Team approach to manage difficult-to-treat TB cases: Experiences in Europe and beyond

Abstract

As recommended by the World Health Organization (WHO), optimal management of MDR-TB cases can be ensured by a multi-speciality consultation body known as 'TB Consilium'. This body usually includes different medical specialities, competences and perspectives (e.g., clinical expertise both for adults and children; surgical, radiological and public health expertise; psychological background and nursing experience, among others), thus lowering the risk of making mistakes - or managing the patients inappropriately, in order to improve their clinical outcomes. At present, several high MDR-TB burden countries in the different WHO regions (and beyond) have introduced TB Consilium-like bodies at the national or subnational level to reach consensus on the best treatment approach for their patients affected by TB. In addition, in countries/settings where a formal system of consultation does not exist, specialized staff from MDR-TB reference centres or international organizations usually spend a considerable amount of their working time responding to phone or e-mail clinical queries on how to manage M/XDR-TB cases. The aim of this manuscript is to describe the different experiences with the TB Consilia both at the international level (European Respiratory Society - ERS/WHO TB Consilium) and in some of the countries where this experience operates successfully in Europe and beyond. The Consilium experiences are described around the following topics: (1) history, aims and focus; (2) management and funding; (3) technical functioning and structure; (4) results achieved. In addition a comparative analysis of the TB Consilia in the different countries has been performed.

Drug-Resistant Tuberculosis 2020: Where We Stand

“…A comparative analysis of the TB Consilia for management of difficult-to-treat MDR/XDR TB cases in Europe and Latin America has been reported [27]. In October 2018, a Global TB Consilium was launched by the Global TB Network, with the goal to provide to a clinician a response on difficult TB cases within 48 h [15,28].…”

Telemedicine in Resource-Limited Settings to Optimize Care for Multidrug-Resistant Tuberculosis

“…A number of countries, including Belarus, Belgium, France, Mexico, Portugal, and the UK have implemented national level TB consilia (11, 12). These were compared in a recent review (11).…”

“…A number of countries, including Belarus, Belgium, France, Mexico, Portugal, and the UK have implemented national level TB consilia (11, 12). These were compared in a recent review (11). Notably, a number of countries were using email-based discussion, which has privacy and legal implications, particularly where identifiable data or clinical images are used (13).…”

“…In many medium and high TB incidence settings, TB consilia have acted as an approval or consensus decision system for accessing new drugs or regimens for MDR TB, specifically relating to the use of the new TB drugs: bedaquiline and delamanid (11, 16, 17). Initially, from 2013, where access to these drugs was only via compassionate access or pilot programs, this facilitated a “gatekeeper” function with restricted use for specific indications only.…”

Tuberculosis and its future in the COVID-19 era: The Pulmonology series 2021

“…Pulmonology tuberculosis (TB) 2018 series was very successful and highly cited, 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 contributing to the journal’s Impact Factor (which increased from 2.096 to 2.778, and moving it into the second quartile of Respiratory Medicine journals) ( Table 1 ). The topics covered ranged from state-of-the-art review on new points of care diagnostic tests, 4 to the new drugs pipeline, 5 while discussing important clinical issues like management of TB in children 7 or how to manage comorbidities and social determinant of TB.…”