MDR-TB Treatment & Prevention
A Community-Based Tuberculosis Program in Cambodia
Research Letter published in JAMA, Vol. 292 No. 5, August 4, 2004. Cambodia has one of the highest global burdens of tuberculosis (TB).1 In 1994, the Cambodian Health Committee (CHC), a nongovernmental organization, developed a community-based approach to the treatment of TB using microfinance and food supplementation in Svay Rieng, one of Cambodia's poorest provinces.
The CHC program achieved case detection rates among the highest in the world.5 CHC strategies to improve treatment compliance, case detection, and cure overcame numerous barriers presented by previous methods, including restricted access to health care facilities in rural areas, the economic burdens of hospitalization and travel to HHC, and low visibility of health workers in the community. To our knowledge, this program is unique in using poverty reduction as a component of community-based tuberculosis treatment. The village banks reduced poverty in the community at large and simultaneously increased the visibility of health workers and the CHC program, thus presumably increasing awareness of TB symptoms within the community, reducing disease-associated stigma, and improving case detection and treatment adherence in conjunction with patient supporters.
Active case-finding by the CHC resulted in a marked increase in case detection, suggesting that in extremely high-prevalence areas such as Cambodia this approach can be a productive component of TB programs, particularly in the initial stages of a program's expansion into a previously unserved area. The decreased time to diagnosis seen in Home DOTS is notable since earlier detection and treatment of TB leads to reduced disease transmission, improved pulmonary fitness, increased ability to work, and to other, unquantifiable, benefits. These results were achieved using transferable methods in one of the world's most resource-poor rural environments.
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