Turning the tide on drug-resistant TB

Dr Diana Wangari, CNS Special Correspondent, Kenya
Photo credit: CNS: citizen-news.org
There is a quote often attributed to Albert Einstein, “If you always do what you always did you will always get what you always got.” The point being that if you want to change the end results, you need to change the way you do things. The escalation of multidrug resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), with approximately 480,000 new cases of MDR-TB reported in 2014 globally, has challenged the principles of care for TB patients.

Keeping in mind that only 48% of these patients are usually able to complete treatment, Dr Lucica Ditiu, Executive Director of the Stop TB Partnership, emphasized that to turn the tides we need to accelerate our efforts and we must be wary not to treat drug sensitive TB and MDR-TB as two separate entities but rather as a continuum.

In one of the sessions at the 46th Union World Conference on Lung Health, models from different countries were presented as best practice examples being implemented across the world to support patients and the community at large.

Innovative nurses of China

A project to train nurses specifically on TB care was launched by the International Council of Nurses (ICN-TB project) in China with 7 courses thus far since 2009. The nurses are thereafter able to go out into the field to provide health education sessions, including schools and prisons, and offer group as well as peer support. With the aim to improve infection control, aside from raising awareness, they came up with the brilliant idea to set up face-masks dispensing machines in waiting areas of out patient clinics and in over crowded set ups. The nurses also came up with an electronic system that they now utilize for follow up of patients and this has made their work that much easier. Furthermore, they have capitalized on the development of technology by using mobile-based applications and running a popular blog that is interactive for patients and health professionals.

Engaging the private sector in India

In India over 50% of the TB patients are diagnosed in the private sector, according to a study done in Mysore. So it was important to design strategies keeping in mind people’s treatment-seeking behaviour in order to reach them where they are. Therefore, a web based software application was developed, which allows for integration of services offered to TB patients in the private healthcare sector with the National TB Control Programme.

The pilot project was launched in Apollo Hospitals, Hyderabad, and aside from linking this private healthcare facility with Nikshay, the Government of India’s TB notification portal, it is able to offer support to TB patients for treatment adherence through messages, interactive voice calls and counselling services. The application that aids patients in remembering to take their medication through regular SMS is also used to monitor treatment adherence.

Speaking to CNS (Citizen News Service), Dr Sarabjit Chadha, Project Director at International Union Against Tuberculosis and Lung Disease (The Union) South East Asia Region, added that this service is free of charge for the patients and includes a counsellor who goes through the data. “Therefore if one selects the option that you missed a dose, you get a follow up call so as to establish the reason behind it and a meeting can be scheduled to address the issue,” he explained.

These are some of the examples presented, including South Africa’s improvement of recording and reporting and Russia’s approach to reaching the hard-to-reach populations.

And as Dr Lucica Ditiu keenly reminded us, we must not shy away from scaling up our efforts. As MDR-TB is such a great challenge the process might be slow and it might not be easy, but it certainly cannot be the end of the world.

Dr Diana Wangari, CNS Special Correspondent, Kenya
5 December 2015
(Dr Diana Wangari MD, is providing thematic coverage from the 46th Union World Conference on Lung Health in Cape Town, South Africa, with kind support from Lilly MDR TB Partnership. Follow her on Twitter: @diana1wangari)