Programmatic Management of Drug-Resistant Tuberculosis: An Updated Research Agenda

There are numerous challenges in delivering appropriate treatment for multidrug-resistant tuberculosis (MDR-TB) and the evidence base to guide those practices remains limited. We present the third updated Research Agenda for the programmatic management of drug-resistant TB (PMDT), assembled through...

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Veröffentlicht in:PloS one Jg. 11; H. 5; S. e0155968
Hauptverfasser: Mitnick, Carole D., Rodriguez, Carly A., Hatton, Marita L., Brigden, Grania, Cobelens, Frank, Grobusch, Martin P., Horsburgh, Robert, Lange, Christoph, Lienhardt, Christian, Oren, Eyal, Podewils, Laura J., Seaworth, Barbara, van den Hof, Susan, Daley, Charles L., Gebhard, Agnes C., Wares, Fraser
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Public Library of Science 25.05.2016
Public Library of Science (PLoS)
Schlagworte:
Acquired immune deficiency syndrome
AIDS
Care and treatment
Categories
Complications and side effects
Development and progression
Disease control
Disease prevention
Disease transmission
Documents
Drug resistance
Drug therapy
Epidemics
Epidemiology
Female
Health surveillance
Hospitals
Humans
Infectious diseases
Laboratories
Literature reviews
Male
Management
Medical diagnosis
Medical treatment
Medicine
Medicine and Health Sciences
Microbial drug resistance
Multidrug resistance
Multidrug resistant organisms
Mycobacterium
Nosocomial infection
Patients
Priorities
Public health
R&D
Research & development
Research and Analysis Methods
Sensitivity analysis
Surveillance
Tuberculosis
Tuberculosis, Multidrug-Resistant - diagnosis
Tuberculosis, Multidrug-Resistant - therapy
Tuberculosis, Pulmonary - diagnosis
Tuberculosis, Pulmonary - therapy
United States
Switzerland
United States > US
Netherlands
ISSN:1932-6203, 1932-6203
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Zusammenfassung:There are numerous challenges in delivering appropriate treatment for multidrug-resistant tuberculosis (MDR-TB) and the evidence base to guide those practices remains limited. We present the third updated Research Agenda for the programmatic management of drug-resistant TB (PMDT), assembled through a literature review and survey. Publications citing the 2008 research agenda and normative documents were reviewed for evidence gaps. Gaps were formulated into questions and grouped as in the 2008 research agenda: Laboratory Support, Treatment Strategy, Programmatically Relevant Research, Epidemiology, and Management of Contacts. A survey was distributed through snowball sampling to identify research priorities. Respondent priority rankings were scored and summarized by mean. Sensitivity analyses explored weighting and handling of missing rankings. Thirty normative documents and publications were reviewed for stated research needs; these were collapsed into 56 research questions across 5 categories. Of more than 500 survey recipients, 133 ranked priorities within at least one category. Priorities within categories included new diagnostics and their effect on improving treatment outcomes, improved diagnosis of paucibacillary and extra pulmonary TB, and development of shorter, effective regimens. Interruption of nosocomial transmission and treatment for latent TB infection in contacts of known MDR-TB patients were also top priorities in their respective categories. Results were internally consistent and robust. Priorities retained from the 2008 research agenda include shorter MDR-TB regimens and averting transmission. Limitations of recent advances were implied in the continued quest for: shorter regimens containing new drugs, rapid diagnostics that improve treatment outcomes, and improved methods of estimating burden without representative data. There is continuity around the priorities for research in PMDT. Coordinated efforts to address questions regarding shorter treatment regimens, knowledge of disease burden without representative data, and treatment for LTBI in contacts of known DR-TB patients are essential to stem the epidemic of TB, including DR-TB.
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Membership of the RESIST-TB and GDI is listed in the Acknowledgments.
Competing Interests: The authors have declared that no competing interests exist.
Conceived and designed the experiments: CDM FC LJP EO SvdH C. Lange MPG. Performed the experiments: CDM CAR GB FC MPG RH C. Lange C. Lienhardt EO LJP BS SvdH CLD ACG FW. Analyzed the data: MH. Wrote the paper: CDM CAR MH. Designed the survey to collect data: CAR.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0155968