Programmatic Management of Drug-Resistant Tuberculosis: An Updated Research Agenda
Programmatic Management of Drug-Resistant Tuberculosis: An Updated Research Agenda
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DOI：
10.1371/journal.pone.0155968
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发表时间：
2016-05-25
期刊：
影响因子：
3.7
通讯作者：
Wares, Fraser
中科院分区：
文献类型：
--
作者：
Mitnick, Carole D.;Rodriguez, Carly A.;Wares, Fraser
在为耐多药结核病（MDR-TB）提供适当治疗方面存在许多挑战，指导这些实践的证据基础仍然有限。我们提出了第三次更新的研究议程耐药结核病（PMDT）的方案管理，通过文献综述和survey.MethodsPublications引用2008年的研究议程和规范性文件进行了审查证据差距。差距被制定成问题，并在2008年的研究议程分组：实验室支持，治疗策略，规划相关的研究，流行病学和接触管理。通过滚雪球抽样进行调查，以确定研究的优先事项。对受访者的优先顺序进行评分，并按平均值进行总结。敏感性分析探讨权重和处理缺失ranking.ResultsThirty规范性文件和出版物进行了审查，规定的研究需求，这些都崩溃成56个研究问题，在5个类别。在500多名接受调查的人中，有133人至少在一个类别中列出了优先事项。各类别中的优先事项包括新的诊断方法及其对改善治疗结果的影响，改善对少菌和肺外结核的诊断，以及开发更短、有效的治疗方案。阻断院内传播和治疗已知耐多药结核病患者接触者的潜伏结核感染也是其各自类别的最高优先事项。结果是内部一致的和robust.DiscussionPriorities保留从2008年的研究议程，包括较短的耐多药结核病治疗方案和避免传播。最近的进展的局限性，暗示在继续寻求：较短的方案，包含新的药物，快速诊断，提高治疗效果，并改进方法，估计负担没有代表性的data.ConclusionThere是连续性的优先事项，在PMDT的研究。协调努力解决有关缩短治疗方案、了解没有代表性数据的疾病负担以及治疗已知耐药结核病患者接触者中的LTBI等问题，对于遏制结核病（包括耐药结核病）的流行至关重要。
IntroductionThere are numerous challenges in delivering appropriate treatment for multidrug-resistant tuberculosis (MDR-TB) and the evidence base to guide those practices remains limited. We present the third updated Research Agenda for the programmatic management of drug-resistant TB (PMDT), assembled through a literature review and survey.MethodsPublications citing the 2008 research agenda and normative documents were reviewed for evidence gaps. Gaps were formulated into questions and grouped as in the 2008 research agenda: Laboratory Support, Treatment Strategy, Programmatically Relevant Research, Epidemiology, and Management of Contacts. A survey was distributed through snowball sampling to identify research priorities. Respondent priority rankings were scored and summarized by mean. Sensitivity analyses explored weighting and handling of missing rankings.ResultsThirty normative documents and publications were reviewed for stated research needs; these were collapsed into 56 research questions across 5 categories. Of more than 500 survey recipients, 133 ranked priorities within at least one category. Priorities within categories included new diagnostics and their effect on improving treatment outcomes, improved diagnosis of paucibacillary and extra pulmonary TB, and development of shorter, effective regimens. Interruption of nosocomial transmission and treatment for latent TB infection in contacts of known MDR-TB patients were also top priorities in their respective categories. Results were internally consistent and robust.DiscussionPriorities retained from the 2008 research agenda include shorter MDR-TB regimens and averting transmission. Limitations of recent advances were implied in the continued quest for: shorter regimens containing new drugs, rapid diagnostics that improve treatment outcomes, and improved methods of estimating burden without representative data.ConclusionThere is continuity around the priorities for research in PMDT. Coordinated efforts to address questions regarding shorter treatment regimens, knowledge of disease burden without representative data, and treatment for LTBI in contacts of known DR-TB patients are essential to stem the epidemic of TB, including DR-TB.