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Tuberculosis: treatment failure, or failure to treat? Lessons from India and South Africa

Tuberculosis (TB) remains an enormous public health concern globally. India and South Africa rank among the top 10 high TB burden countries with the highest absolute burden of TB, and the second highest rate of TB incidence, respectively. Although the primary drivers of TB transmission vary consider...

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Autores principales: Padayatchi, Nesri, Daftary, Amrita, Naidu, Naressa, Naidoo, Kogieleum, Pai, Madhukar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357918/
https://www.ncbi.nlm.nih.gov/pubmed/30805207
http://dx.doi.org/10.1136/bmjgh-2018-001097
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author Padayatchi, Nesri
Daftary, Amrita
Naidu, Naressa
Naidoo, Kogieleum
Pai, Madhukar
author_facet Padayatchi, Nesri
Daftary, Amrita
Naidu, Naressa
Naidoo, Kogieleum
Pai, Madhukar
author_sort Padayatchi, Nesri
collection PubMed
description Tuberculosis (TB) remains an enormous public health concern globally. India and South Africa rank among the top 10 high TB burden countries with the highest absolute burden of TB, and the second highest rate of TB incidence, respectively. Although the primary drivers of TB transmission vary considerably between these two countries, they do indeed share common themes. In 2017, only 64% of the global estimated incident cases of TB were reported, the remaining 36% of ‘missing’ cases were either undiagnosed, untreated or unreported. These ‘missing TB cases’ have generated much hype for the challenges they present in achieving the End TB Strategy. Although India and South Africa have indeed made significant strides in TB control, analysis of the patient cascade of care clearly suggests that these ‘missed’ patients are not really missing—most are actively engaging the health system—the system, however, is failing to appropriately manage them. In short, quality of TB care is suboptimal and must urgently be addressed, merely focusing on coverage of TB services is no longer sufficient. While the world awaits revolutionary vaccines, drugs and diagnostics, programmatic data indicate that much can be done to accelerate the decline of TB. In this perspective, we compare and contrast these two national epidemics, and explore barriers, with a particular focus on the role of health systems in finding the missing millions.
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spelling pubmed-63579182019-02-25 Tuberculosis: treatment failure, or failure to treat? Lessons from India and South Africa Padayatchi, Nesri Daftary, Amrita Naidu, Naressa Naidoo, Kogieleum Pai, Madhukar BMJ Glob Health Analysis Tuberculosis (TB) remains an enormous public health concern globally. India and South Africa rank among the top 10 high TB burden countries with the highest absolute burden of TB, and the second highest rate of TB incidence, respectively. Although the primary drivers of TB transmission vary considerably between these two countries, they do indeed share common themes. In 2017, only 64% of the global estimated incident cases of TB were reported, the remaining 36% of ‘missing’ cases were either undiagnosed, untreated or unreported. These ‘missing TB cases’ have generated much hype for the challenges they present in achieving the End TB Strategy. Although India and South Africa have indeed made significant strides in TB control, analysis of the patient cascade of care clearly suggests that these ‘missed’ patients are not really missing—most are actively engaging the health system—the system, however, is failing to appropriately manage them. In short, quality of TB care is suboptimal and must urgently be addressed, merely focusing on coverage of TB services is no longer sufficient. While the world awaits revolutionary vaccines, drugs and diagnostics, programmatic data indicate that much can be done to accelerate the decline of TB. In this perspective, we compare and contrast these two national epidemics, and explore barriers, with a particular focus on the role of health systems in finding the missing millions. BMJ Publishing Group 2019-01-30 /pmc/articles/PMC6357918/ /pubmed/30805207 http://dx.doi.org/10.1136/bmjgh-2018-001097 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Analysis
Padayatchi, Nesri
Daftary, Amrita
Naidu, Naressa
Naidoo, Kogieleum
Pai, Madhukar
Tuberculosis: treatment failure, or failure to treat? Lessons from India and South Africa
title Tuberculosis: treatment failure, or failure to treat? Lessons from India and South Africa
title_full Tuberculosis: treatment failure, or failure to treat? Lessons from India and South Africa
title_fullStr Tuberculosis: treatment failure, or failure to treat? Lessons from India and South Africa
title_full_unstemmed Tuberculosis: treatment failure, or failure to treat? Lessons from India and South Africa
title_short Tuberculosis: treatment failure, or failure to treat? Lessons from India and South Africa
title_sort tuberculosis: treatment failure, or failure to treat? lessons from india and south africa
topic Analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357918/
https://www.ncbi.nlm.nih.gov/pubmed/30805207
http://dx.doi.org/10.1136/bmjgh-2018-001097
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