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TB Policies in 29 Countries TB for a minimum of 2 years, with prompt initiation of empirical MDR-TB treatment based on the resistance pattern of the known contact for those with likely TB.127 the second involves the provision of FLQ-based treatment of infection. A recent meta-analysis of the efficacy of FLQ-based treatment found a 90% reduc-

tion in TB incidence in persons exposed to DR-TB who received 6 months of FLQ-based therapy.128 A trio of clinical trials are currently exploring optimal preventive regimens for MDR-TB contacts, using levofloxacin versus delamanid or placebo, but results are not expected until 2020.

TABLE 12. PREVENTIVE THERAPY IN COUNTRIES SURVEYED (2015)1 Country and classification

Coverage, by percent, of TB preventive therapy among HIV-positive people newly enrolled in care

Bangladesh (

)

Cambodia ( ) Ethiopia (

)

Indonesia ( Kenya (

) )

Mozambique ( Myanmar ( Nigeria (

) )

)

Philippines (

)

South Africa ( Viet Nam ( Zimbabwe (

) ) )

Percentage coverage of preventive therapy for TB in estimated underfive children who were household contacts of lab confirmed TB

Not reported

22%

25%

14%

47%

Not reported

2%

Not reported

33%

5.5%

45%

Not reported

10%

3.6%

20%

16%

43%

14%

38%

Not reported

Not reported

11%

31%

31%

WHO classified high-burden countries: TB, TB/HIV,

MDR-TB

FINDINGS • All countries are providing treatment for LTBI to children and people living with HIV/AIDS, while 52% (15) have widely implemented it; • Swaziland, Russian Federation, Belarus and Brazil provide preventive therapy to adult contacts, child contacts and people living with HIV/AIDS. All four of these countries have widely implemented it, except for Swaziland, which is implementing the policy - but not on a wide scale; • In 61% (17/28) of countries, it is not compulsory to carry out a test for LTBI, such as a TST or interferon-gamma releasing assay (IGRA), prior to prescribing preventive therapy but a clinical assessment is carried out to exclude active TB. Brazil and Kyrgyzstan request compulsory TSTs to select people eligible for preventive therapy, but when they have TST shortages – which occurs often – they prescribe preventive therapy based on a clinical evaluation; • In all countries, the guidelines recommend 6-month isoniazid treatment to treat LTBI upon exclusion of active TB; • In all countries, 6 months of daily INH is the preferred regimen. Some of the surveyed countries use different preventive therapies, as highlighted in table 13.

TABLE 13: EXAMPLES OF PREVENTIVE THERAPY REGIMENS IN THREE COUNTRIES THAT USE REGIMENS OTHER THAN INH ALONE Country

Medicines used in preventive therapy and duration of treatment (including RPT, RIF and Rfb)

China

6 months INH, 3 months weekly RPT+INH

Georgia

6 months INH (preferred) 9 months INH 3 months on a weekly basis RPT+INH 3–4 months INH+RIF 3–4 months RIF

Russian Federation

6 months INH 3–4 months INH and RIF/Rfb 3 months (once a week) INH+RPT

INH = isoniazid, RIF = rifampicin, RPT = rifapentine, Rfb = rifabutin

 POTLIGHT – LATENT TB AMONG S CHILD CONTACTS IN ARMENIA In Armenia, MSF followed 150 paediatric contacts of people with DR-TB for 24 months. The prevalence of LTBI among these children was high (52.7%), especially among those with smear-positive contacts. During follow-up, the incidence of LTBI was important (17 new infections/100 person-years); however, only two children had active TB disease at inclusion in the study (both were under 1 year old). These findings support TB screening and close follow-up for paediatric contacts, especially for infants and contacts of people with smear-positive TB, rather than preventive treatment in this setting.137

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결핵: 새 보고서 – 세계에서 가장 치명적인 감염병 결핵을 각국이 아직도 해결하지 않고 있다는 사실 드러내  

국경없는의사회와 세계보건기구(WHO) 산하 ‘결핵 퇴치 국제협력사업단’(Stop TB Partnership)은 ‘Out of Step’ 보고서 3판을 발표했다. 이 보고서는 세계에서 가장 치명적인 감염병인 결핵에 맞서기 위해 각국 정부가 더 큰 노력을...

결핵: 새 보고서 – 세계에서 가장 치명적인 감염병 결핵을 각국이 아직도 해결하지 않고 있다는 사실 드러내  

국경없는의사회와 세계보건기구(WHO) 산하 ‘결핵 퇴치 국제협력사업단’(Stop TB Partnership)은 ‘Out of Step’ 보고서 3판을 발표했다. 이 보고서는 세계에서 가장 치명적인 감염병인 결핵에 맞서기 위해 각국 정부가 더 큰 노력을...