As Chronic Pulmonary Aspergillosis (CPA) may follow TB in about 10% of cases, discussion on establishment of coordination with the work of the WHO’s STB Department is important. Mario Raviglione, (Director), an Infectious Diseases physician originally from Italy who trained in the USA in Boston and New York in the early AIDS era, described CPA as one the ‘post-TB sequelae’ that had been neglected for too long largely due to lack of information and capacity to diagnose and treat.
In detailed discussions, which also included Dr Mukund Uplekar (Policy, Strategy & Innovations team) and Dr Salah Ottmani (Technical Support Coordination team), the need for research and standardization goals were emphasized. Raviglione articulated the value of surveillance and better estimate of the burden as well as of standardization of diagnosis and treatment management to achieve sustained healthcare benefits across different countries and societies.
The WHO Global Tuberculosis Report 2012 describes the impact of proper TB care in the past 17 years:20 million lives saved, annual number of TB cases have fallen 2.2% since 2011; and a rapid diagnostic test (GeneXpert) is now available in 67 low- and middle-income countries. The GAFFI program should aspire to such uniform, effective and cost-effective approaches.
Accompanying David Denning for GAFFI were David Perlin, Juan Luis Rodriguez Tudela (pictured) and Jag Jugessur. It was agreed that GAFFI and the WHO’s STB Department would together facilitate both retrospective and prospective studies of CPA to establish the size of the problem and how it might impact on current TB management protocols.
Commenting on the fact that fungal infections are absent on WHO priority lists, Raviglione noted the major educational task facing GAFFI, without which progress will be limited in a global agenda dominated by many priorities.