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The WHO Regional Office for Europe in collaboration with the Center for Health Policy and Studies (PAS Center) within the TB REP 2.0 Regional Project, announced the creation of the Virtual Medical Consilium (VMC). The consilium was created to support clinicians from countries in the WHO European Region participating in the regional operational research on the inclusion of modified short-term regimens for the treatment of rifampicin-resistant tuberculosis (RR-TB) with oral drugs only and on making clinical decisions on patient management.

The VMC support will be provided on a case-by-case basis in the form of expert opinion on inquiries submitted by individual clinicians and/or national medical consilium. The applicant will receive a written reply within 48 hours from the request date.

The mission of the VMC within this virtual platform is to provide expert advice and guidance based on the requirements of the regional operational research, the latest WHO guidelines for the treatment of drug-resistant tuberculosis, and evidence-based scientific evidence. In response to inquiries, the consilium's experts will propose the most appropriate and alternative therapeutic options for managing each individual case in accordance with the requirements of the operational research protocol. The final answer of the VMC will be drawn up on the basis of consensus and quorum of three international experts.

Dr. Askar Yedilbaev, Head of Tuberculosis Unit of the Joint Program on Tuberculosis, HIV and Viral Hepatitis at the WHO Regional Office for Europe, noted that the final decision regarding patient accompaniment clearly rests with clinicians and national medical consiliums. VMC is seen as an important component of additional assistance to countries in establishing the most appropriate treatment tactics for a patient included in the regional project. “Our goal is to facilitate the rapid adoption of the right clinical decision in the framework of the operational research, increase the level of comfort on the part of clinicians in the use of new anti-tuberculosis drugs recommended by the WHO, and, as a result, improve the outcomes of MDR-TB treatment in the region,” he said.

The medical consilium consists of 10 clinical experts, including the VMC Coordinator Dr. Elmira Gurbanova, who is responsible for formulating the collegial response to the country on behalf of the entire consilium. The consultations and recommendations of the VMC experts will cover the following issues:

• Management of patients receiving mSTR, including questions on inclusion and exclusion from the operational research;
• In case of exclusion from the operational research, recommendations on the composition of the regimen for continuation of therapy with a longer drug-resistant TB treatment regimen;
• Management of complex clinical RR-TB cases, including those with comorbidities and infections;
• Off-label use of anti-TB drugs.

“Today, countries are starting to introduce new treatment regimens for patients with the most severe forms of tuberculosis and, in the early stages, clinicians may face various practical challenges - said Svetlana Nikolaescu, Program Coordinator at the Center for Health Policy and Studies (PAS Center). – Quick access to expert support provided within the format of the consilium's activity, will accelerate the introduction of new treatment regimens and their rational use. The consilium is expected to handle an average of 9-12 clinical cases per week. In addition to the support and recommendations that will be provided to individual countries, the consilium is a platform for exchanging experience regarding the use of new anti-tuberculosis drugs and improving knowledge in this direction”.

Clinicians or national clinical consiliums from countries of the European Region can send a request to the VMC, to the following email address: mstrconsilium@who.int.

Further on, the WHO Regional Office for Europe plans to hold virtual educational seminars/webinars aimed at improving the knowledge of healthcare workers of anti-tuberculosis services on topical issues regarding the clinical management of patients with drug-resistant tuberculosis, which will be announced later.

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