Abstract
SUMMARYExtensively drug-resistant tuberculosis (XDR TB) has emerged as a threat to TB control efforts in several high-burden areas, generating international concern. XDR TB is now found in every region of the world, but appears most worrisome in the context of HIV and in resource-limited settings with congregate hospital wards. Here, we examine the emergence and transmission dynamics of the disease, incorporating the mathematical modelling literature related to airborne infection and epidemiological studies related to the operations of TB control programmes in resource-limited settings. We find that while XDR TB may present many challenges in the setting of resource constraints, the central problems highlighted by the emergence of XDR TB are those that have plagued TB programmes for years. These include a slow rate of case detection that permits prolonged infectiousness, the threat of airborne infection in enclosed spaces, the problem of inadequate treatment delivery and treatment completion, and the need to develop health systems that can address the combination of TB and poverty. Mathematical models of TB transmission shed light on the idea that community-based therapy and rapid detection systems may be beneficial in resource-limited settings, while congregate hospital wards are sites for major structural reform.
Publisher
Cambridge University Press (CUP)
Subject
Infectious Diseases,Epidemiology
Reference96 articles.
1. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005;Jensen;Morbidity and Mortality Weekly Report,2005
2. A Comparison of Outbreak‐ and Nonoutbreak‐Related Multidrug‐Resistant Tuberculosis Among Human Immunodeficiency Virus–Infected Patients in a South African Hospital
3. Clinical predictors of multidrug and extensively drug-resistant tuberculosis – Tugela Ferry, South Africa;Andrews;International Journal of Tuberculosis and Lung Disease,2007
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