Tuberculosis (TB) kills close to 2 million people around the world each year. Its impact is greatest on adults in their most productive working years (ages 15-54). WHO estimates that two billion people are infected with TB worldwide, nearly one-third of the global population. Of nine million new tuberculosis cases each year, nearly half a million are multidrug-resistant tuberculosis (MDR-TB). China and India account for 50 percent of MDR-TB cases worldwide. Multidrug-resistant tuberculosis (MDR-TB) is a major global public health threat resulting from interrupted or incomplete treatment of TB. MDR-TB does not respond to standard TB drugs, and treatment relies on a handful of antibiotics. The treatment for MDR-TB is long and complex, often resulting in poor patient compliance and development of further drug resistance. The recent emergence of extensively drug-resistant (XDR) strains of TB has initiated a call for TB control measures to be strengthened in order to prevent XDR-TB’s deadly spread. This strain of TB leaves those infected, including many people living with HIV, virtually untreatable using currently available TB drugs.

The shortage of trained medical personnel damages the effort to prevent and treat endemic diseases such as tuberculosis. It is important that frontline healthcare personnel in both the public and private sectors have access to appropriate and state-of-the art training because close to 60% of healthcare in countries with limited resources is provided by doctors, nurses and other related health professionals in the private sector.

WMA Current Policy & Action

WMA activities in the field of TB

MDR-TB and TB-refresher online course

Multidrug-Resistant Tuberculosis is difficult to treat. WHO and other international Organisations have developed guidelines on how to prevent and treat MDR-TB using the existing evidence from around the world. Guidelines, however, are theoretical knowledge that does not always translate easily into real world’s practice. Therefor WMA produce a self- learning program for the MDR-TB Guidelines and offer it through the internet free of charge. The CME-accredited MDR-TB online training course is available in English, Chinese. The pdf version is available in English, French, Spanish and Azeri. 

Still knowledge about basic tuberculosis is missing and therefore WMA decided to develop an online TB refresher course for physicians. The course is developed as a preparation course to the MDR-TB course of WMA and both courses together offers a complete summary of management of TB. The refresher course will provide basic clinical care information for TB including the latest diagnostics, treatment and information about multidrug-resistant TB. It will also provide information on how to ensure patient adherence and infection control and will include many aspects of TB care and management with a global scope so that it can be used across regions.The course is based on the International Standards for Tuberculosis Care (ISTC), which presents a set of widely accepted, evidence-based standards that all practitioners, public and private, should seek to achieve. The course also refers to and is consistent with the World Health Organization (WHO) Guidelines and recommendations for TB control. It Is as an online course available and to be downloaded as PDF in English. 

Master trainer course in MDR-TB

The recent identification of XDR-TB and the increasing number of MDR-TB cases show that the knowledge and handling of TB treatment is still insufficient. The MDR-TB online course provides physicians with education about MDR-TB treatment. However many questions remain unanswered and physicians require the opportunity to discuss difficult treatment processes with other experts. The WMA decided to offer a training course for trainers of physicians who are experts in TB.  Participants received the intense MDR-TB training in combination with training in adult learning and accelerated learning principles and beliefs. The objective was for these physicians to pass on their knowledge to other TB physicians in their hospital or area, so that this critical information can be widely distributed on a local level. The workshops took place in Pretoria, South Africa, in  India and in China.

MDR-TB and TB online patient cases

Together with New Jersey Medical School and their Global Tuberculosis Institute, and INMEDEA, a company creating interactive software for medical professionals, WMA has developed as training material 2 interactive patient cases based on the existing TB and MDR-TB cases. Due to the use of new multimedia technology and the web, the user has the impression to solve a real patient case when doing anamnesis, physical examination, making the diagnosis and deciding on a treatment plan. This does not replace the online courses which are more textbook based, but it is a complement to the existing courses and helps to check whether the learned content is really understood and, if not, one can fill the knowledge gaps.

Infection control and health care workers safety workshop

Given the already critical shortage of health providers and generally weak health systems in the regions most affected by XDR-TB and MDR-TB, anxiety about safety in the health care environment runs high and can dissuade health providers from accepting assignments in these settings. Together with the International Council of Nurses, International Hospital Federation and International Red Cross and Red Crescent, the WMA organised a set of inter-professional workshops on health worker safety in the context of drug-resistant TB in low and middle-income countries. The workshops addressed TB infection protection with the objective of identifying good practices, implementing joint recommendations for facilities and health workers and establishing a working group with a plan of action to communicate the identified practices and recommendations. The first workshop took place in Cape Town South Africa in November 2007, the following in Rio De Janeiro, Brazil in March 2009, in Durban, South Africa in June 2009, in Cotonou, Benin in 2010 and in Hangzhou, China in 2011.  All infection control and health workers safety workshops are on invitation only.

Mapping out ethical issues in TB control

Failure to treat and contain TB properly can result in the creation of new, more resistant strains of the disease. Now, the question remains whether patients can ethically be forced to complete their treatment regimen(s). Where does the autonomy of a patient end and the right of society begin? From a public health perspective, the bioethical interpretation of patients’ rights is not easily applicable to communicable diseases like tuberculosis. Hence, the WMA in cooperation with the WHO mapped out the ethical issues emerging in TB control, especially on XDR-TB and MDR-TB.

The workshops and other traning courses were funded by the Lilly MDR-TB partnership. The recent update of the TB refresher course was funded by the USAID TB CARE II project, implemented by University Research Co.LLC with technical assistance from the Global Tuberculosis Institute at Rutgers, The State University of New Jersey. 

WMA Educational Activities

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