Responding to MDR-TB from the ground

Nenet L Ortega, CNS Special Correspondent
Photo credit: CNS:
Community participation indeed play a major role in bringing TB care and control services to populations that are geographically isolated, marginalized, and/or belong to disadvantaged groups. Community based non government organizations bring together key players from government, private sectors, faith based groups, TB patients, their families and survivors to work through partnership and inclusive collaboration–-these are key to effective and low cost TB services in the communities.  Examples of creative, effective and low-cost solutions to improving MDR-TB treatment outcomes, supported by the Lilly MDR-TB Partnership and implemented in several high burden countries, were shared during the 45th Union World Conference on Lung Health in Barcelona.

The success stories show that supporting people on treatment at a one-on-one level improves treatment success rates. This has been made possible through models that can be easily replicated-- collaborating with religious groups and traditional medicine in China; building pharmacist and rural healthcare provider capacity as community support in India; developing a sustainable approach for groups at greatest risk of loss to follow-up in Russia; strengthening the support web by partnering with government in South Africa; and tipping the scales on treatment outcomes through small investments in social support.

In India, rural health care providers of the local government health units are tapped for active case finding and immediate referral to a TB health service facility, while community based local pharmacists are engaged as partners for treatment of MDR-TB patients. Pharmacists provide the daily regimen to their assigned patients. As part of the partnership, the government’s health office provides the training to capacitate community providers in information provision, counselling and treatment literacy.

In China, the group of Yongcheng Ma has designed a community based MDR-TB programme where faith based organizations, together with traditional hospitals, play a major role in providing daily care and treatment to MDR-TB patients. The media also has been tapped to collaborate by providing information on TB related available services, through various channels like the radio, television, and local newspapers.

In South Africa, the government acts as a steward, working with community based organizations, to help develop a system of strengthening a web of community based partners from the private sector, local government health centres and workers, including the patients. They have tapped schools, prisons and homes to make sure that MDR-TB patients take their regimen and complete their treatment and do not drop out midway.

Small scale projects have been implemented by the International Federation of Red Cross (IFRC) and Red Crescent in nine countries – Armenia, Azerbaijan, China, Georgia, Kazakhstan, Russia, Honduras, South Africa and Kenya. IFRC engaged with the governments of these countries where they implemented the initiative. This model is more of a fill-in-the-gap initiative to help in the local TB control. The outreach work is mainly done by IFRC volunteers and social supporters.

In these different community based MDR-TB programmes, it was found that around 20% of the patients were co-infected with HIV, except for Honduras and Kenya where all clients had TB and HIV. A vast majority of the patients --80%-- completed their treatment. This was mainly because of the correct information conveyed to them that TB and MDR-TB can be cured, and also that they need to be treated to protect their families from getting the infection. Their families too were provided with training on supportive care.

These efforts have also linked the services to HIV diagnosis and treatment, drug abuse and migration issues, holistically addressing the needs of TB patients.The partnership for community based MDR-TB programmes has yielded positive health outcomes; patients and families are meaningfully engaged; and all stakeholders are clear about their roles and responsibilities.

Nenet L Ortega, Citizen News Service - CNS
7 November 2014
(The author is reporting for Citizen News Service (CNS) from the 45th Union World Conference on Lung Health in Barcelona, Spain, with support from Lilly MDR TB Partnership. Email: