Evaluation of community‐based treatment for drug‐resistant tuberculosis in Bangladesh

Abstract

OBJECTIVE Drug-resistant tuberculosis (TB) threatens global TB control because it is difficult to diagnose and treat. Community-based programmatic management of drug-resistant TB (cPMDT) has made therapy easier for patients, but data on these models are scarce. Bangladesh initiated cPMDT in 2012, and in 2013, we sought to evaluate programme performance. METHODS In this retrospective review, we abstracted demographic, clinical, microbiologic and treatment outcome data for all patients enrolled in the cPMDT programme over 6 months in three districts of Bangladesh. We interviewed a convenience sample of patients about their experience in the programme. RESULTS Chart review was performed on 77 patients. Sputum smears and cultures were performed, on average, once every 1.35 and 1.36 months, respectively. Among 74 initially culture-positive patients, 70 (95%) converted their cultures and 69 (93%) patients converted the cultures before the sixth month. Fifty-two (68%) patients had evidence of screening for adverse events. We found written documentation of musculoskeletal complaints for 16 (21%) patients, gastrointestinal adverse events for 16 (21%), hearing loss for eight (10%) and psychiatric events for four (5%) patients; conversely, on interview of 60 patients, 55 (92%) reported musculoskeletal complaints, 54 (90%) reported nausea, 36 (60%) reported hearing loss, and 36 (60%) reported psychiatric disorders. CONCLUSIONS The cPMDT programme in Bangladesh appears to be programmatically feasible and clinically effective; however, inadequate monitoring of adverse events raises some concern. As the programme is brought to scale nationwide, renewed efforts at monitoring adverse events should be prioritised.

“Death is a better option than being treated like this”: a prevalence survey and qualitative study of depression among multi-drug resistant tuberculosis in-patients

“…The importance of using appropriate screening tools for depression is highlighted in a recent review of community MDR-TB programmes in Bangladesh, where despite only 5% of cases having documented psychiatric symptoms in a chart review, once 60 patients were interviewed, 60% reported psychiatric symptoms. As interviews were not conducted by a psychiatrist, it is hard to determine the clinical significance of these symptoms, however the study does indicate potential missed opportunities for mental health treatment [15]. The limited but growing evidence base has raised the profile of treatment and support for depression within National TB programmes.…”

“Death is a better option than being treated like this”: a prevalence survey and qualitative study of depression among multi-drug resistant tuberculosis in-patients.

“…The importance of using appropriate screening tools for depression is highlighted in a recent review of community MDR-TB programmes in Bangladesh, where despite only 5% of cases having documented psychiatric symptoms in a chart review, once 60 patients were interviewed, 60% reported psychiatric symptoms. As interviews were not conducted by a psychiatrist, it is hard to determine the clinical signi cance of these symptoms, however the study does indicate potential missed opportunities for mental health treatment (15). The limited but growing evidence base has raised the pro le of treatment and support for depression within National TB programmes.…”

“Death is a better option than being treated like this”: a prevalence survey and qualitative study of depression among multi-drug resistant tuberculosis in-patients.

“…A meta-analysis of MDR-TB patients found the median time when loss to follow-up occurred 7 months (IQR = 3-11) with the majority of loss to follow-up occurring in the initial phase of treatment (75% in the first 11 months) (14). The importance of using appropriate screening tools is highlighted in a recent review of community MDR-TB programmes in Bangladesh, where despite only 5% of cases having documented psychiatric symptoms in a chart review, once 60 patients were interviewed, 60% reported psychiatric symptoms (15). The limited but growing evidence base has raised the profile of treatment and support for depression within National TB programmes.…”