New York: National Tuberculosis Association, 1932:47. The direct nonmedical cost was higher for accommodation (median cost of 800 INR) and direct medical cost for non-TB drugs (median cost of 2000 INR). Contact screening practice and isoniazid preventive therapy initiation of children under the age of 5 in Bahir Dar zone were very low. Nongovernmental organizations worked with the Peruvian Health Ministry to apply the standard-of-care treatment used in New York City and elsewhere in the United States. Increasing numbers of international health donors and policymakers, slow to contribute resources toward the ambitious Alma-Ata agenda, embraced the idea of selective primary health care: discrete, targeted, and inexpensive interventions.25,26 Bilateral assistance withered, and poor countries became increasingly reliant on loans from international financial institutions such as the World Bank, which based its health agenda on the principles of “cost-effectiveness” and “affordable health for all” — the latter concept a nod to the Alma-Ata Declaration.27, Selective primary health care offered clear targets, measurable outcomes, and a high return on health investments, all of which appealed to donors worried about investing in countries that were on the brink of default.28,29 But several leading causes of disability and death, including tuberculosis, were deemed too costly and complex to address in resource-poor settings and were largely excluded from the emerging, constricted agenda for effective health investments. In Peru, for example, a campaign to promote the DOTS strategy had been so successful in making short-course chemotherapy available that the country's leaders elevated it as a point of national pride. Although many patients were cured, a substantial proportion had a relapse; mycobacterial isolates cultured from the latter patients showed resistance to streptomycin.12 That same year, two new antituberculosis agents, thiacetazone and para-aminosalicylic acid, came on the market. By the early-to-mid-1990s, MDR tuberculosis had been found wherever the diagnostic capacity existed to reveal it. Optimism that tuberculosis would soon be eliminated was not restricted to wealthy countries. Tuberculosis in New York City -- turning the tide. Of these, 16 (64%) were started on treatment. The median indirect cost incurred was 300 INR overall, and the maximum total indirect cost was 40000 INR in the postdiagnostic period. Daniel TM. Using treatment failure under effective directly observed short-course chemotherapy programs to identify patients with multidrug-resistant tuberculosis. Prepare to become a physician, build your knowledge, lead a health care organization, and advance your career with NEJM Group information and services. Nearly three-fourths (73.5%) of TB patients had a favourable attitude towards MDR-TB. 2019 Sep 30;14(9):e0223077. Cost of Tuberculosis Care in Programmatic Settings from Karnataka, India: Is It Catastrophic for the Patients? Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery. Association between outcome and independent variables was explored using logistic regression. 1. Background. The early hypothesis that resistance always conferred a loss of bacterial fitness, and hence led to lower case fatality rates and decreased transmission of such strains, had been disproved by the 1950s.19 The first national drug-resistance survey in the world, which involved 974 clinical isolates cultured from newly diagnosed cases of tuberculosis in Britain (1955–1956), showed strains that were resistant to streptomycin (2.5%), para-aminosalicylic acid (2.6%), and isoniazid (1.3%).20 Similarly, data from the United States showed that isoniazid resistance increased from 6.3% (between 1961 and 1964) to 9.7% (between 1965 and 1968) among patients with newly diagnosed tuberculosis.21 Between 1970 and 1990, there were numerous outbreaks of drug-resistant tuberculosis involving strains resistant to two or more drugs.17,22,23 As early as 1970, an outbreak in New York City of highly virulent tuberculosis that was resistant to multiple drugs proved to be a grim reminder that resistance did not necessarily reduce a microbe's fitness: the index patient died; 23 of 28 close contacts had evidence of new infection, and active, drug-resistant disease developed in 6 of these 23 contacts, 5 of whom were children.21, Tuberculosis, whether caused by drug-susceptible or drug-resistant strains, rarely made even medical headlines, in part because its importance as a cause of death continued to decline in areas in which headlines are written. National action plan to combat multidrug-resistant tuberculosis. In 2013, a survey result showed that in Ethiopia, tuberculosis patients from new cases and retreatment cases had resistance to at least isoniazid and rifampicin with a significant increase over time. Becerra MC, Freeman J, Bayona J, et al. Among those positive for TB, 6 (60%) received cotrimoxazole preventive therapy (CPT) and antiretroviral therapy. Unger JP, Killingsworth JR. The findings revealed a threefold burden of TB in prisons, compared with what is reported by national survey. Results. The research path to tuberculosis control: an NIH perspective. Forty-four (31.9%) children started isoniazid preventive therapy. Therefore, household contact screening and isoniazid preventive therapy initiation should be paid attention to reduce transmission. Independent predictors of adverse treatment outcome were found to be as follows: being HIV positive (aOR: 3.85, 95% CI: 2.19-6.75; ); aged 65 and above (aOR: 1.76, 95% CI: 1.44-1.54; ); and previously failed TB treatment (aOR: 5.02, 95% CI: 2.09-28.87; ). Though prisons are known high-prevalence sites for TB, the paucity of data affects the quantification of the disease and treatment outcomes in these settings. But tuberculosis, which persisted in settings of poverty, could not be hidden away for long. A total of 405 (11%) inmates with presumptive TB were identified, and 370 (91%) of these were evaluated for TB, mostly using rapid molecular testing of sputum specimens. Some international policymakers thought that treating MDR tuberculosis would be too expensive and complex — claims similar to those made about treating drug-susceptible tuberculosis before this approach was found to be “cost-effective” — and would distract attention from the newly branded (and often successful) DOTS strategy.38 Contemporaneous experience in the United States and in several countries in the former Soviet Union suggested, however, that short-course chemotherapy was ineffective against strains shown to be resistant to precisely those drugs on which such therapy was based.1,17,39,40, The failure of short-course chemotherapy against MDR tuberculosis, though unsurprising clinically, was difficult politically. Methods. Despite recent advances in diagnostics and treatment options, tuberculosis (TB) remains a substantial global health challenge. Tuberculosis, Drug Resistance, and the History of Modern Medicine. World Health Forum 1997;18:225-232, 33. Origin and interstate spread of a New York City multidrug-resistant Mycobacterium tuberculosis clone family. Kimerling ME, Kluge H, Vezhnina N, et al. Medical Research Council. HIV status, age, and category of patient of the TB patients were associated with adverse treatment outcome. The backbone of such empirical regimens was the combination of isoniazid and rifampin, the most effective and reasonably well-tolerated oral agents, given for 6 to 8 months. Berkeley: University of California Press, 1999. Keshavjee S, Farmer PE. Keshavjee S, Farmer PE. There are different costs incurred during health care utilization, and this study was conducted to estimate such costs. Increasingly, poor countries began implementing the DOTS approach; many lives were saved and many new cases averted. Wildfires, Global Climate Change, and Human Health, Reparations as a Public Health Priority — A Strategy for Ending Black–White Health Disparities, Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19, Lessons We’ve Learned — Covid-19 and the Undocumented Latinx Community, Exome Sequencing for Prenatal Diagnosis in Nonimmune Hydrops Fetalis, Covid-19, Ebola, and HIV — Leveraging Lessons to Maximize Impact, Early Rhythm-Control Therapy in Patients with Atrial Fibrillation, Evolocumab in Pediatric Heterozygous Familial Hypercholesterolemia, http://iom.edu/~/media/Files/Activity%20Files/Research/DrugForum/Fauci.pdf. Or an existing research area that has been overlooked or would benefit from deeper investigation? Results. “Leprosy and tuberculosis require years of drug therapy and even longer follow-up periods to ensure cure,” wrote two of the architects of selective primary health care in 1979. Int J Tuberc Lung Dis 2010;14:1222-1225, September 6, 2012N Engl J Med 2012; 367:931-936 Clinical outcome of individualised treatment of multidrug-resistant tuberculosis in Latvia: a retrospective cohort study. Twenty-five inmates were diagnosed with TB resulting in a prevalence of 649/100,000 population. But therapy lagged. Tubercle 1957;38:71-84, 21. Stay connected to what's important in medical research and clinical practice, Subscribe to the most trusted and influential source ofmedical knowledge. Overall treatment success for all TB patients was 88.1% (668/758). Fox W, Wiener A, Mitchison DA, Selkon JB, Sutherland I. Selikoff IJ, Robitzek EH, Ornstein GG. Picking up the pace -- scale-up of MDR tuberculosis treatment programs. HIV infection fanned epidemics of tuberculosis. We reviewed TB treatment cards of patients who received treatment for tuberculosis in the hospital from 2008 to 2016. N Engl J Med 1970;283:1353-1358, 22. Instead, selective primary health care and “cost-effectiveness” have shaped an anemic response to the ongoing global pandemic. Tuberculosis Research and Treatment publishes original research articles, review articles, and clinical studies related to all aspects of tuberculosis, from the immunological basis of disease to translational and clinical research. In such settings, where many of the social determinants of tuberculosis — extreme poverty, severe malnutrition, and overcrowded living conditions — became the exception rather than the norm, some public health experts declared that “virtual elimination of the disease as a public health problem” was in sight.24 In the United States, federal funding for tuberculosis research was cut; consequently, drug discovery, development of diagnostics, and vaccine research ground almost to a halt.17. We measured the prevalence of TB disease and treatment outcomes among inmates at two major prisons in Harare, Zimbabwe.

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