Tuberculosis infection control
The association of TB and HIV/AIDS, the lack of concern paid to TB transmission in health care and congregate settings, and the absence of a global TB infection control strategy have created a suitable environment for efficient transmission and spread of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB), as well as drug-susceptible TB among patients, health-care workers, and the community.
Weak health systems in general, and weak TB control programmes in particular, have caused MDR-TB to emerge in countries where TB short-course chemotherapy was introduced in the absence of a strong (public health) DOTS programme. High default rates and poor clinical practice have resulted in increasing MDR-TB rates in new and previously treated patients. Inadequate treatment of these patients with second-line TB drugs has resulted in XDR-TB. A recent outbreak of XDR-TB in a hospital in rural South Africa served to illustrate the devastating impact that TB transmission can have on fellow patients and health-care workers, in a high HIV-prevalence setting.
The potential impact of TB transmission in health-care and congregate settings on global TB morbidity and mortality has highlighted the urgent need to refocus attention on TB infection control. Lessons must be garnered from successful pilots and innovations, leading to models for national scale-up. This process requires the commitment of all implementing partners, coordination of stakeholder actions, and donor support.