The most recent treatment of tuberculosis is based on a blending of drugs that were invented a number of decades ago. The rates of being cured are currently high for strains of Mycobacterium tuberculosis that are drug sensitive. This often takes place when the required complex and lengthy treatment procedures are followed. Medical practitioners are however faced with the challenge of appropriately prescribing and adhering to these practices. There has been an emergence of Mycobacterium tuberculosis strains that are resistant to a number of drugs and drug-drug interactions that mess with the prime treatment of Tuberculosis co-infected patients. This has led to a great need for the improvement of Tuberculosis therapies.

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These problem experienced in the recent has led to an interest in the invention of better treatment and protocols for treatment of tuberculosis (Deun, Maug, Salim, Das, Sarker, & Daru, 2010). This leads to the question, How has the emergence of Mycobacterium tuberculosis strains that are resistant to a number of drugs affected the treatment and prevention of Tuberculosis in Hong Kong? In this report, I will discuss how this health problem affects the people of Hong Kong, how the government of Hong Kong is responding to this health problem and how community-based services in Hong Kong can help to reduce the effect of this health issue.

Table of Contents

ABSTRACT2

INTRODUCTION3

Overview3

Objectives3

MAIN BODY4

Treatment of multi-resistant tuberculosis4

How Hong Kong based services has promoted strategies to reduce the impact of multi-resistant tuberculosis5

CONCLUSION7

REFERENCE9

Overview

In 1993, the World Health Organization declared tuberculosis as a global emergency (Tam, Yew, Leung, & Chan, 2001). From that time, special projects were started all over the world with the aim of stopping the spread of the disease. In Hong Kong, the disease remains a major infectious disease. Tuberculosis became a notifiable disease in Hong Kong in 1939. The first public service for tuberculosis treatment was established at Harcourt center. Other small clinics later followed it. In 2000, the country experienced 7578 notifications of the disease and around 300 deaths. This was tallied to crude notifications and death rates of 111.7 per 100,000 and 4.4 per 100,000. With time, the rate of tuberculosis in Hong Kong has indicated an overall downward trend. This trend, however, became constant since the 1990s.

Objective

The present method used in the cure of tuberculosis is based on principles of combined chemotherapy. This involves the use of multiple drugs to improve efficiency and to prevent the development of resistant organisms. The greatest problem with tuberculosis therapy with the modern treatment is the long length of time required to receive cure (Chan & Chan, 2007). This happens mainly because of the physiological heterogeneity of tuberculosis bacteria. Most patients with multi-drug-resistant tuberculosis can obtain treatment through a mixture of second- line drugs. However, the cost of obtaining such treatment is too high, and the patient may experience frequent adverse drug events.

There has been a major concern with the occurrence of TB (MDR-TB) that is multidrug resistant and broadly drug-resistant TB (XDR-TB) (Yew & Leung, 2008). MDR-TB is tuberculosis that has resistance to at least isoniazid and rifampicin. XDR-TB, on the other hand, is defined as MDR-TB together with bacillary resistance to any fluoroquinolone and one of the second-line drugs that are injectable: amikacin, kanamycin, and capreomycin. Reports obtained from the WHO and the International Union against Tuberculosis has made it possible to identify some hot spots for XDR-TB and MDR-TB

According to the data, MDR-TB rates are on a decline in the United States and Hong Kong. Drug resistance often develops due to selection pressure. Multidrug resistance, on the other hand, occurs when where there is a large bacillary population when there is a multiple failure of both the patient and medical provider to ensure enough regimen is taken or when the provider has prescribed inadequate drug regimen.

The emergence of Mycobacterium tuberculosis strains that are resistant to some drugs have affected the treatment and control of tuberculosis by increasing the cost of treatment. Since tuberculosis is mostly considered a disease of the poor, most of the patients may not be able to access treatment. MDR-TB is difficult to treat compared to drug-susceptible disease; as a result, there is an extremely low treatment rate of success. The patients suffering from MDR-TB may remain sick for a long time, and the cost of treatment is high. A dots plus strategy is required for the control of MDR-TB. This strategy integrates continuous drug-resistance surveillance, culture, and drug susceptibility testing for the patients and crafting of personal drug regimen by making use of first and second-line drugs.

The rate of tuberculosis notification in Hong Kong is high compared to other developed countries. In Hong Kong, the rate of MDR-TB ranges from 0.3 to 0.6 per 100,000 individuals from the year 1997 to 2006. MDR-TB and XDR-TB cases are about 1% and 0.1% respectively of the overall bacteriologically-positive tuberculosis notifications. It is, however, necessary for doctors to remain alerted and continually update knowledge and measures for the control of drug-resistant tuberculosis.

Treatment of multi-resistant tuberculosis

It has been advised that the susceptibility of drug testing of all pretreatment positive culture isolates should be conducted (Mukhrjee, Rich, & Socci, 2004). When the results are availed, the diagnosis of drug-resistant tuberculosis can easily be made, and the treatment regimen can be modeled as required. Early diagnosis of drug resistant tuberculosis ( MDR-TB and XDR-TB) is highly advantageous. Late diagnosis can lead to a gradual destruction of the lung, high bacillary load and gradual transmission of disease (Motus, Skorniakov, & Sokolov, 2006). A recent research revealed that the non-permanent residents of China living on financial aid, often travel and young age are more risk factors. It is important to obtain the number, details of past treatment as well as certification of non-adherence. To identify a probable pattern of drug resistance, a careful investigation of prior anti-TB treatment may be helpful.

It is advisable to contact the Public Health Laboratory Centre (PHLC) of Department of Health (DH) for consideration of drug receptiveness for first line as well as second line anti-tuberculosis drugs (Guptaa & Jain, 2004). PHLC may also be contacted for determining the drug susceptibility to being used. This can either be a rapid susceptibility test or a susceptibility test alongside mycobacterium identification test.

Research conducted revealed that in Hong Kong, the rate of rifampicin resistant strain that provides anchorage to rpo gene mutation was 93% (Morgan, Haritakul, & Keller, 2003). The incidence of MDR, on the other hand, is quite minimal. Before asking for rapid genetic tests for rifampicin resistance, the clinical risk factors for MDR should be considered. Genetic testing for rifampicin resistance can be useful, in specific patients with known risk factors of MDR-TB, specifically patients that have a public history of poor adherence to past treatment.

Role of the government in treatment of multi-resistant tuberculosis

The government of Hong Kong government has helped to deal with the issue of multi-resistant tuberculosis by employing a number of tactical strategies (Yew & Chau, 2003). This has been made possible by providing funds necessary to conduct public health surveillance and commencing contact screening. This is in addition to the normal registry of TB notification.

An MDR-TB registry was put up within the TB&CS since 1995 (Organization). These procedures were later updated in 2007. Each time an active and unreported case of MDR-TB or XDR-TB is diagnosed, the health practitioners are supposed to forward the case to Wanchai Chest Clinic using the MDR-TB notification form. A set of special program forms have been invented to help in tracking the progress of patients diagnosed with MDR-TB and XDR-TB. The forms are to be filled after the completion of the normal set of record program forms, within two and a half year to five years from the date of commencing treatment. The forms are normally obtained from the Department of Health (DH) TB website. Collection of such data is vital for the control and further prevention of the disease. It also enables the government to allocate enough resources for the treatment of multi-resistant tuberculosis. Such data also enables the government to keep track of the health status of a nation (Suzanne, et al., 2007).

The government can also help in the organizing for admission to hospital; this can mainly be done through government chest clinics. It is advisable to admit patients with MDR-TB to special care centers such as Kowloon Hospital and Grantham Hospital or to the particular chest hospitals during the initial stage. This applies to both newly diagnosed cases and old cases (Munsiff, Ahuja, & Li, 2006). Doing this enables proper assessment, optimization and stabilization of drug regime, reinforcement of health education and devotion to treatment during consequent follow-ups after being discharged. Doing this helps to control and minimize the spread of the health problem.

The government through the Department of Health should organize seminars that could provide health education on the treatment and prevention of tuberculosis. (Campbell & Ramsey, 2009) To stop the development and spread of organisms that are drug resistant, good public health measures are crucial. The most important public measures conducted by the Department of Health include contact screening, notification, surveillance, infection control together with health education. The overall rules for the screening of close contacts are also used in cases of MDR-TB. Moreover, for MDR-TB contacts with ordinary chest radiograph findings are advised to go for regular screening, this may be every six to twelve months (Shope & Hurst, 1933). This varies depending on the infectiousness of the index case as analyzed from the updated results on chest radiograph and sputum bacteriological status. The contact should be well conversant with symptoms suspicious of tuberculosis. The contact should also be advised to return for consultation if such symptoms develop. The health staff can be contacted to arrange contact screening if the latter has not been undertaken by general health practitioners.

How Hong Kong based services has promoted strategies to reduce the impact of multi-resistant tuberculosis

The public also plays a crucial role in developing strategies that can help minimize the effect of multi-resistant tuberculosis (Laurenzi, Ginsberg, & Spigelman, 2007). They can do this by offering assistance to people suffering from tuberculosis as they may have a difficult time accessing government services. In a community, community- joined efforts can help in the prevention of the disease, diagnosis, and treatment. This can be done by finding individuals with tuberculosis symptoms, educating the public and health practitioners, reducing stigma, offering support for those taking medication, advocating for better services and so much more (Klemens & Cyanamon, 1996).

The World Health Organization in its global MDR-TB and XDR-TB cautioned that XD-TB elevated the possibility that the present tuberculosis epidemic of mostly drug-susceptible TB would be substituted with a type of tuberculosis with extremely restricted treatment alternatives. The genera...

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