D Oyieng'o1, P Park2, A Gardner1, G Kisang3, L Diero3, J Sitienei4, J Carter1. 1. Internal Medicine, Brown University, Providence, Rhode Island, USA. 2. Internal Medicine, Duke University, Durham, North Carolina, USA. 3. Internal Medicine, Moi University, Eldoret, Rift Valley, Kenya. 4. Division of Leprosy, Tuberculosis and Lung Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya.
Abstract
BACKGROUND: In the light of the 2010 World Health Organization estimation of 650 000 cases of multidrug-resistant tuberculosis (MDR-TB) globally, the need to develop, implement and scale up MDR-TB treatment programs is clear. The need is greatest and urgent in resource-poor countries, such as Kenya, with a high TB burden and an anticipated rise in reported cases of MDR-TB with increasing access to drug susceptibility testing. OBJECTIVES: To describe the set-up of a community-based program, early clinical outcomes, challenges and possible solutions. SETTING: The Moi Teaching and Referral Hospital (Moi Hospital) catchment areas: Western and North Rift Provinces, Kenya. DESIGN: Program description and retrospective chart review. RESULTS: An MDR-TB team established a community-based program with either home-based DOT or local facility-based DOT. Following referral, the team instituted a home visit, identified and hired a DOT worker, trained family and local health care professionals in MDR-TB care and initiated community-based MDR-TB treatment. In the first 24 months, 14 patients were referred, 5 died prior to initiation of treatment and one had extensively drug-resistant TB. Among eight patients who initiated community-based DOT, 87% underwent culture conversion by 6 months, and 75% were cured with no relapse after a median follow-up of 15.5 months. Multiple challenges were experienced, including system delays, stigma and limited funding. CONCLUSION: Despite multiple challenges, our model of an MDR-TB team that establishes a community-based treatment system encircling diagnosed cases of MDR-TB is feasible, with acceptable treatment outcomes.
BACKGROUND: In the light of the 2010 World Health Organization estimation of 650 000 cases of multidrug-resistant tuberculosis (MDR-TB) globally, the need to develop, implement and scale up MDR-TB treatment programs is clear. The need is greatest and urgent in resource-poor countries, such as Kenya, with a high TB burden and an anticipated rise in reported cases of MDR-TB with increasing access to drug susceptibility testing. OBJECTIVES: To describe the set-up of a community-based program, early clinical outcomes, challenges and possible solutions. SETTING: The Moi Teaching and Referral Hospital (Moi Hospital) catchment areas: Western and North Rift Provinces, Kenya. DESIGN: Program description and retrospective chart review. RESULTS: An MDR-TB team established a community-based program with either home-based DOT or local facility-based DOT. Following referral, the team instituted a home visit, identified and hired a DOT worker, trained family and local health care professionals in MDR-TB care and initiated community-based MDR-TB treatment. In the first 24 months, 14 patients were referred, 5 died prior to initiation of treatment and one had extensively drug-resistant TB. Among eight patients who initiated community-based DOT, 87% underwent culture conversion by 6 months, and 75% were cured with no relapse after a median follow-up of 15.5 months. Multiple challenges were experienced, including system delays, stigma and limited funding. CONCLUSION: Despite multiple challenges, our model of an MDR-TB team that establishes a community-based treatment system encircling diagnosed cases of MDR-TB is feasible, with acceptable treatment outcomes.
Entities:
Keywords:
Kenya; MDR-TB; community DOTS-Plus; resistant tuberculosis
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