Promoting adherence to tuberculosis treatment

Abstract

Tuberculosis (TB) is a good test of a health system: addressing the problem requires the use of laboratories and Xrays, the input of skilled clinicians, a reliable supply of drugs, the use of health education, the provision of continuity of care as well as good follow-up and information systems. WHO's DOTS strategy has helped improve outcomes in TB in many ways: new resources have been channelled towards TB control programmes, drug supplies and information systems have been strengthened and targets have been set. The strategy has helped ensure that national governments take notice of TB control efforts in their countries and also that advances have been made in the coverage and quality of TB control globally.WHO has refined the global programme in the Stop TB Strategy.

Strategies for reducing treatment default in drug-resistant tuberculosis: systematic review and meta-analysis [Review article]

“…103 Treatment default may also result from disrespectful, uncaring treatment from the health care staff involved, 7 issues that are not systematically reported. An important area for future research would be to investigate the impact of interventions focusing on health care system improvement, for example the impact of intensive staff education on the default rates of patients in MDR-TB programmes.…”

Socioeconomic, Disease, and Biochemical Factors in Adherence to Anti tuberculosis Treatment Regime in Benin City, Nigeria: A Comparative Study

“…We also recommend that private, and not only public health facilities, be well integrated into the DOTS scheme since these are usually closer to the local communities and many patients shy away from government -run health facilities. The overall purpose is to ensure that we scale up to meet targets in global tuberculosis control [19,20,21,22,23]. …”

Response to opt-out approach to prevent mother-to-child transmission of HIV

“…Without swift corrective action on multiple levels (community-based behaviour change, national and global funding and policy), we may indeed see reversals in the dramatic decline in diarrhoea mortality of the past 20 years, a decline frequently attributed to the advent of oral rehydration therapy. 4 Renewed commitment to decreasing the highly preventable and treatable infant and child mortality from diarrhoea, which remains at 2 million deaths annually, is long overdue. …”

“…9 In exceptional situations, the DOTS approach of facilitating adherence might not achieve its objectives, since patients need to make themselves available for treatment and are less likely to do so if they are imprisoned, suffer medication side-effects or experience homelessness, drug addiction, unemployment or alcoholism. 4,10 In Kyrgyzstan prisons, the practice of selfadministered anti-TB treatment on weekends was discontinued in March 2007 due to repeated documented evidence that many patients were trafficking their weekend TB medications, despite concerted efforts aimed at enhancing patient empowerment and peer support.…”

“…Since 2003, 53 developing countries have started implementing RED to various degrees, mostly in Africa and south and south-east Asia. 4 All 53 countries belong to the groups of lower income and lower-middle income countries, as per World Bank classification. In 2005, an evaluation of 5 countries in Africa that had implemented RED found that, in 4 of the 5 countries, immunization coverage had increased since the implementation of RED, and that the proportion of districts with DTP3 (three-dose diphtheria, tetanus and pertussis vaccine) coverage above 80% had more than doubled.…”