Drug-resistant tuberculosis: time for visionary political leadership

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• 作者：Prof Ibrahim Abubakar ; FRCP^a ; ^b ; Matteo Zignol ; MD^c ; Dennis Falzon ; MD^c ; Prof Mario Raviglione ; FRCP^c ; Lucica Ditiu ; MD^d ; Baroness Susan Masham^e ; ^f ; Ifedayo Adetifa ; PhD^g ; Nathan Ford ; PhD^h ; ⁱ ; Helen Cox ; PhD^h ; ⁱ ; Stephen D Lawn ; FRCP^j ; Ben J Marais ; FCPaed^k ; Prof Timothy D McHugh ; PhD^l ; Peter Mwaba ; FRCP^m ; ⁿ ; Matthew Bates ; PhD^l ; ^m ; Marc Lipman ; FRCP^o ; Prof Lynn Zijenah ; PhD^p ; Simon Logan ; MSc^e ; Ruth McNerney ; PhD^j ; Adam Zumla ; MD^m ; ^q ; Krishna Sarda ; MD^r ; Payam Nahid ; MD^s ; Prof Michael Hoelscher ; FRCP^t ; Michel Pletschette ; FRCP^u ; Prof Ziad A Memish ; FRCP^w ; ^x ; Peter Kim ; MD^ab ; Richard Hafner ; MD^ab ; Prof Stewart Cole ; PhD^y ; Prof Giovanni Battista Migliori ; FRCP^v ; Prof Markus Maeurer ; FRCP^z ; Marco Schito ; PhD^aa ; Prof Alimuddin Zumla ; FRCP^l ; ^{a.zumla@ucl.ac.uk}
• 刊名：The Lancet Infectious Diseases
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：13
• 期：6
• 页码：529-539
• 全文大小：396 K

文摘

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Summary

Two decades ago, WHO declared tuberculosis a global emergency, and invested in the highly cost-effective directly observed treatment short-course programme to control the epidemic. At that time, most strains of Mycobacterium tuberculosis were susceptible to first-line tuberculosis drugs, and drug resistance was not a major issue. However, in 2013, tuberculosis remains a major public health concern worldwide, with prevalence of multidrug-resistant (MDR) tuberculosis rising. WHO estimates roughly 630?000 cases of MDR tuberculosis worldwide, with great variation in the frequency of MDR tuberculosis between countries. In the past 8 years, extensively drug-resistant (XDR) tuberculosis has emerged, and has been reported in 84 countries, heralding the possibility of virtually untreatable tuberculosis. Increased population movement, the continuing HIV pandemic, and the rise in MDR tuberculosis pose formidable challenges to the global control of tuberculosis. We provide an overview of the global burden of drug-resistant disease; discuss the social, health service, management, and control issues that fuel and sustain the epidemic; and suggest specific recommendations for important next steps. Visionary political leadership is needed to curb the rise of MDR and XDR tuberculosis worldwide, through sustained funding and the implementation of global and regional action plans.