Saktiawati Antonia Morita Iswari, Vasiliu Anca, Saluzzo Francesca, Akkerman Onno W
Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 55584, Indonesia.
Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 55584, Indonesia.
Pathogens. 2024 Nov 28;13(12):1045. doi: 10.3390/pathogens13121045.
The global burden of drug-resistant tuberculosis (DR-TB) continues to challenge healthcare systems worldwide. There is a critical need to tackle DR-TB by enhancing diagnostics and drug susceptibility testing (DST) capabilities, particularly for emerging DR-TB drugs. This endeavor is crucial to optimize the efficacy of new therapeutic regimens and prevent the resistance and overuse of these invaluable weapons. Despite this urgency, there remains a lack of comprehensive review of public health measures aimed at improving the diagnostics and DST capabilities. In this review, we outline strategies to enhance the capabilities, especially tailored to address the challenges posed by resistance to new DR-TB drugs. We discuss the current landscape of DR-TB drugs, existing diagnostic and susceptibility testing methods, and notable gaps and challenges in these methods and explore strategies for ensuring fair access to DST while narrowing these disparities. The strategies include public health interventions aimed at strengthening laboratory infrastructure, workforce training, and quality assurance programs, technology transfer initiatives, involving drug developers in the DST development, establishing national or regional referral hubs, fostering collaboration and resources pooling with other infection control efforts, extending testing access in underserved areas through public-private partnerships, advocating for lowering costs or loans at low interest, remote technical support, and implementing mandatory molecular surveillance monitoring. This review underscores the urgent need to enhance DST capacities for new DR-TB drugs and identifies opportunities for innovation and improvement. Assessing the extent of the global health impact of these measures is crucial to ensure their effectiveness in combating DR-TB.
耐多药结核病（DR-TB）的全球负担继续对全球医疗系统构成挑战。迫切需要通过提高诊断和药物敏感性测试（DST）能力来应对耐多药结核病，特别是针对新兴的耐多药结核病药物。这一努力对于优化新治疗方案的疗效以及防止这些宝贵药物的耐药性和过度使用至关重要。尽管存在这种紧迫性，但仍缺乏对旨在提高诊断和DST能力的公共卫生措施的全面审查。在本综述中，我们概述了提高这些能力的策略，特别是针对应对耐多药结核病新药耐药性带来的挑战而量身定制的策略。我们讨论了耐多药结核病药物的现状、现有的诊断和药敏测试方法，以及这些方法中明显的差距和挑战，并探讨了在缩小这些差距的同时确保公平获得DST的策略。这些策略包括旨在加强实验室基础设施、劳动力培训和质量保证计划的公共卫生干预措施、技术转让倡议、让药物开发商参与DST开发、建立国家或区域转诊中心、促进与其他感染控制工作的合作和资源共享、通过公私伙伴关系扩大服务不足地区的检测机会、倡导降低成本或提供低息贷款、远程技术支持以及实施强制性分子监测。本综述强调了迫切需要提高对耐多药结核病新药的DST能力，并确定了创新和改进的机会。评估这些措施对全球健康影响的程度对于确保其在抗击耐多药结核病方面的有效性至关重要。
