Integrating tuberculosis and antimicrobial resistance control programmes.

Rumina Hasan,Johanna Hanefeld,Sadia Shakoor,Mishal Khan

doi:10.2471/blt.17.198614

Abstract

Many low- and middle-income countries facing high levels of antimicrobial resistance, and the associated morbidity from ineffective treatment, also have a high burden of tuberculosis. Over recent decades many countries have developed effective laboratory and information systems for tuberculosis control. In this paper we describe how existing tuberculosis laboratory systems can be expanded to accommodate antimicrobial resistance functions. We show how such expansion in services may benefit tuberculosis case-finding and laboratory capacity through integration of laboratory services. We further summarize the synergies between high-level strategies on tuberculosis and antimicrobial resistance control. These provide a potential platform for the integration of programmes and illustrate how integration at the health-service delivery level for diagnostic services could occur in practice in a low- and middle-income setting. Many potential mutual benefits of integration exist, in terms of accelerated scale-up of diagnostic testing towards rational use of antimicrobial drugs as well as optimal use of resources and sharing of experience. Integration of vertical disease programmes with separate funding streams is not without challenges, however, and we also discuss barriers to integration and identify opportunities and incentives to overcome these.

Highlights

Public health programmes that address the threats of antimicrobial resistance and of tuberculosis are major contributors towards gains in global health.[1,2] Unlike tuberculosis, antimicrobial resistance is not mentioned in the health targets of United Nations’ sustainable development goal 3.3 Both health issues, are encompassed in the overarching goal of ensuring healthy lives and promoting well-being for all
Integration across programme components has been limited, possibly leading to economic inefficiencies and suboptimal service delivery. This is exemplified most clearly by the initial decision to exclude Mycobacterium tuberculosis from the global priority list of antibiotic-resistant bacteria,[6] even though estimates suggest that by the year 2050 drug resistant tuberculosis will be responsible for 2.6 million of the total 10 million annual deaths associated with antimicrobial resistance.[1,7]
The protests and concerns raised following this decision eventually led to the inclusion of M. tuberculosis within the priority list, highlighting the importance of integrating activities aimed at addressing both health issues.[8]

Summary

Introduction

Establishment of an efficient and far-reaching specimen referral network has been explored by investigators in Ethiopia and Uganda, and shown to be effective for multiple diseases, including tuberculosis, HIV and hepatitis.[21,24] establishing shared laboratory spaces, equipment and supplies, human resources and transport systems would be mutually beneficial to both tuberculosis and antimicrobial resistance programmes and improve universal access to diagnostics for the population served. It will create opportunities for accessing a larger patient population with a wider spectrum of infections, along with engaging health-care providers from various specialties and government bodies from different sectors This can only be achieved through coordinated planning by antimicrobial resistance and tuberculosis control programmes at the country level; for example, to include managing the expanded remit of staff and their training in the use of a wider set of technologies

Conclusions

Global tuberculosis report