Guidelines for surveillance of drug resistance in tuberculosis
Fourth edition
Overview
This fourth edition of World Health Organization (WHO) Guidelines for surveillance of drug resistance in tuberculosis is an updated version of earlier editions published in 1994, 1997 and 2003.
These guidelines incorporate the 2007 WHO "Interim recommendations for the surveillance of drug resistance in tuberculosis", as well as the conclusions of an Expert Committee Meeting on Anti-Tuberculosis Drug Resistance Surveys held in Geneva in September 2008. In addition, the guidelines take into account recent advancements in laboratory diagnostics and subsequent WHO guidance, including the 2008 WHO "Policy guidance on drug-susceptibility testing (DST) of second-line anti-tuberculosis drugs" and the 2008 WHO Policy Statement, "Molecular line probe assays for rapid screening of patients at risk of multidrug-resistant tuberculosis".
Furthermore, these updated guidelines incorporate the wealth of experience gained from 15 years of the Global Project on Anti-Tuberculosis Drug Resistance Surveillance (hereinafter, referred to as the Global Project), a project initiated by WHO and the International Union Against Tuberculosis and Lung Disease (The Union).
The aim of the current guidelines is to assist national tuberculosis control programmes (NTPs) in developing the strongest possible mechanisms of surveillance, starting from periodic country-specific surveys of sampled patients, but moving towards surveillance systems based on routine drug susceptibility testing (DST). Mechanisms for carrying out surveillance vary from country to country, but these guidelines promote certain standardized criteria for surveillance within the Global Project to ensure that results are comparable between participating countries, as well as within countries over time.
The target audience of these guidelines is the NTP, and in particular a coordination team for surveillance composed of the NTP manager, laboratory specialist, logistics specialist, epidemiologist, and statistician.
This edition of the guidelines is divided into two parts. Part I describes the principles of the Global Project that should be considered fundamental to both surveillance systems and periodic surveys. Part II describes the steps needed to plan and implement a survey, as well as manage and interpret the collected data.
Supplementary materials to the guidelines
Script for use in analysis of data
This script in Stata (http://www.statacorp.com) analyzes a sample cluster survey dataset using methods for multiple imputation of missing data and logistic regression with robust errors, to account for sampling design effects. (Please download the files below by right clicking and then select save as.)