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Open Access Clinical perspectives on treatment of rifampicin-resistant/multidrug-resistant TB

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Rapid diagnostics, newer drugs, repurposed medications, and shorter regimens have radically altered the landscape for treating rifampicin-resistant TB (RR-TB) and multidrug-resistant TB (MDR-TB). There are multiple ongoing clinical trials aiming to build a robust evidence base to guide RR/MDR-TB treatment, and both observational studies and programmatic data have contributed to advancing the treatment field. In December 2019, the WHO issued their second ‘Rapid Communication´ related to RR-TB management. This reiterated their prior recommendation that a majority of people with RR/MDR-TB receive all-oral treatment regimens, and now allow for specific shorter duration regimens to be used programmatically as well. Many TB programs need clinical advice as they seek to roll out such regimens in their specific setting. In this Perspective, we highlight our early experiences and lessons learned from working with National TB Programs, adult and pediatric clinicians and civil society, in optimizing treatment of RR/MDR-TB, using shorter, highly-effective, oral regimens for the majority of people with RR/MDR-TB.
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Keywords: MDR-TB; TB; drug-resistant; human rights; oral regimen

Document Type: Research Article

Affiliations: 1: Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Soauth Africa 2: Treatment Action Group, New York, NY, USA 3: Médecins Sans Frontières (MSF), Khayelitsha, South Africa 4: Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, and Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa 5: Eswatini National TB Control Programme, Manzini, Eswatini 6: Global TB Program, Baylor College of Medicine, Houston, TX, USA 7: Hinduja Hospital & Research Centre, Mumbai, India 8: MSF, Cape Town, South Africa 9: Independent Consultant, Maputo, Mozambique 10: Republican Scientific and Practical Centre for Pulmonology and TB, Minsk, Belarus 11: Department of Infectious Diseases, Imperial College London, UK, and Desmond Tutu TB Centre, Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg, South Africa 12: National Department of Health, Mahikeng, North West Province, South Africa 13: Partners In Health (PIH), Boston, MA, USA 14: National Department of Health, Johannesburg, Gauteng Province, South Africa 15: PIH, Maseru, Lesotho 16: MSF, Eshowe, South Africa 17: National Tuberculosis and Leprosy Programme, Ministry of Health, Lusaka, Zambia 18: Health Systems Research Unit, South African Medical Research Council, Durban, South Africa 19: Interactive Research and Development, Karachi 20: Interactive Research and Development, Karachi, Pakistan, and Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK 21: Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa 22: MSF, Paris, France 23: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

Publication date: November 1, 2020

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

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