MDR-TB Treatment & Prevention
MDR TB Management
Dear All
As you all know , MDR TB is one of the huge challenges now adays in developing countries where there is not strong health sytem to carry on,no adequate and sustainalbe funding for drugs, weak monitoring and evaluation, lack of incentives for health care workers and etc
So, in countries where thousands of MDR TB cases esimated annually,which sort of strategies is well accommodable? In patient management of caes or out patient MX and community based MDR TB management.
The comment should bear in mind that resource limited countries have huge challenges with respect to finance, health sytem, M&E ,Weak infection control,and low awareness of public to major diseases ETC
or else can acountry utilize both strategies?
Wubaye Walelgne Dagnaw
I think from PIH-Lesotho's experience a referral Hospital is definitely needed to treat very sick patients initially & to manage complications of treatment,but the major strategy should be community based.
6:09 AM, 14 Sep 2010 | Permalink
Salem Barghout
Dear All:
The debate "hospitalized vs community based models" in MDR care has been going on among various experts for quite some time. During the last 13 years of practice in the MDR fields I have yet to see a project where it's managers can get by with one model without the other. Both models need and complete "not compete" each other. Whether an MDR project starts managing patients in a community base, until some patients develop severe adverse reaction before admitting them into a treatment facility, or starts managing the patients in a treatment center, until stable enough to be managed as out-patients, both are needed and each project(country)needs to carefully evaluate its own situation and decides what works the best.
2:29 PM, 14 Sep 2010 | Permalink
Sandeep Saluja
I feel we need to do a couple of things on an urgent basis:
1)Develop easy to perform tests to diagnose tuberculosis and make them widely available in the periphery.
2)Realise that radiology will not work in the periphery also for the reason that adequate electricity is not available
3)Develop a mobile phone based network where expert advice is easily and freely available to doctors in the periphery.
We also need to appreciate the practical difficulties of patients why they choose to be non compliant.One problem relates to non availability of drugs in the peripheral centres.If a patient goes to a centre today and is told to take only half the drugs and the remaining half the next day,he will never come the next day because travel in remote areas is not easy and the person has to sacrifice his daily wages to come.
9:33 PM, 15 Sep 2010 | Permalink
Shelly Batra, MD
Certain debates go on and on, and there is never any concurrence , with no-one willing to concede a point. Treatment of MDR-TB seems one of these.
expand commentOnce again let us talk of resource limited settings.I have a few thoughts and observations. Diagnostics and drugs are all difficult to come by, there is terrible social stigma against TB , and more so against MDR-TB. I have come across situations where family members are willing to keep an AIDS patient in the home , but not an MDR-TB patient, for the simple reason that the MDR-Tb can infect others just by being around them in the same room. So if we say, community/home based treatment should be the norm for MDR-Tb patients, this does not make sense, for if there is no home to go to, how is this achieved? But neither do we have resources to hospitalise all MDR-Tb cases?
My view is that the solution lies in comprehensive and repeated TB education and counselling of patients , familes and entire communities. Our aim should be to get rid of the fear of spread, ( which can partly be achieved by teaching sputum disposal techniques)ensure that the patient is treated with compassion ...
2:47 PM, 17 Sep 2010 | Permalink