Paz, Mexican officials debut new TB policy
Paz, Mexican officials debut new TB policy
How a local conference turned global overnight
Like a party where celebrity guests are expected to show up, it began looking as if half of Latin America was headed for a TB conference last month in the Mexican state of Oaxaca.
It wasn’t just because folks figured Tony Paz, MD, the amiable manager of San Francisco’s TB control program, would throw a good conference, either. As it turned out, top TB officials in Mexico had decided to use Paz’s conference as a place to announce the national government’s decision to move to four-drug therapy.
Along with the addition of a fourth drug, ethambutol, to the regimen, the government also was expected to announce the start of tuberculin skin-testing, expansion of contact investigation activities, expansion of directly observed therapy to the private sector, and an upgrade of labs’ culture capabilities. "All told, these are the kinds of things that will bring Mexico in line with what the rest of us [in TB control] are doing," says Paz.
The debate over whether to add ethambutol to the existing three-drug regimen had simmered for years. Presumably, TB experts here say, a recently published spate of new, binational research on drug-resistance levels tipped the argument in favor of making the changes.
"Changes like these have big economic consequences, and you don’t want to go shooting in the dark," says Peter Small, MD, assistant professor of medicine in the infectious disease division at Stanford University in San Francisco. "But these new data pretty much speak for themselves, so Mexico did the rational thing and added a fourth drug."
Signing off on a $16 million grant from USAID intended to beef up outreach and laboratory services probably didn’t hurt, either.
Last month, two weeks from the Oaxaca conference (set for Oct. 25-27), Paz was trying without much success to contain his excitement.
The guest list — originally limited to Paz’s colleagues and fellow medical school graduates in Oaxaca — had expanded by decree of Mexico City officials to include health department administrators and pulmonologists from across Mexico, Central America, the Caribbean, and even parts of South America.
Next, Paz got the word that invitations also would be going out to the heads of Mexican professional medical organizations, as well as to the World Health Organization, the Pan-American Health Organization, and UNAIDS. Yet another addition to the guest list was the official representative from the health care transition team of newly elected Mexican President Vicente Fox.
"The last I heard, they were looking for a bigger auditorium," Paz said.
Even before the conference was co-opted for unveiling the new policy changes, the agenda looked pleasantly crowded. There was to be a talk by Paz on the epidemiology of TB worldwide, more news on resistance rates and fingerprinting data, a presentation by Charles Daley, MD, head of the chest clinic at San Francisco General Hospital, sessions on multidrug-resistant TB, and presentations on meningeal TB and TB of the bone, with accompanying case studies.
Almost as well-timed as the conference was what followed — the country’s famous Day of the Dead celebration. To savor the aftermath of the conference, Paz planned to show Daley and other American colleagues the town.
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