Tuberculosis Drug Resistance and the History of Modern Medicine Salmaan Keshavjee and Paul Farmer N Engl J Med 2012 Sep 6367109316 Tuberculosis whether caused by drugsusceptible or drugresistant strains rarely made even medical headlines in part because its importance as a caus ID: 1046092
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1. Why are new drugs and cheaper, more user friendly regimes needed?
2. * Tuberculosis, Drug Resistance, and the History of Modern Medicine. Salmaan Keshavjee and Paul Farmer. N Engl J Med. 2012 Sep 6;367(10):931-6."Tuberculosis, whether caused by drug-susceptible or drug-resistant strains, rarely made even medical headlines, in part because its importance as a cause of death continued to decline in areas in which headlines are written.”Keshavjee and Farmer, NEJM, 2012*And what TB crisis?
3. *Tuberculosis, Drug Resistance, and the History of Modern Medicine. Salmaan Keshavjee and Paul Farmer. N Engl J Med. 2012 Sep 6;367(10):931-6.Cost-ineffective?“…selective primary health care and ‘cost-effectiveness’ have shaped an anemic response to the ongoing global pandemic.”*
4. Slide courtesy: Prof Keertan Dheda
5. Financing the scale-up of MDR-TB prevention and Treatment. Katherine Floyd, Stop TB, WHO. Ministerial meeting. Beijing, China, 2009http://www.who.int/tb_beijingmeeting/media/press_pack/presentations/day2_presentation3.pdfSA : MDR-TB already >55% of TB budget!
6. The perception among the majority is that we are not at risk of being infected by TB. This assumption is deeply flawed.Dr Madhukar Pai, India Tribune, 29 October 2012http://www.tribuneindia.com/2012/20121029/edit.htm#6The RNTCP needs to think beyond treatment of drug-resistant TB, and focus on preventing a major epidemic. In the case of drug-resistant TB, an ounce of prevention is definitely better than a pound of cure
7. Care for the carer±1/100: number of South Africans diagnosed with TB last year (WHO, 2012). 3x: increased rate of TB among Health Care Workers globally (Baussano, 2011).6.3%: confirmed drug-resistance among occupational TB cases at Tygerberg Hospital (Data: 2008-2011).5.56x higher incidence rate of MDR- and XDR (O’Donnell, 2010)Means 3/100 HCW’s could be diagnosed with TB every yearAt least 1/16 could have MDR-TB or worse
8. Lucky and thankful…Dalene got her life back, she can still hear, and can even practice as a clinician again…what next?TB PROOF
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10. Start at the beginning:
11. 2nd Year Medical Students
12. Anyone can get TBhttp://www.health24.com/tools/Slideshows/1891-4704-4775,61850.aspNobel peace prize TB survivors“UBUNTU” – I am because we areWe are all in this together!
13. HOPE: Life after TBSA record: 114m in one breath!
14. Thank you!Physicians:Paul Willcox Andreas DiaconSimon SchaafTony BiebuyckJantjie TaljaardKeertan DhedaPharmacologyGary MaartensElsimé Kift Jeannine Du Bois SupportiveJustus Apffelstaedt - SurgeryMou Manie - RheumatologyAnton Doubell - CardiologyMark Abelson – CardiologyProf Loock – Ear, nose and throatRadiologySucari VlokArthur Maydall Jan Lotz Occupational Health/TBHJack MeintjiesSr SamuelsSr ArendseMatodzi Mukosi - superElmarie MalekMariana KrugerSAMA - Daniel MadibaCBTBR/Genetics:Gerhard WalzlBelinda KrielDaleen KrielRob WarrenTommie VictorSoraya Bardien-KrugerLizma StreicherTibotec/Janssen:David McNeeleyGilles van BaarNHLS Mariza HoffmanHaematology and Microbiology TechnologistsAudiology:Rene VisagieSharon PitheyTygerberg AudiologistsCAPRISANesri PadayatchiKogieleum NaidooTB PROOFAngela DramowskiBart WillemsHeena NarotamHelene-Mari van der WesthuizenKoot KotzeTreatment Action Group
15. “The momentum to break this disease is in real danger. We are now at a crossroads between TB elimination within our lifetime, and millions more TB deaths.” Dr Mario Raviglione; Director of the WHO Stop TB Department; 17 October 2012Questions?