How the ATS Continues to Fight the Global Spread of TB and MDR-TB
Patricia W. Finn, MD
Last month, I attended the European Respiratory Society Congress in Barcelona, Spain, where there was a strong focus on tuberculosis, particularly around the issues of the growth of TB in densely populated urban areas around the world and of drug resistant TB, which continues to spread globally.
According to the Centers for Disease Control and Prevention's new report released September 16, "Antibiotic Resistance Threats to the United States, 2013," drug-resistant TB is a "serious threat" to U.S. public health. Although the Xpert diagnostic test is significantly improving our ability to diagnose TB quickly and provides the first indication of drug-resistant strains, the excessive length and toxicity of the MDR regimen is a barrier to controlling MDR.
Meanwhile, here in the U.S., federal and state public health funding cuts and drug shortages threaten our control and prevention of the disease. Yet most Americans do not know that every state in the U.S. has TB. Although TB remains the second-leading infectious disease killer, right behind HIV, it is not a global health priority.
I am proud that the ATS is leading efforts to improve TB care and increase awareness and funding for TB control and research. On the clinical level, Phil Hopewell, MD, is leading development of the third edition of the International Standards of TB Care (ISTC), a collaboration funded by the U.S. Agency for International Development (USAID) with the ATS, the World Health Organization, the CDC and other partners. The standards have been widely utilized in all countries that are highly burdened by TB, have been translated into at least 15 languages, and have been endorsed more than 50 international and national medical and nursing professional organizations in collaboration with national TB programs.
The standards are facilitating the effective engagement of all care providers in delivering high quality care for TB patients of all ages. As originally conceived in 2004, the standards are to be routinely reviewed and revised as technology, resources and circumstances change. The third edition will be published on World TB Day, March 24, 2014, and will include new information on ethics, diagnostics, treatment of MDR-TB, and prevention. The ERS will be collaborating with the ATS on private sector implementation strategies as recommended by the Strategic and Technical Advisory Group for Tuberculosis (STAG), including dissemination through professional associations and the development of mobile applications.
Alongside the ISTC revision, the WHO Stop TB Department is undertaking a broad-based revision of the Global Stop TB Strategy, currently called the "Post-2015 TB Strategy." The updated strategy will incorporate a number of changes in strategic emphasis in the global fight against TB.
Our Washington, D.C., office is at the forefront of advocacy efforts to strengthen domestic and global TB control and research funding by educating and working with members of Congress and the Administration, including the Tuberculosis Elimination Caucus in the U.S. House of Representatives and our partner organizations.
I am hopeful that these and other initiatives, such as the forthcoming "Roadmap to Address Childhood TB," which will be launched by our partners this month, will serve to elevate TB in the public mindset and increase resources, even in this constrained fiscal climate. But this will not happen until we challenge ourselves as individual clinicians and researchers to commit to stopping TB in our lifetime.