Towards elimination of tuberculosis in New Zealand.

Autor:	Verrall AJ; Senior Lecturer, Department of Pathology and Molecular Medicine, University of Otago Wellington, Wellington; Infectious Diseases Physician, Infection Services, Capital and Coast District Health Board, Wellington., Hill PC; Professor, Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin., Thorburn D; General Practitioner, Hutt Union and Community Health Services, Lower Hutt; Clinical Director, Te Awakairangi Health Network, Lower Hutt; Clinical Senior Lecturer, University of Otago Wellington, Wellington., Maze M; Respiratory Physician, Respiratory Department, Canterbury District Health Board; Senior Lecturer, Department of Medicine, University of Otago, Christchurch., Perumal L; Public Health Medicine Specialist, Auckland District Health Board, Auckland., Grimwade K; Infectious Diseases and General Physician, Bay of Plenty District Health Board, Tauranga., Thornley CN; Medical Officer of Health, Regional Public Health, Hutt Valley District Health Board, Lower Hutt., Freeman J; Clinical Microbiologist, Canterbury District Health Board, Christchurch; Clinical Senior Lecturer, Department of Pathology and Biomedical Science, University of Otago, Christchurch., Nisbet M; Infectious Disease and Respiratory Physician, Auckland District Health Board, Auckland., Blackmore TK; Microbiologist, Wellington Southern Community Laboratories, Wellington.
Jazyk:	angličtina
Zdroj:	The New Zealand medical journal [N Z Med J] 2020 Apr 24; Vol. 133 (1513), pp. 89-96. Date of Electronic Publication: 2020 Apr 24.
Abstrakt:	New Zealand could be the first country in the world to eliminate tuberculosis (TB). We propose a TB elimination strategy based on the eight-point World Health Organization (WHO) action framework for low incidence countries. Priority actions recommended by the WHO include 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) identify active TB and undertake screening for latent tuberculosis infection (LTBI) in recent TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. In New Zealand, central government needs to take greater responsibility for TB policy and programme governance. Urgent action is required to prevent TB in higher risk groups including Māori communities, and to enable immigration screening to detect and treat LTBI. Clinical services need to be supported to implement new guidelines for LTBI that enable better targeting of screening and shorter, safer treatment regimens. Access to WHO recommended treatment regimens needs to be guaranteed for drug-resistant TB. Better use of existing data could better define priority areas for action and assist in the evaluation of current control activities. Access to GeneXpert® MTB-RIF near the point of care and whole genome sequencing nationally would greatly improve clinical and public health management through early identification of drug resistance and outbreaks. New Zealand already has a world-class TB research community that could be better deployed to assist high-incidence countries through research and training. Competing Interests: Dr Perumal reports and works as the local Medical Officer of Health for TB control in the Auckland Region.
Databáze:	MEDLINE
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