Excerpt

The objectives of the workshop were to learn from the historical and contemporary experiences of the Russian public health community in its efforts to control and combat the spread of drug-resistant tuberculosis (TB), and to draw lessons regarding best practices and novel approaches that can be applied in the region and across the globe. An important objective of the presentations and discussions among workshop speakers and guests was to forge new linkages and collaborations across multiple disciplines and countries and facilitate the sharing of scientific knowledge to benefit TB control efforts. Specifically, the workshop was designed to:

• increase awareness and create a renewed sense of urgency with respect to the growing global burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB and its profile in Russia;
• consider the magnitude of transmission of drug-resistant strains and options for control of transmission and infection;
• address the MDR TB burden in vulnerable populations, including children, those coinfected with HIV, and substance abusers;
• assess current treatment options and approaches to patient care, taking into account the unique needs of the population being treated;
• discuss the supply of quality-assured second-line TB drugs and the pipeline for a new “cocktail” of TB drugs;
• assess the current state of the art for rapid detection of drug resistance and the implications for patient management; and
• suggest policies for accelerating improvements in treatment and infection control for drug-resistant TB.

Contents

• The National Academies
• Planning Committee for the Workshop on the New Profile of Drug-Resistant Tuberculosis in Russia: a Global and Local Perspective
• Forum on Drug Discovery, Development, and Translation
• Reviewers
• 1. Introduction
  • THE PROBLEM OF DRUG RESISTANCE
  • THE BURDEN OF DRUG-RESISTANT TB
  • WORKSHOP OBJECTIVES
  • A REALISTIC ASSESSMENT OF THE CHALLENGES OF DRUG-RESISTANT TB
  • ORGANIZATION OF THE REPORT
• 2. A Global Perspective on Drug-Resistant Tuberculosis
  • DIFFICULTIES IN ESTIMATING THE BURDEN OF MDR TB
  • MDR AND XDR TB IN SOUTH AFRICA
  • MDR AND XDR TB IN CHINA
  • HISTORICAL PERSPECTIVE ON MDR TB CONTROL EFFORTS
  • REMAINING CHALLENGES
• 3. Drug-Resistant Tuberculosis in the Russian Federation
  • A HISTORICAL PERSPECTIVE
  • EPIDEMIOLOGY OF TB IN THE RUSSIAN FEDERATION
  • NATIONAL MDR TB SURVEILLANCE SYSTEM
• 4. Transmission and Infection Control of Drug-Resistant TB
  • TRANSMISSION OF DRUG-RESISTANT TB IN CHINA
  • TRANSMISSION-BASED GENETIC ANALYSIS IN SOUTH AFRICA
  • REDUCING NOSOCOMIAL DRUG-RESISTANT TB TRANSMISSION
• 5. Diagnosis of Drug-Resistant TB
  • RAPID DIAGNOSTIC METHODS
  • BIOCHIP TECHNOLOGY FOR TB DIAGNOSIS
  • NEED FOR IMPROVED LABORATORY CAPACITY
• 6. Treatment of Drug-Resistant TB
  • PETTS: MAKING THE CASE FOR DRUG RESISTANCE TESTING AND TAILORED TREATMENT REGIMENS
  • TREATMENT OF DRUG-RESISTANT TB IN THE RUSSIAN FEDERATION
  • DRUG-RESISTANT TB AND COINFECTION WITH HIV
  • INNOVATIVE RESEARCH IN MDR TB TREATMENT
• 7. TB and Drug-Resistant TB in Vulnerable Populations
  • DRUG-RESISTANT TB IN CHILDREN: THE HIDDEN EPIDEMIC
  • MDR TB TREATMENT FOR PEOPLE WITH DRUG AND ALCOHOL DEPENDENCIES
  • TB IN THE PRISON SYSTEM OF THE RUSSIAN FEDERATION
• 8. The Second-Line Drug Supply Chain
  • A NEW PARADIGM FOR THE DRUG SUPPLY FOR DRUG-RESISTANT TB
  • MDR TB TREATMENT AND THE DRUG SUPPLY CHAIN IN THE RUSSIAN FEDERATION
• 9. The Development of New TB Diagnostics and Drugs
  • THE GLOBAL CHALLENGE
  • THE ROLE OF REGULATORY SCIENCE
  • THE NEED FOR COLLABORATION
• 10. Convergence of Science and Policy to Create a Call for Action
  • KEY CHALLENGES
  • INFECTION CONTROL
  • DIAGNOSTICS
  • TREATMENT
  • HIGH-QUALITY CARE FOR ALL
  • LINKAGES FROM SCIENCE TO CLINICAL CARE
• References
• Acronyms
• Appendix A Agenda
• Appendix B Summary of a Meeting of the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Held May 24–25, 2010, Moscow, Russian Federation
• Appendix C Participant Biographies

Rapporteurs: Steve Olson, Rebecca English and Anne Claiborne

This study was supported by Department of Health and Human Services (Contract Nos. N01-OD-4-2139 and 223001003T), the U.S. State Department (S-LMAQM-08-GR-071), the American Diabetes Association, the American Society for Microbiology, Amgen Inc., the Association of American Medical Colleges, Bristol-Myers Squibb, the Burroughs Wellcome Fund, Celtic Therapeutics, LLLP, the Critical Path Institute, the Doris Duke Charitable Foundation, Eli Lilly & Co., GlaxoSmithKline, Johnson & Johnson, Novartis Pharmaceuticals Corporation, and Pfizer, Inc.

Suggested citation:

IOM (Institute of Medicine). 2011. The New Profile of Drug-Resistant Tuberculosis in Russia: A Global and Local Perspective: Summary of a Joint Workshop. Washington, DC: The National Academies Press.

Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.