This strategy remains the generally accepted approach in settings characterized by substantial contamination.
The other potential challenge is the utility of this approach in settings where there are no NSHWs within the health system.
Further research is warranted to test this approach in settings where the spatial pattern of TB differs from that of Lima, preferably by using datasets in which DST has been conducted for all TB patients to prevent potential sampling bias.
The enthusiasm of BMA and KDHW staff to integrate care for survivors across their programs is a testament of the utility and promises of this community-based approach in settings where insecurity and other barriers prevent access to facility-based care.
They also suggested new approaches appropriate in settings where biomarkers reflect only indirectly the important processes on the causal path to clinical disease and where biomarker measurement errors are of concern.
It then sketches why and how a Global Skill Partnership could do better than traditional approaches in some settings, and offers examples in the North African setting.
However, there is still much debate about the value of such approaches in real settings.
It is important to think carefully before applying participatory approaches in DRR settings, to ensure that realistic outcomes are defined and considerable attempts are made to foster equitable relationships between stakeholders.
Several groups have since shown success with similar approaches in various settings of CLL, including failure of ibrutinib treatment and in patients who relapse after allogeneic stem cell transplantation.
