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On July 8-11, 2019, the Harvard Medical School Center for Global Health Delivery–Dubai hosted a four-day workshop focused on best practices in multidrug-resistant tuberculosis care. Convening 106 individuals, the workshop focused on the current and future state all-oral short regimens for MDR-TB. Representatives from Interactive Research & Development (IRD), Medecins San Frontieres (MSF), Partners In Health (PIH), and the HMS Center for Global Health Delivery–Dubai facilitated the workshop.
The workshop opened with an introduction and welcome from Dr. Salmaan Keshavjee, Director of the Harvard Medical School Center for Global Health Delivery–Dubai and Dr. Aamir Khan, Executive Director of Interactive Research & Development. Dr. Keshavjee then gave an overview of current state of therapy for MDR-TB and reviewed the agenda for the workshop. Through a combination of presentations, discussions, and breakout sessions, the workshop aimed to achieve the following objectives:
- Understand the components of a comprehensive program to drive down TB rates
- Understand how MDR-TB care fits into a comprehensive approach
- Choose an all-oral shorter regimen(s) for participant countries
- Write a full first draft of an operational research protocol
- Understand the role of pharmacovigilance reporting, including different PV reporting options based on participant country’s conditions
- Adapt standard data collection forms and the endTB electronic medical record (EMR) to your country
- Safety monitoring for serious adverse events
- Implementation of EMR for data collection
- Overview of paper forms for simplified data collection
- Review of clinical management
- To review experiences delivering preventive therapy for MDR-TB
- To brainstorm approaches to delivering preventive therapy in households of patients receiving shorter regimens for MDR-TB disease
On day one of the workshop, Dr. Keshavjee and Dr. Courtney Yuen presented an overview of the three pieces of a comprehensive approach to control the TB epidemic: SEARCH, TREAT, and PREVENT. Later in the day Dr. Norbert Ndjeka and Dr. Khan presented case examples of the comprehensive approach in action in South Africa and Pakistan respectively.
On day two, participants learned about what factors to consider when choosing an all-oral shorter regimen for their country and then divided into breakout sessions to discuss operational research protocols, examples of all-oral shorter regimens being implemented under research conditions, and examples when changes to the backbone regimen are needed.
Day three was focused on monitoring, management and, reporting on safety. Presenters also reviewed tools for data collection data capture and management, workflow, and databases. Dr. Uzma Khan from IRD also presented an overview of clinical decision making and pointed to helpful resources.
Day four of the workshop focused on post-exposure management of persons exposed to MDR-TB at home. Dr. Jennifer Furin reviewed the rationale for preventive therapy and global experience. Examples of case experiences from Pakistan and Russia were also presented. The second half of day four was comprised of a facilitated group discussion focused on challenges to implementation and experience sharing.
Participants were extremely pleased with the workshop and said that the information they learned was valuable. A Dropbox folder including all presentations and data collection forms discussed during the workshop has been distributed to all participants. Proceedings from the workshop are forthcoming.
Number of Participants: 106
Number of Countries: 28
Countries Represented: Afghanistan, Amsterdam, Armenia, Belgium, China, France, Georgia, Haiti, India, Indonesia, Kazakhstan, Lesotho, Liberia, Malaysia, Mexico, Mozambique, Pakistan, Peru, Russia, Rwanda, Sierra Leone, South Africa, Switzerland, United Arab Emirates, United States of America, Vietnam, Zimbabwe