Tools to implement the World Health Organization End TB Strategy: Addressing common challenges in high and low endemic countries

Aim: The purpose of this viewpoint is to summarize the advantages and constraints of the tools and strategies available for reducing the annual incidence of tuberculosis (TB) by implementing the World Health Organization (WHO) End TB Strategy and the linked WHO TB Elimination Framework, with special reference to Oman. Methods: The case-study was built based on the presentations and discussions at an international workshop on TB elimination in low incidence countries organized by the Ministry of Health, Oman, which took place from September 5 to September 7, 2019, and supported by the WHO and European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Results: Existing tools were reviewed, including the screening of migrants for latent TB infection (LTBI) with interferon-gamma release assays, clinical examination for active pulmonary TB (APTB) including chest X-rays, organization of laboratory services, and the existing centres for mandatory health examination of pre-arrival or arriving migrants, including examination for APTB. The need for public-private partnerships to handle the burden of screening arriving migrants for active TB was discussed at length and different models for financing were reviewed. Conclusions: In a country with a high proportion of migrants from high endemic countries, screening for LTBI is of high priority. Molecular typing and the development of public-private partnerships are needed. (C) 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.Funding Agencies|WHOWorld Health Organization; ESCMID; Qiagen; Cepheid; Advanced Healthcare Solutions; PfizerPfizer; MSD; QIAGEN Sciences Inc.</p

Clinical standards for the assessment, management and rehabilitation of post-TB lung disease

BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR).METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement).RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR.CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD

Clinical standards for the assessment, management and rehabilitation of post-TB lung disease

59sireservedBACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR). METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement). RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR. CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD.mixedMigliori G.B.; Marx F.M.; Ambrosino N.; Zampogna E.; Schaaf H.S.; van der Zalm M.M.; Allwood B.; Byrne A.L.; Mortimer K.; Wallis R.S.; Fox G.J.; Leung C.C.; Chakaya J.M.; Seaworth B.; Rachow A.; Marais B.J.; Furin J.; Akkerman O.W.; Al Yaquobi F.; Amaral A.F.S.; Borisov S.; Caminero J.A.; Carvalho A.C.C.; Chesov D.; Codecasa L.R.; Teixeira R.C.; Dalcolmo M.P.; Datta S.; Dinh-Xuan A.-T.; Duarte R.; Evans C.A.; Garcia-Garcia J.-M.; Gunther G.; Hoddinott G.; Huddart S.; Ivanova O.; Laniado-Laborin R.; Manga S.; Manika K.; Mariandyshev A.; Mello F.C.Q.; Mpagama S.G.; Munoz-Torrico M.; Nahid P.; Ong C.W.M.; Palmero D.J.; Piubello A.; Pontali E.; Silva D.R.; Singla R.; Spanevello A.; Tiberi S.; Udwadia Z.F.; Vitacca M.; Centis R.; D'Ambrosio L.; Sotgiu G.; Lange C.; Visca D.Migliori, G. B.; Marx, F. M.; Ambrosino, N.; Zampogna, E.; Schaaf, H. S.; van der Zalm, M. M.; Allwood, B.; Byrne, A. L.; Mortimer, K.; Wallis, R. S.; Fox, G. J.; Leung, C. C.; Chakaya, J. M.; Seaworth, B.; Rachow, A.; Marais, B. J.; Furin, J.; Akkerman, O. W.; Al Yaquobi, F.; Amaral, A. F. S.; Borisov, S.; Caminero, J. A.; Carvalho, A. C. C.; Chesov, D.; Codecasa, L. R.; Teixeira, R. C.; Dalcolmo, M. P.; Datta, S.; Dinh-Xuan, A. -T.; Duarte, R.; Evans, C. A.; Garcia-Garcia, J. -M.; Gunther, G.; Hoddinott, G.; Huddart, S.; Ivanova, O.; Laniado-Laborin, R.; Manga, S.; Manika, K.; Mariandyshev, A.; Mello, F. C. Q.; Mpagama, S. G.; Munoz-Torrico, M.; Nahid, P.; Ong, C. W. M.; Palmero, D. J.; Piubello, A.; Pontali, E.; Silva, D. R.; Singla, R.; Spanevello, A.; Tiberi, S.; Udwadia, Z. F.; Vitacca, M.; Centis, R.; D'Ambrosio, L.; Sotgiu, G.; Lange, C.; Visca, D