentmoreeffectivethandailytreatmentinanimalmodel;equallyeffectiveinclinicaltrialsSafeandeffectiveforpreventivetreatmentRoleofIsoniazidMainstayofa32DOTScanreducetheTBburdenAnnualpercentagedeclineinincidence/prevalenceDOTScanreducetheTBburdenA33TB:theleadingsingleinfectiouscauseofdeathinSEAsiaNumberofdeaths(1000s)DeathsfrominfectiousagentsinSouth-EastAsia34TB:theleadingsingleinfectiTBisaLeadingKillerofWomenDeathsamongwomenTBisaLeadingKillerofWome35DiagnosisofpulmonaryTB

PatientswithTBfeelillandseekcarepromptlyActivecasefindingisunnecessaryandunproductiveMicroscopyisappropriatetechnology,indicatinginfectiousness,riskofdeath,andpriorityfortreatmentX-rayisnon-specificforTBdiagnosisSerologicalandamplificationtechnologies(PCR,etc.)currentlyofnoprovenvalueinTBcontrolDiagnosisofpulmonaryTBPati36ProportionofpulmonaryTBpatientswithpositiveAFBsmears

010203040506070HIVNegativeEarlyHIVLateHIVAFBpositivityinTBpatientsProportionofpulmonaryTBpat37PrompttreatmentofinfectiouscasesreducesspreadofTBSmear-positivepatientsusuallyseekcareSmear-positivepatientsare4-20timesmoreinfectiousUntreated,asmear-positivepatientmayinfect10-15persons/yearSmear-positivepatientsaremuchmorelikelytodieifuntreatedRouillonA.Tubercle1976;57:275-99Prompttreatmentofinfectious38Severeandlesssevereformsofextra-pulmonaryTBSevereMeningitisLessSevereLymphnodesMiliaryPericarditisBone(excludingspine)BilateralorextensivepleuraleffusionSpinalIntestinalTB/HIV,AClinicalManual,WorldHealthOrganization1996Pleuraleffusion(unilateral)PeripheraljointSevereandlesssevereformso39RoleofPyrazinamideEssentialfor6-and8-monthregimensNobenefitifgiven>2monthsRelativelyineffectiveatpreventingemergenceofresistancetootherdrugsRoleofPyrazinamideEssential40Pyrazinamideessentialforfirsttwomonthsof6/8-monthtreatmentAmRevRespirDis1987;136:1339-42RelapsesPyrazinamideessentialforfir41RoleofEthambutol/StreptomycinPreventemergenceofresistancetootherdrugsgivenHastensputumconversionBacteriostaticorweaklybactericidalagainstrapidlydividingorganismsRoleofEthambutol/Streptomyc42RelapserateslowwithdirectlyobservedtreatmentinbothHIV(+)andHIV(-)patientsAmJRespirCritCareMed1996:154:1034-38RelapseratesRelapse(%)Relapserateslowwithdirectl43Adversereactionstoanti-TBdrugsIsoniazidl

Peripheralneuropathyl

HepatitisDrugsAdversereactionsPyrazinamidel

Jointpainsl

HepatitisRifampicinl

Gastroentestinal(anorexia,nausea,vomiting,abdominalpain)l

Hepatitisl

ReducedeffectivenessoforalcontraceptivepillEthambutoll

OpticneuritisStreptomycinl

Auditory&vestibularnervedamage(alsotofoetus)l

RenaldamageAdversereactionstoanti-TBd44ManagementofDrugLogisticsManagementofStocksCHOICEUSEPURCHASEDISTRIBUTIONSTORAGEQuantificationFinancingTenderbidsOrderQualityControlRe-packagingTransportationInformationforuser&forconsumerAdequatebufferstocksmustbemaintainedatnational,state/regional,andlocallevelsManagementofDrugLogisticsMa45谢谢！21、要知道对好事的称颂过于夸大，也会招来人们的反感轻蔑和嫉妒。——培根

22、业精于勤，荒于嬉；行成于思，毁于随。——韩愈

23、一切节省，归根到底都归结为时间的节省。——马克思

24、意志命运往往背道而驰，决心到最后会全部推倒。——莎士比亚

25、学习是劳动，是充满思想的劳动。——乌申斯基供娄浪颓蓝辣袄驹靴锯澜互慌仲写绎衰斡染圾明将呆则孰盆瘸砒腥悉漠堑脊髓灰质炎(讲课2019)脊髓灰质炎(讲课2019)谢谢！21、要知道对好事的称颂过于夸大，也会招来人们的反感轻46TBandDOTS肺结核与点31、别人笑我太疯癫，我笑他人看不穿。(名言网)32、我不想听失意者的哭泣，抱怨者的牢骚，这是羊群中的瘟疫，我不能被它传染。我要尽量避免绝望，辛勤耕耘，忍受苦楚。我一试再试，争取每天的成功，避免以失败收常在别人停滞不前时，我继续拼搏。33、如果惧怕前面跌宕的山岩，生命就永远只能是死水一潭。34、当你眼泪忍不住要流出来的时候，睁大眼睛，千万别眨眼!你会看到世界由清晰变模糊的全过程，心会在你泪水落下的那一刻变得清澈明晰。盐。注定要融化的，也许是用眼泪的方式。35、不要以为自己成功一次就可以了，也不要以为过去的光荣可以被永远肯定。TBandDOTS肺结核与点TBandDOTS肺结核与点31、别人笑我太疯癫，我笑他人看不穿。(名言网)32、我不想听失意者的哭泣，抱怨者的牢骚，这是羊群中的瘟疫，我不能被它传染。我要尽量避免绝望，辛勤耕耘，忍受苦楚。我一试再试，争取每天的成功，避免以失败收常在别人停滞不前时，我继续拼搏。33、如果惧怕前面跌宕的山岩，生命就永远只能是死水一潭。34、当你眼泪忍不住要流出来的时候，睁大眼睛，千万别眨眼!你会看到世界由清晰变模糊的全过程，心会在你泪水落下的那一刻变得清澈明晰。盐。注定要融化的，也许是用眼泪的方式。35、不要以为自己成功一次就可以了，也不要以为过去的光荣可以被永远肯定。TB:AGlobalEmergency1/3oftheworld(2billionpeople)infected1personinfected/secondresultingin>30millionnewinfections,8millionnewcasesLeftuntreated1/3die,1/3self-cure,1/3remaininfectiousTBkills1personevery10seconds=5000/day=2-3millioneachyear22HighBurdenCountriesIndiaChinaIndonesiaBangladeshPakistanNigeriaPhilippinesSouthAfricaEthiopiaVietnamRussianFederationCongoBrazilTanzaniaKenyaThailandMyanmarAfghanistanUgandaPeruZimbabweCambodiaTBandDOTS肺结核与点31、别人笑我太疯癫，我笑他47TB-and-DOTS肺结核与点共46张课件48TB-and-DOTS肺结核与点共46张课件49TB-and-DOTS肺结核与点共46张课件50TB-and-DOTS肺结核与点共46张课件51WhendoesTBinfection

becomedisease?MostlikelytooccurinfirsttwoyearsafterinfectionIfpersonbecomesimmunocompromisedHIVCancerChemotherapyPoorlycontrolleddiabetesmalnutritionWhendoesTBinfection

become52The5EssentialComponentsoftheDOTSStrategy

GovernmentcommitmenttoaNationalTBProgramPrioritytodetectinfectiouscasesbysputumsmearmicroscopyStandardizedregimensofshort-coursechemotherapy,givenunderdirectobservationfor,atleast,theintensivephaseRegular,uninterruptedsupplyofanti-TBmedsMonitoringsystemforprogramsupervisionandevaluationThe5EssentialComponentsof531.Political/AdministrativeCommitmentPerceptionofTBasapriorityproblemwithrealsolutionGovernmentacknowledgesimportanceofdiseasePubliccommitmenttoNationalTBProgram(NTP)Supportforpersonnel,training,transportation,drugs1.Political/AdministrativeCo542.AccurateDiagnosis=SputumMicroscopyIdentification/cureofinfectiouscases(smear+)ishighestpriorityofTBcontrolSmear+s4-20timesmoreinfectious;mayinfect10-15/year;morelikelytodieifuntreatedTimelyresultstoreducepotentialfortransmissionQualityassurance/training--nationalreferencelabiskey2.AccurateDiagnosis=SputumM55DiagnosisofpulmonaryTBCough3weeksAFBX3Broad-spectrumantibiotic10-14daysIfsymptomspersist,repeatAFBsmears,X-rayIfconsistentwithTBAnti-TBTreatmentIf1positive,X-rayandevaluation

If2/3positive:Anti-TBRxIf

negative:DiagnosisofpulmonaryTBCough56ChestX-ray(CXR)asDiagnosticToolNoCXRpatternistypicalManyTBcasesaremissed(10-15%culture+s)Manynon-TBcasesmisdiagnosed(40%diagnosedbyCXRalonedonothaveactiveTBPreviousMDtrainingemphasizedCXRasbestdiagnostictoolOftenreactiontopoor,inaccurate,orunavailablelabservicesChestX-ray(CXR)asDiagnosti57X-ray-basedevaluationcausesover-diagnosisofTBNTI,IndJTuberc,1974Over-diagnosisX-ray-basedevaluationcauses58MicroscopyisamorespecifictestthanX-rayforTBdiagnosisSpecificityMicroscopyisamorespecific593.AdequateSupplyofDrugsTreatmentrequiresregulardosesofcombinationregimensfor>6monthsIdentificationofanadequatesupplyofappropriatedrugsforpatientspriortoinitiationoftreatmentessentialIfregimensincomplete,realchanceofdevelopmentofdrug-resistantstrainswhicharehardorimpossibletocureRequirescontinuumofdrugmanagementservices:selection,

procurement,distribution,use.3.AdequateSupplyofDrugsTre604.DirectlyObservedTreatmentWhy?Manypatientsdon’ttakemedicinesregularly,evenifexcellenthealtheducationprovidedWho?Allpatients...impossibletopredictwhichpatientwilltakemedicine(1/3notadherent)What?ObserverwatchesandhelpspatientswallowtabletsWhere?Anywhere!(home,clinic,work,school,etc)Whodoesit?HCW,communityliaisons,teachers,Directobservationensurestreatmentforentirecoursewiththerightdrugs,intherightdoses,attherightintervals4.DirectlyObservedTreatment61DOTisnecessaryevenwhendrugsupplyensured

ChaulkCP.JAMA1998;279:943-8TreatmentSuccessDOTNoDOTDOTisnecessaryevenwhenChau62DOTprolongssurvivalofHIV-infectedTBpatients

SCCwithDOTSCCwithoutDOTDOTprolongssurvivalofSCCwi635.SystematicMonitoring/AccountabilityRecordingsystemissimpletouse,essential,integratedcomponentofDOTSenablingMonitoringofpatientoutcomesEvaluationofprogramperformanceAnalysisofepidemiologicdataIdentificationofareasforOREverylevelofhealthsystemaccountableforpatientdiagnosisandcure;“reportcard”TBRegister5.SystematicMonitoring/Accou64TBandHIV/AIDSHIVnegativelyimpactsTBandTBnegativelyimpactsHIVHIV+individualsinfectedwithTBare30xmorelikelytodevelopTBdiseaseTBisleadingcauseofdeathamongHIV+,accountingfor~40%ofAIDSdeathsHIVincreasestheprevalenceofactiveTBinHIV-andHIV+populationsTBandHIV/AIDSHIVnegatively65Multidrug-ResistantTB(MDRTB)DefinedasresistancetoINHandRIFCausedbyinconsistentorpartialtreatmentofsusceptibleTB(primary)Curerates<70%causetheepidemicanddrugresistancetoincreaseDrugsaremoretoxicandexpensive,andlesseffective;treatmentmoredifficult/expensive,andmorelikelyfatalindevelopingworldPoorlysupervised,incompletetreatmentisworsethannotreatmentatall:PreventionofMDRTBistheprimarystrategytoaddressMDRTBMultidrug-ResistantTB(MDRTB)66USAIDTBStrategySupportfortheSTOPTBInitiativeEstablishmentoffieldsites/programstoserveasmodelsforinnovativewide-scaleTBcontrolInvestigation/implementationofpotentialtechnologiesandmethodologiesforTBprophylaxis,diagnosis,andtreatmentSupportforsurveillancetomonitorTBtrendsandidentifyMDRTB

strainsbeforetheybecomewidespreadUSAIDTBStrategySupportfort67USAIDExpandedResponseContinuedinvestmentsinglobalandregionalpartnerships:supportfortheStopTBinitiativecontinuedworkwithotherUSGagenciesGlobalpartnershiptodevelopnewanti-TBdrugsGlobalDrugFacilityNewInternationalcoalitionoforganizationsandagenciesincludingKNCV,IUATLD,WHO,CDC,ALA/ATStoprovideTA/developTBexpertiseContinuedsupportforcoordinatedresearchtooptimizediagnosticsandtreatmentregimensUSAIDExpandedResponseContinu68USAIDExpandedResponseExpandedresearchinvestmentsrapidandsensitiveTBdiagnostictestsincreasefunding,workwithourpartnerstomobilizeeffortsandexpertiseofPHworkers,industry,academicresearchers,donors,otherpartnersinlab/ORcomponentsTargetcollaborativeeffortstodevelopcost-effectiveTBdrugsandcombinationtherapiesPotentialexpansiontovaccinedevelopmentUSAIDExpandedResponseExpande69USAIDExpandedResponseFocused,expandedprogramsinkeycountries,targetingcountriesofgreatestneed,definedbyTBburdencountrieswithhighHIV/AIDSprevalencecountriesatriskofescalatingMDRepidemicsUSAIDExpandedResponseFocused70TB-and-DOTS肺结核与点共46张课件71Partners/ImplementersCurrentWHO,CDC,Fogarty/NIH,IUATLD,GorgasInstitute,MSH/RPM,PATH,QAP,FHITBCTA(TBCoalitionforTechnicalAssistance)PotentialNGOs(MSF,DOW,MERLIN)Foundations,WorldBank,USModelCentersPartners/ImplementersCurrent72GlobalPrograms/MechanismsGlobal/BureauumbrellaagreementswithWHOandCDCMultipleagreementstoaddresstechnicalareas:RPM,PATH,TBCTANewinteragencyalliancesunderdevelopmentfordrugprocurement/management/developmentStandardindicatorsalreadydevelopedGlobalPrograms/MechanismsGlob73CommonHealthAssumptionsnotapplicabletoTBAccessisnecessarybutNOTsufficientDrugsServicesNoteveryhealthcenter/NGOsiteappropriateasTBcarecenterPoorprogramisworsethannoprogramatallCommonHealthAssumptionsnot74PrioritiesofTBControlMakesurethepersoncompletesTBtreatment!Donotcausedrugresistance;apoorTBprogramisworsethannoTBprogram!Treatingnon-pulmonarycasesandthoseinfectedwithoutactivediseaseareoflesserpublichealthimportancePrioritiesofTBControlMakes75WithTB,treatmentismorethantreatment,treatmentispreventionWithTB,treatmentismoretha76RoleofRifampicinNecessaryforshort-coursetreatmentEssentialforatleastfirst2monthsofregimensBactericidalforrapidlydividingandslow-growingorganismsPreventsemergenceofresistancetootherdrugsIntermittenttreatmentmoreeffectivethandailytreatmentinanimalmodel;equallyeffectiveinclinicaltrialsRoleofRifampicinNecessaryfo77RoleofIsoniazidMainstayofanti-TBtreatmentLifesavinginTBmeningitisBactericidalforrapidlydividingorganismsPreventsemergenceofresistancetootherdrugsIntermittenttreatmentmoreeffectivethandailytreatmentinanimalmodel;equallyeffectiveinclinicaltrialsSafeandeffectiveforpreventivetreatmentRoleofIsoniazidMainstayofa78DOTScanreducetheTBburdenAnnualpercentagedeclineinincidence/prevalenceDOTScanreducetheTBburdenA79TB:theleadingsingleinfectiouscauseofdeathinSEAsiaNumberofdeaths(1000s)DeathsfrominfectiousagentsinSouth-EastAsia80TB:theleadingsingleinfectiTBisaLeadingKillerofWomenDeathsamongwomenTBisaLeadingKillerofWome81DiagnosisofpulmonaryTB

PatientswithTBfeelillandseekcarepromptlyActivecasefindingisunnecessaryandunproductiveMicroscopyisappropriatetechnology,indicatinginfectiousness,riskofdeath,andpriorityfortreatmentX-rayisnon-specificforTBdiagnosisSerologicalandamplificationtechnologies(PCR,etc.)currentlyofnoprovenvalueinTBcontrolDiagnosisofpulmonaryTBPati82ProportionofpulmonaryTBpatientswithpositiveAFBsmears

010203040506070HIVNegativeEarlyHIVLateHIVAFBp