Bennani K, van den Boom M, ElMedrek M G, Hutin Y
WHO Regional Office for the Eastern Mediterranean Region, Cairo, Egypt.
IJTLD Open. 2024 Sep 1;1(9):398-403. doi: 10.5588/ijtldopen.24.0348. eCollection 2024 Sep.
Since 2012, WHO has supported countries in scaling up programmatic management of drug-resistant tuberculosis (PMDT). We assessed progress and challenges to formulate recommendations for improvement.
We reviewed the regional Green Light Committee (rGLC)mission reports and analysed data to describe the progression of programme indicators.
The proportion of TB patients initially tested using Xpert MTB/RIF rose from 5% in 2017 to 54% in 2022. Testing for rifampicin-resistant TB (RR-TB) increased from 4% in 2015 to 68% in 2022 among new patients and from 17% in 2015 to 94% in 2022 among those previously treated. Consequently, in 2021-2022, the number of multidrug-resistant (MDR)/RR-TB patients diagnosed increased by 29% and 84% of them were treated, accounting for 22% of estimated cases. By 2023, fourteen countries had implemented all-oral regimens, with three initiating the 6-month bedaquiline, pretomanid, linezolid, and moxifloxacin regimen (BPaL(M)). MDR/RR-TB treatment success increased from 64% in 2017 to 73% in 2020.
Eastern Mediterranean Region countries progressed in PMDT using Xpert MTB/RIF, increased diagnosis and treatment of MDR/RR-TB patients using all-oral regimens, and improved treatment success. They must now enhance diagnostic capacity using WHO-recommended diagnostics, decentralise services while integrating them into primary health care, and prioritise the BPaL(M) regimen.
自2012年以来，世界卫生组织支持各国扩大耐多药结核病的规划管理（PMDT）。我们评估了进展情况和挑战，以制定改进建议。
我们审查了区域绿灯委员会（rGLC）的任务报告并分析数据，以描述项目指标的进展情况。
最初使用Xpert MTB/RIF检测的结核病患者比例从2017年的5%上升至2022年的54%。新患者中耐利福平结核病（RR-TB）的检测率从2015年的4%增至2022年的68%，既往治疗患者中的检测率从2015年的17%增至2022年的94%。因此，在2021-2022年，耐多药/利福平耐药结核病（MDR/RR-TB）患者的诊断数量增加了29%，其中84%接受了治疗，占估计病例的22%。到2023年，14个国家实施了全口服方案，3个国家启动了6个月的贝达喹啉、普瑞玛尼、利奈唑胺和莫西沙星方案（BPaL(M)）。MDR/RR-TB治疗成功率从2017年的64%提高到2020年的73%。
东地中海区域各国在使用Xpert MTB/RIF进行PMDT方面取得了进展，采用全口服方案增加了MDR/RR-TB患者的诊断和治疗，并提高了治疗成功率。它们现在必须使用世界卫生组织推荐的诊断方法提高诊断能力，在将服务纳入初级卫生保健的同时实现服务的分散化，并优先采用BPaL(M)方案。
