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

• Published in: Pulmonology Vol. 24; no. 2; pp. 132 - 141
• Main Authors: D’Ambrosio, L, Bothamley, G, Caminero Luna, J.A, Duarte, R, Guglielmetti, L, Muñoz Torrico, M, Payen, M.C, Saavedra Herrera, N, Salazar Lezama, M.A, Skrahina, A, Tadolini, M, Tiberi, S, Veziris, N, Migliori, G.B
• Format: Journal Article
• Language: English
• Published: Spain Elsevier 01-03-2018; Taylor & Francis
• Subjects: Adult; Child; Europe; Human health and pathology; Humans; Infectious diseases; Internal Medicine; Life Sciences; Patient Care Team; Pulmonary/Respiratory; Pulmonology and respiratory tract; Tuberculosis, Multidrug-Resistant - drug therapy; Europe; Prevention; MDR-TB; Clinical management; XDR-TB; Drug resistance; Consilium
• ISSN: 2173-5115; 2531-0437; 2173-5115; 2531-0437
• DOI: 10.1016/j.rppnen.2017.10.005

AbstractAs 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.