Pulmonology Pulmonology
Pulmonol 2018;24:132-41 - Vol. 24 Num.2 DOI: 10.1016/j.rppnen.2017.10.005
Review
Team approach to manage difficult-to-treat TB cases: Experiences in Europe and beyond
L. D’Ambrosioa,b, , , G. Bothamleyc, , J.A. Caminero Lunad,e, , R. Duartef, , L. Guglielmettig,h, , , M. Muñoz Torricoi, , , M.C. Payenl, , N. Saavedra Herreram, , M.A. Salazar Lezamai, , , A. Skrahinan, , M. Tadolinio, , S. Tiberip,q, , N. Vezirisg,h, G.B. Miglioria,,
a WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy
b Public Health Consulting Group, Lugano, Switzerland
c Homerton University Hospital, London, United Kingdom
d Pneumology Department, Hospital General de Gran Canaria “Dr. Negrin”, Las Palmas de Gran Canaria, Spain
e MDR-TB Unit, Tuberculosis Division, International Union against Tuberculosis and Lung Disease The Union, Paris, France
f National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Department of Pneumology, Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal
g Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI, F-75013 Paris, France
h AP-HP, Hôpitaux Universitaires de l’Est Parisien, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, F-75013 Paris, France
i Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico
l Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles ULB, Brussels, Belgium
m National Tuberculosis Programme, Mexico City Mexico
n Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
o Unit of Infectious Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy
p Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
q Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
Received 17 October 2017, Accepted 29 October 2017
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.

Keywords
MDR-TB, XDR-TB, Clinical management, Drug resistance, Prevention, Consilium
Pulmonol 2018;24:132-41 - Vol. 24 Num.2 DOI: 10.1016/j.rppnen.2017.10.005