National advisory services for multidrug-resistant tuberculosis (MDRTB) in Europe: an ERS-TBnet survey
Journal
European Respiratory Journal
Date Issued
2019-09-28
Author(s)
Bothamley, Graham H.
Andre, Emmanuel
Kuksa, Liga
Barkana, Linda
Keane, Joseph
Veziris, Nicolas
Van Crevel, Reinout
Magis-Escurra, Cecile
Jankovic, Mateja
Schoch, Otto
Zellweger, Jean-Pierre
Vasankari, Tuula
Eyuboglu, Fusun
Holland, Regina
Normark, Johan
Macedo, Rita
Korzeniewska, Maria
Butov, Dmytro
Akkerman, Onno
Kirakosyan, Ohanna
Solovic, Ivan
Calcagno, Andrea
Kruczak, Katarzyna
Garcia Garcia, Jose Maria
Sanchez Montalva, Adrian
Dyatlov, Alexander
Starshinova, Anna
Kulcitkaia, Stela
Lillebaek, Troels
Wiese, Lothar
Hafizi, Hasan
Papaventis, Dimitros
Heldel, Einar
Arnesen, Trude Marget
Lanoix, Jean-Philippe
Chiappini, Elena
Wejse, Christian
Manika, Kataerina
Pesut, Dragica
Wetzstein, Nils
Skrahina, Alena
Flick, Holger
Arias, Miguel
Konstantynovska, Olha
Millet, Joan Pau
Bakker, Marleen
Lange, Christoph
DOI
10.1183/13993003.congress-2019.pa5285
Abstract
Introduction: Treatment of MDRTB is complex: regimens require microbiological data; adverse events are frequent; availability of drugs and authorization for new drugs varies. The aim of this study was to scope the available national resources.
Method: A survey to determine whether practising physicians could access MDRTB advice was sent to TBnet members by email. The ERS Office also contacted national respiratory societies. Questions included the name and contact details for their national advisory service, whether it was national policy to use the service for each patient with MDRTB and whether advice was required to access bedaquiline and delaminid.
Results: 65 replies were received (14 were uninformative). 26/31 EU/EEA and 10/19 other countries in the WHO European Region were represented. 7 countries referred all MDRTB to a tertiary centre; 12 countries had tertiary referral centres that also gave advice to physicians treating MDRTB. 11 countries had an electronic system for advice, 6 with multidisciplinary team meetings to review patients’ progress. Lead clinicians were identified for a further 8 countries, one of which had no national advisory service and the other 7 had not responded by the time of abstract submission. For 18 (58%) countries, discussion of MDRTB by a national /regional committee was national policy and most (15/18) required consultation to use bedaquiline or delamanid. Electronic platforms had a wide range of functionality but few retained anonymised data and audited patient outcomes.
Conclusion: MDRTB management is often concentrated in tertiary centres. Clinical governance, regarding audit and outcome, are at an early stage in managing MDRTB.
Method: A survey to determine whether practising physicians could access MDRTB advice was sent to TBnet members by email. The ERS Office also contacted national respiratory societies. Questions included the name and contact details for their national advisory service, whether it was national policy to use the service for each patient with MDRTB and whether advice was required to access bedaquiline and delaminid.
Results: 65 replies were received (14 were uninformative). 26/31 EU/EEA and 10/19 other countries in the WHO European Region were represented. 7 countries referred all MDRTB to a tertiary centre; 12 countries had tertiary referral centres that also gave advice to physicians treating MDRTB. 11 countries had an electronic system for advice, 6 with multidisciplinary team meetings to review patients’ progress. Lead clinicians were identified for a further 8 countries, one of which had no national advisory service and the other 7 had not responded by the time of abstract submission. For 18 (58%) countries, discussion of MDRTB by a national /regional committee was national policy and most (15/18) required consultation to use bedaquiline or delamanid. Electronic platforms had a wide range of functionality but few retained anonymised data and audited patient outcomes.
Conclusion: MDRTB management is often concentrated in tertiary centres. Clinical governance, regarding audit and outcome, are at an early stage in managing MDRTB.