MDR-TB Treatment & Prevention
Principles of out-patients MDR-TB Treatment & Management
This presentation was given during the Istanbul training last April.
How to respond to the epidemic? Several cases presented with lessons learned:
- Peru
- Lesotho
- Tomsk
It is possible to successfully treat TB and MDR TB in an ambulatory setting.
Directly Observed Therapy (DOT) is more than just observation:
- It is the direct observation of patients taking their medicines
- It is the documentation of the visit
- It allows a daily rechecking of the patient medications
- It is the control of side effects
- It involves home visits if patients do not come to the clinic
- It involves looking for patients who are non-adherent or are defaulting
- DOT is an extension of the clinic into the patients community
- The system of DOT can be used to find programmatic solutions to patient barriers
- Food assistance for patients
- Choice of treatment site
- Improved side effect management (provision of ancillary medications)
- Improvement of working hours at medical facilities to make it more convenient for patients
- Treatment at home for patients who are unable to ambulate or who live too far
- Use of volunteers (e.g. neighbors) for DOT
- Rapid search for non-adherent patients and defaulters
- The use of enablers and incentives
Incentives for patients:
- Improved nutrition in the hospital with snacks
- Hot meals at the day hospital
- Food packets monthly for adherent patients
- Travel vouchers (government provided)
- Small gifts for adherence
- Help with passports, access to pensions, etc.
Incentives for staff:
- Hot meals at the day hospital
- Food packets monthly for rural health workers and nurses
Attached resource:
