Treat TB

Global Consultation on Digital Radiography - 2010

Over the past five decades, public health policy discouraged the use of chest radiography as a diagnostic tool for TB primarily due to the unreliability of chest X-ray interpretations. Despite these concerns, chest radiography remained part of the algorithm for the diagnosis of sputum smear-negative pulmonary TB. Because other approaches to chest radiography for evaluation of lung disease has overcome these problems and because it is nevertheless widely used in practice, investigators have continued to work to improve the quality of chest radiography and to standardize the reading and recording of X-rays. Because the complex supply, development and storage requirements for traditional film-based radiography are no longer applicable in these situations and high-quality images can be transmitted efficiently through electronic networks, it is possible that digital radiography could radically improve the detection, diagnosis, and treatment of patients in these settings. There are many requirements, however, for effective use of digital radiography in low resource-high burden health systems including the purchase of appropriate equipment, adequate transmission capacity, professional interpretation of results, and informed incorporation of the technology into diagnostic algorithms of TB control programs. Many of these requirements may best be examined through operational research focused on key implementation questions relevant to low resource-high burden operating environments. To move forward on the development of this research agenda, a TREAT TB-sponsored global consultation on digital radiography was held in 2010. Over 20 experts from 15 countries were convened to review historical data on both traditional film-based and digital radiography and identify and refine the priority research questions related to digital radiography.

The report and research agenda from this consultation can be accessed here (PDF 422KB).

Global Consultation on Retreatment Regimens - 2009

The management of TB patients who fail, relapse or default from first‐line treatment is becoming an increasingly complex and urgent problem. An estimated 1 million patients worldwide may be in need of 'retreatment' for TB. The development of currently recommended retreatment regimens pre‐dated the use of rifampicin‐throughout regimens and there is concern that they may no longer be ideal in the current environment of widespread six‐month, rifampicin‐throughout, first-line regimens. Moreover, their use may be accompanied by a risk of amplification of drug‐resistance and contribute to the global MDR‐TB epidemic. While the state of research evidence and particularly clinical trial evidence for TB treatments in general is lacking, the necessary evidence to guide decision making for retreatment patients is almost non‐existent. There is an urgent need for a comprehensive and efficient program of operations and clinical research in this area to ensure a sufficient evidence base for future decision making in the field. To move forward on the development of this research agenda, a TREAT TB-sponsored global consultation on retreatment regimens was held in 2009. Over 20 technical experts were convened to review available systematic review data on retreatment regimens, to consider data from recent projects related to retreatment regimens, to identify key research issues related to retreatment regimens, to further develop the priority research questions related to retreatment regimens, and to identify key steps required to move forward to address a retreatment regimen-focused research agenda.

The report and research agenda from this consultation can be accessed here (PDF 561KB).