scholarly journals Introducing bedaquiline: experiences from the Challenge TB Project

2020 ◽  
Vol 24 (10) ◽  
pp. 1046-1053
Author(s):  
C. G. Edwards ◽  
D. F. Wares ◽  
G. Dravniece ◽  
A. Gebhard ◽  
E. Tiemersma ◽  
...  

BACKGROUND: Drug-resistant tuberculosis (DR-TB) remains a global public health crisis. In 2013, the World Health Organization recommended the introduction of bedaquiline (BDQ) for eligible DR-TB patients.METHODS: We conducted a retrospective review and analyses of project reports from 2016 to mid-2019 on the processes, activities implemented, available results on enrolment and interim treatment outcomes, across the 23 Challenge TB (CTB) supported countries.RESULTS: Initial introduction of BDQ-containing regimens in the 23 CTB-supported countries took on average 2 years, with subsequent nation-wide scale-up achieved in Ethiopia and Kyrgyzstan within a short time period. Successful implementation required critical interventions including advocacy, revision of policies and guidelines, capacity building of health care workers, and strengthening of laboratory networks. The number of countries providing BDQ increased from 9 to 23; 9398 patients were enrolled on bedaquiline containing regimens; 71% were culture-negative after 6 months of treatment; and the number of countries reporting serious adverse events increased (from 5 to 18). Major challenges included limited in-country coordination with drug regulatory agencies, unrealistic quantification and drug ordering, weak laboratory networks and reporting systems for drug safety.CONCLUSION: BDQ introduction required a systematic and programmatic approach. The initial time investment helped achieve initial introduction and scale-up of coverage, ownership and sustainability by National TB Programmes.

2020 ◽  

In the past 100 years, the world has faced four distinctly different pandemics: the Spanish flu of 1918-1919, the SARS pandemic of 2003, the H1N1 or “swine flu” pandemic of 2012, and the ongoing COVID-19 pandemic. Each public health crisis exposed specific systemic shortfalls and provided public health lessons for future events. The Spanish flu revealed a nursing shortage and led to a great appreciation of nursing as a profession. SARS showed the importance of having frontline clinicians be able to work with regulators and those producing guidelines. H1N1 raised questions about the nature of a global organization such as the World Health Organization in terms of the benefits and potential disadvantages of leading the fight against a long-term global public health threat. In the era of COVID-19, it seems apparent that we are learning about both the blessing and curse of social media.


Author(s):  
Ishani Pathmanathan ◽  
Anand Date ◽  
William L. Coggin ◽  
John Nkengasong ◽  
Amy S. Piatek ◽  
...  

Background: To eliminate preventable deaths, disease and suffering due to tuberculosis ,improved diagnostic capacity is critical. The Cepheid Xpert MTB/RIF® assay is recommended by the World Health Organization as the initial diagnostic test for people with suspected HIV associatedtuberculosis. However, despite high expectations, its scale-up in real-world settings has faced challenges, often due to the systems that support it.Opportunities for System Strengthening: In this commentary, we discuss needs and opportunities for systems strengthening to support widespread scale-up of Xpert MTB/RIF as they relate to each step within the tuberculosis diagnostic cascade, from finding presumptive patients, to collecting, transporting and testing sputum specimens, to reporting and receiving results, to initiating and monitoring treatment and, ultimately, to ensuring successful and timely treatment and cure. Investments in evidence-based interventions at each step along the cascade and within the system as a whole will augment not only the utility of Xpert MTB/RIF, but also the successful implementation of future diagnostic tests.Conclusion: Xpert MTB/RIF will only improve patient outcomes if optimally implemented within the context of strong tuberculosis programmes and systems. Roll-out of this technology to people living with HIV and others in resource-limited settings offers the opportunity to leverage current tuberculosis and HIV laboratory, diagnostic and programmatic investments, while also addressing challenges and strengthening coordination between laboratory systems, laboratory-programme interfaces, and tuberculosis-HIV programme interfaces. If successful, the benefits of this tool could extend beyond progress toward global End TB Strategy goals, to improve system-wide capacity for global disease detection and control.


2021 ◽  
pp. 008124632110015
Author(s):  
Siphelele Nguse ◽  
Douglas Wassenaar

COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2, has affected most parts of the globe since its first appearance in the city of Wuhan, China, in December 2019. As a result, the World Health Organization declared the virus a global public health crisis and a pandemic within 2 weeks, after the virus had spread to 114 countries with 118 000 recorded cases and 4291 deaths due to the virus and related complications. The World Health Organization declaration is indicative of the enormous impact of the pandemic on human life globally. South Africa has not been exempted from that impact. While the pandemic has affected all South Africans in various ways, the poor have been most affected due to structural inequality, poverty, unemployment, and lack of access to quality health care and other services. Furthermore, public mental health has also been negatively affected by the pandemic, and this comes against a backdrop of an ailing mental health care system. We argue that the psychology profession, as a mental health profession and behavioural science, working as part of a multidisciplinary team, ought to play a significant role in addressing the mental health ramifications of the pandemic. In so doing, lessons can be drawn from other countries while establishing contextual immediate and long-term interventions.


2021 ◽  
Author(s):  
Grace Nyendwoha Namaganda ◽  
Audrey Whitright ◽  
Everd Bikaitwoha Maniple

Abstract BackgroundStaffing of health services ought to consider the workload experienced to maximize efficiency. However, this is rarely the case, due to lack of an appropriate approach. The World Health Organization (WHO) developed and has promoted the Workload Indicators of Staffing Need (WISN) methodology globally. Due to its relative simplicity compared to previous methods, the WISN has been used extensively, particularly after its computerization in 2010. Many lessons have been learnt from the introduction and promotion of the methodology across the globe but have, hitherto, not been synthesized for technical and policy consideration. This study gathered, synthesized, and now shares the key adaptations, innovations, and lessons learned. These could facilitate lesson-learning and motivate the WHO’s WISN Thematic Working Group to review and further ease its application.MethodsThe study aimed to answer four questions: (1) how easy is it for the users to implement each step of the WISN methodology? (2) what innovations have been used to overcome implementation challenges? (3) what lessons have been learned that could inform future WISN implementation? and (4) what recommendations can be made to improve the WISN methodology? We used a three-round traditional Delphi method to conduct a case study of user-experiences during the adoption of the WISN methodology. We sent three email iterations to 23 purposively selected WISN expert users across 21 countries in five continents. Thematic analysis of each round was done simultaneously with data collection.ResultsParticipants rated seven of the eight technical steps of the WISN as either “very easy” or “easy” to implement. The step considered most difficult was obtaining the Category Allowance Factors (CAF). Key lessons learned were that: the benefits gained from applying the WISN outweigh the challenges faced in understanding the technical steps; benchmarking during WISN implementation saves time; data quality is critical for successful implementation; and starting with small-scale projects sets the ground better for more effective scale-up than attempting massive national application of the methodology the first time round. ConclusionsThe study provides a good reference for easing WISN implementation for new users and for WHO to continue promoting and improving upon it.


2020 ◽  
Vol 72 ◽  
pp. 29-34 ◽  
Author(s):  
Rameshwar S. Cheke ◽  
Sachin Shinde ◽  
Jaya Ambhore ◽  
Vaibhav Adhao ◽  
Dnyaneshwar Cheke

The novel coronavirus disease (COVID-19) or also known as the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been recognized as the cause of respiratory infection in Wuhan, Hubei Province, China, in late December 2019. As of April 5, 2020, this epidemic had spread to worldwide with 12,03,485 confirmed cases, including 62,000 deaths. The World Health Organization has declared it a Global Public Health Crisis. Coronavirus causes respiratory illness coughing, sneezing, breathlessness, and fever including pneumonia. The disease is transmitted person to person through infected droplets. At present, the research on novel coronavirus is still in the primary stage. Based on the published study, we thoroughly summarize the history and origin, microbiology and taxonomy, mode of transmissions, target receptor, clinical features, diagnosis, prevention, and treatment about COVID-19. This short report writes in hope for providing platform to community and researcher dealings against with the novel coronavirus and providing a reference for further studies.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 807-808
Author(s):  
Bonnielin Swenor ◽  
Varshini Varadaraj ◽  
Moon Jeong Lee ◽  
Heather Whitson ◽  
Pradeep Ramulu

Abstract In 2019, the World Health Organization World Report on Vision estimated that that 2.2 billion people have a vision impairment, of which almost half could have been prevented or is yet to be addressed. As the global population ages and the prevalence of visual impairment increases, inequities in eye care and the downstream health and aging consequences of vision loss will become magnified. This session will: (1) provide key information regarding the burden of eye disease and visual impairment among older adults worldwide; (2) outline a framework created to conceptualize the aging and long-term health implications of vision loss, and (3) discuss the global public health challenges to eye care and to maximizing health for older adults with visual impairments.


Author(s):  
Grigoris Gerotziafas ◽  
Mariella Catalano ◽  
Ioannis Theodorou ◽  
Patrick van Dreden ◽  
Vincent Marechal ◽  
...  

One year after the declaration of the COVID-19 pandemic by the World Health Organization (WHO) and despite the implementation of mandatory physical barriers and social distancing, humanity remains challenged by a long-lasting and devastating public health crisis. Non-pharmacological interventions (NPI) are efficient mitigation strategies. The success of these intense NPI is dependent on the approval and commitment of the population. The launch of a mass vaccination program in many countries in late December 2020 with mRNA vaccines, adenovirus-based vaccines, and inactivated virus vaccines has generated hope for the end of the pandemic. Current issues: The continuous appearance of new pathogenic viral strains and the ability of vaccines to prevent infection and transmission raise important concerns as we try to achieve community immunity against SARS-CoV-2 and its variants. The need of a second and even third generation of vaccines and the possibility of potentially harmful side-effects of the vaccines (i.e. venous thromboembolism ) have already been acknowledged. Perspectives: There is a critical and urgent need for a balanced and integrated strategy for the management of the COVID-19 outbreaks organized on three axes: (1) Prevention of the SARS-CoV-2 infection, (2) Detection and early diagnosis of patients at risk of disease worsening, and (3) Anticipation of medical care (PDA). Conclusion: The “PDA strategy” integrated into state policy for the support and expansion of health systems and introduction of digital organization (i.e. telemedicine, artificial intelligence and machine learning technology) is of major importance for the preservation of citizens’ health and life world-wide.


2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Nafisa Qibriya Khan ◽  
A. H. Farooqui ◽  
Syed Ayesha Fatima ◽  
Jalil Ahmad ◽  
Tausif S. Khan

Coronavirus disease 2019 (COVID-19) is a pandemic disease of modern time with unique and rapid transmission rate and affected almost all the nations without respecting any border. Coronavirus disease 2019 (COVID-19) is arguably the biggest health crisis the world has faced in 21st century. It is an infectious disease and declared pandemic by the World Health Organization. The coronavirus disease 2019 (COVID-19) outbreak, which originated in Wuhan, China, has now spread to 192 countries and administrative regions infecting nearly 800,000 individuals of all ages as of 31 March 2020. Though most infected individuals exhibit mild symptoms including fever, upper respiratory tract symptoms, shortness of breath, and diarrhoea, or are asymptomatic altogether, severe cases of infection can lead to pneumonia, multiple organ failure, and death. Globally, at least 7900 deaths have been directly attributed to COVID19, and this number is expected to rise with the ongoing epidemic. This is particularly crucial as the current outbreak involves a new pathogen (SARS-CoV-2), on which limited knowledge exists of its infectivity and clinical profile. Research is in progress on therapeutic efficacy of various agents including anti-malarials (Chloroquine and Hydroxychloroquine), antiviral drugs, and convalescent serum of recovered patients. Unani system of medicine is one of the traditional systems of medicine which is being explored for providing preventive, supportive and rehabilitative care to patients. Unani system of medicine has a detailed description of drugs that are utilized in many infectious diseases, including respiratory infections. Immune response is essential to eliminate virus and to preclude disease progression to severe stages. Therefore, it is important to summarize the evidence regarding the preventive measures, control options such as immune-stimulator and prophylactic treatment in Unani medicine against Covid19. This review summarizes various pharmacological actions of Unani formulation Tiryaq-e-Arba in Unani literature and various reported pharmacological activities which can possibly provide prevention, control and reduction of complications of this deadly disease.


2021 ◽  
pp. 19-23
Author(s):  
Donizete Tavares Da Silva ◽  
Priscila De Sousa Barros Lima ◽  
Renato Sampaio Mello Neto ◽  
Gustavo Magalhães Valente ◽  
Débora Dias Cabral ◽  
...  

In March 2020, the World Health Organization (1) declared COVID-19 as a pandemic and a threat to global public health (2). The virus mainly affects the lungs and can cause acute respiratory distress syndrome (ARDS). In addition, coronavirus 2 severe acute respiratory syndrome (SARSCOV2) also has devastating effects on other important organs, including the circulatory system, brain, gastrointestinal tract, kidneys and liver


2014 ◽  
Vol 27 (3) ◽  
pp. 511-529 ◽  
Author(s):  
Sudeepa Abeysinghe

ArgumentScientific uncertainty is fundamental to the management of contemporary global risks. In 2009, the World Health Organization (WHO) declared the start of the H1N1 Influenza Pandemic. This declaration signified the risk posed by the spread of the H1N1 virus, and in turn precipitated a range of actions by global public health actors. This article analyzes the WHO's public representation of risk and examines the centrality of scientific uncertainty in the case of H1N1. It argues that the WHO's risk narrative reflected the context of scientific uncertainty in which it was working. The WHO argued that it was attempting to remain faithful to the scientific evidence, and the uncertain nature of the threat. However, as a result, the WHO's public risk narrative was neither consistent nor socially robust, leading to the eventual contestation of the WHO's position by other global public health actors, most notably the Council of Europe. This illustrates both the significance of scientific uncertainty in the investigation of risk, and the difficulty for risk managing institutions in effectively acting in the face of this uncertainty.


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