MDR-TB Treatment & Prevention

I would recommend the articles below for reference. I hope other members of the list can offer additional resources for you as well.

Also, Socios En Salud in Peru has published a book on the topic: Mejorando la Adherencia: El Rol de la Psicoterapia de Grupo en el Tratamiento de la TB-MDR en el Perú Urbano [Enhancing Adherence: The Role of Group Psychotherapy in the Treatment of MDR-TB in Urban Peru]
Authors: Annika Sweetland, Julio Acha, Dalia Guerra
Published by Socios En Salud Sucursal Perú. April 2004. Peru.
http://www.pih.org/where/peru/Peru-info.html
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BMC Public Health. 2008 May 8;8:154.
Tackling tuberculosis patients' internalized social stigma through patient-centered care: an intervention study in rural Nicaragua.
Macq J, Solis A, Martinez G, Martiny P.
Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium.
http://www.biomedcentral.com/1471-2458/8/154

BACKGROUND: We report a patient-centered intervention study in 9 municipalities of rural Nicaragua aiming at a reduction of internalized social stigma in new AFB positive tuberculosis (TB) patients diagnosed between March 2004 and July 2005. METHODS: Five out of 9 municipal teams were coached to tailor and introduce patient-centered package. New TB patients were assigned to ...

I would recommend the articles below for reference. I hope other members of the list can offer additional resources for you as well.

Also, Socios En Salud in Peru has published a book on the topic: Mejorando la Adherencia: El Rol de la Psicoterapia de Grupo en el Tratamiento de la TB-MDR en el Perú Urbano [Enhancing Adherence: The Role of Group Psychotherapy in the Treatment of MDR-TB in Urban Peru]
Authors: Annika Sweetland, Julio Acha, Dalia Guerra
Published by Socios En Salud Sucursal Perú. April 2004. Peru.
http://www.pih.org/where/peru/Peru-info.html
-----------------------------------------------------------------
BMC Public Health. 2008 May 8;8:154.
Tackling tuberculosis patients' internalized social stigma through patient-centered care: an intervention study in rural Nicaragua.
Macq J, Solis A, Martinez G, Martiny P.
Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium.
http://www.biomedcentral.com/1471-2458/8/154

BACKGROUND: We report a patient-centered intervention study in 9 municipalities of rural Nicaragua aiming at a reduction of internalized social stigma in new AFB positive tuberculosis (TB) patients diagnosed between March 2004 and July 2005. METHODS: Five out of 9 municipal teams were coached to tailor and introduce patient-centered package. New TB patients were assigned to the intervention group when diagnosed in municipalities implementing effectively at least TB clubs and home visits.We compared the changes in internalized stigma and TB treatment outcome in intervention and control groups. The internalized stigma was measured through score computed at 15 days and at 2 months of treatment. The treatment results were evaluated through classical TB program indicators. In all municipalities, we emphasized process monitoring to capture contextual factors that could influence package implementation, including stakeholders. RESULTS: TB clubs and home visits were effectively implemented in 2 municipalities after June 2004 and in 3 municipalities after January 2005. Therefore, 122 patients were included in the intervention group and 146 in the control group. After 15 days, internalized stigma scores were equivalent in both groups. After 2 months, difference between scores was statistically significant, revealing a decreased internalized stigma in the intervention group and not in the control group. CONCLUSION: This study provides initial evidences that it is possible to act on TB patients' internalized stigma, in contexts where at least patient centered home visits and TB clubs are successfully implemented. This is important as, indeed, TB care should also focus on the TB patient's wellbeing and not solely on TB epidemics control.

Trop Med Int Health. 2007 Jul;12(7):873-85.
Patient empowerment in tuberculosis control: reflecting on past documented experiences.
Macq J, Torfoss T, Getahun H.
School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
http://www3.interscience.wiley.com/cgi-bin/fulltext/118507012/PDFSTART

OBJECTIVES: To review the available published and non-published literature on patient empowerment in tuberculosis (TB) control, describe what it entails, identify possible trends and conclusions, and suggest areas both for informing policy makers and for orienting further research. METHODS: We searched MEDLINE and PSYCINFO databases, used World Wide Web research tools and included conference abstracts and specific project reports. RESULTS: Experience shows that operational definitions, potential barriers towards empowerment and contextual issues need to be considered. Four types of experiences were reported: (1) enabling patients to take more responsibility for their health, especially regarding adherence to treatment, (2) organizing TB patients into groups and clubs, (3) building patient-centred care in TB and general health services, and (4) using TB patients' advocacy skills to improve TB control. CONCLUSION: Patient empowerment conceptions through interventions and studies should primarily involve TB patients themselves. Patients' activism--their role, the shape it takes and resulting effects--is insufficiently documented.


Soc Sci Med. 2008 Nov;67(10):1559-70. Epub 2008 Sep 3.
Can social capital be intentionally generated? a randomized trial from rural South Africa.
Pronyk PM, Harpham T, Busza J, Phetla G, Morison LA, Hargreaves JR, Kim JC, Watts CH, Porter JD.
London School of Hygiene and Tropical Medicine, London, United Kingdom.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4TC5H71-2&_use...

While much descriptive research has documented positive associations between social capital and a range of economic, social and health outcomes, there have been few intervention studies to assess whether social capital can be intentionally generated. We conducted an intervention in rural South Africa that combined group-based microfinance with participatory gender and HIV training in an attempt to catalyze changes in solidarity, reciprocity and social group membership as a means to reduce women's vulnerability to intimate partner violence and HIV. A cluster randomized trial was used to assess intervention effects among eight study villages. In this paper, we examined effects on structural and cognitive social capital among 845 participants and age and wealth matched women from households in comparison villages. This was supported by a diverse portfolio of qualitative research. After two years, adjusted effect estimates indicated higher levels of structural and cognitive social capital in the intervention group than the comparison group, although confidence intervals were wide. Qualitative research illustrated the ways in which economic and social gains enhanced participation in social groups, and the positive and negative dynamics that emerged within the program. There were numerous instances where individuals and village loan centres worked to address community concerns, both working through existing social networks, and through the establishment of new partnerships with local leadership structures, police, the health sector and NGOs. This is among the first experimental trials suggesting that social capital can be exogenously strengthened. The implications for community interventions in public health are further explored.

Hi Ada,

Here are some group discussion sessions on Personal Awareness that may suit your purpose. I designed and ran them here in Manila.

Good luck!

Dr. Ruben Encarnacion