Lecture 9: Tuberculosis Flashcards
What are basic facts needed to design an intervention for tuberculosis (TB)?
Tuberculosis is caused by an airborne bacteria. Every person with TB has the potential to infect 10-15 people. However, not everyone infected with TB will get sick with TB. This is dependent on the immune system of the patient. This is why in HIV-endemic countries, TB can’t be eradicated without eradicating HIV. Other people at risk are people with other immune weaknesses, the elderly and the very young.
What is an important TB intervention?
Active case finding to ensure early diagnosis and treatment. Treatment can also be given prophylactically.
What is a good tertiary intervention for TB?
A good tertiary intervention for TB is stimulating treatment adherence
Why is the focus on respiratory TB?
Because then there is potential for transmission (contrary to e.g. knee and spleen). It also starts in the lungs and can spread throughout the body when a person doesn’t have a good immune system.
What is an extra screening done in a TB patient in an HIV-endemic country?
Screening for HIV. If they have HIV, they must get ART because in these countries TB is the most common cause of death for people with HIV.
What is the difference in the risk of developing TB for immunocompetent and immunocompromised people?
The lifetime risk of an immunocompetent person developing TB is 5-10%. The risk of an immunocompromised person developing TB is 10% per year.
How is TB treated?
TB is treated with rifampicin, isoniazid, pyrazinamide and ethambutol daily for two months. Then it is switched to rifampicin and isoniazid for 4 months.
What are the different treatment options for latent TB?
If you know a person has latent TB, there are four treatment options:
• One tablet isoniazid daily for six-nine months
• Isoniazid and rifapentine once a week for three months
• Isoniazid and rifampin daily for three months
• Rifampin daily for four months
Choice depends on what the patients wants and what makes them most likely to complete the treatment, as that is essential in TB treatment.
In what way can TB help diagnose HIV treatment efficacy?
An HIV patient being diagnosed with TB is a sign that the antiretroviral treatment is failing
Why is diagnosing TB in a child difficult?
Taking an X-ray and sputum from a child is very difficult
What is the strategy used for TB control since 1993?
Global strategies used for TB control since 1993: Directly Observe Treatment, Short-course (DOTS) with five pillars:
•Government commitment to sustained TB control activities.
•Case detection by sputum smear microscopy among symptomatic patients self-reporting to health services.
•Standardized treatment regimen of six to eight months for at least all confirmed sputum smear positive cases, with directly observed treatment (DOT) for at least the initial two months.
•A regular, uninterrupted supply of all essential anti-TB drugs.
•A standardized recording and reporting system that allows assessment of treatment results for each patient and of the TB control programme overall
What is the new strategy used since 2015?
The END TB strategy:
1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION
A. Early diagnosis of tuberculosis including universal drug-susceptibility testing, and systematic screening of contacts
and high-risk groups
B. Treatment of all people with tuberculosis including drug-resistant tuberculosis, and patient support
C. Collaborative tuberculosis/HIV activities, and management of comorbidities
D. Preventive treatment of persons at high risk, and vaccination against tuberculosis
2. BOLD POLICIES AND SUPPORTIVE SYSTEMS
A. Political commitment with adequate resources for tuberculosis care and prevention
B. Engagement of communities, civil society organizations, and public and private care providers
C. Universal health coverage policy, and regulatory frameworks for case notification, vital registration, quality and
rational use of medicines, and infection control
D. Social protection, poverty alleviation and actions on other determinants of tuberculosis
3. INTENSIFIED RESEARCH AND INNOVATION
A. Discovery, development and rapid uptake of new tools, interventions and strategies
B. Research to optimize implementation and impact, and promote innovations
