The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
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Int. J. Tuberc. Lung Dis. · Jun 1999
ReviewWill DOTS do it? A reappraisal of tuberculosis control in countries with high rates of HIV infection.
In 1993 the WHO declared tuberculosis a global emergency, and subsequently introduced the DOTS strategy, a technical and management package based on earlier work of the IUATLD and international experience with directly observed therapy. Despite successful implementation of most of the elements of this strategy in several African countries and settings, tuberculosis case rates continue to escalate where the prevalence of HIV infection is high. We explore possible reasons for the failure to control tuberculosis even in the context of tuberculosis programmes that have been considered models for others to emulate. ⋯ Strategies for tuberculosis control programmes in countries of high and low HIV prevalence cannot be the same, but must take into account the epidemiology of HIV infection. HIV/AIDS in Africa poses severe challenges of purpose and identity to tuberculosis control programmes, which have not adapted to the altered realities of the HIV/AIDS era. DOTS alone is unlikely to control tuberculosis in sub-Saharan Africa; one major achievement of DOTS when implemented, however, has been its apparent ability to limit the development and spread of drug resistance.
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Int. J. Tuberc. Lung Dis. · Dec 1998
Tuberculosis control in Bangladesh: success of the DOTS strategy.
Tuberculosis (TB) has been a major public-health problem in Bangladesh for many decades. National control efforts in the past have not been successful, with less than half of detected cases being cured. In 1993, a project based on the DOTS (directly observed treatment, short-course) strategy was initiated for a population of approximately one million in a rural setting. Following a 78% cure rate in the initial cohort of new smear-positive patients, the project was expanded in phases to cover a rural population of 67 million in 1996. ⋯ The DOTS strategy can be successfully implemented in phases in large countries with a high tuberculosis burden. This success is due to decentralizing sputum smear microscopy and treatment delivery services to peripheral health facilities, utilizing the existing primary health care network. High cure rates can be maintained despite rapid expansion of coverage, with proper implementation of the strategy and regular monitoring of reports on case finding, sputum smear conversion and treatment outcome. Case detection needs to be further increased by informing and involving the community in TB control efforts through social mobilization.
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Int. J. Tuberc. Lung Dis. · Jul 1998
Clinical features of non-tuberculous mycobacterial disease: comparisons between smear-positive and smear-negative cases, and between Mycobacterium avium and Mycobacterium intracellulare.
To evaluate the differences in clinical symptoms and radiological findings between smear-positive non-tuberculous mycobacteria (NTM) and smear-negative, culture-positive NTM. Also, to evaluate the differences in clinical symptoms and radiological findings between Mycobacterium avium and M. intracellulare. ⋯ The present study demonstrates differences in clinical symptoms and radiological findings between smear-positive and smear-negative NTM cases, as well as between M. avium and M. intracellulare.
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Int. J. Tuberc. Lung Dis. · Apr 1998
Multicenter StudyDrug-resistant tuberculosis in human immunodeficiency virus infected persons in Italy. The Italian Drug-Resistant Tuberculosis Study Group.
To describe the prevalence and epidemiological-clinical characteristics of tuberculosis (TB) resistance to first-line drugs in Italian human immunodeficiency virus (HIV)-infected subjects. ⋯ As drug-resistant tuberculosis in Italy is thus far relatively scarce, detection of a large MDR-TB epidemic among HIV-infected subjects was alarming. Aggressive control measures are urgently needed to prevent the spread of MDR-TB throughout the country and among the general population.