Reviewing our program data for weekly treatment adherence conclusively put this to rest: adherence to treatment remained higher than 90% regardless of the resources or staff available.Further, we could pick out the groups of patients who were vulnerable to missed treatment.Imagine schoolchildren excusing themselves from class once a day, or adults managing this around work, or the hundreds of people contributing to the implementation of this sort of treatment program.Imagine a similar program of IV chemotherapy if it were a large cluster of cancer cases in a similar low resource setting.By Jeremy Hill (London School of Hygiene & Tropical Medicine) World tuberculosis (TB) day is a valuable opportunity to focus on the global epidemic of tuberculosis.In London, I’ll be attending a symposium hosted by LSHTM and UCL where the program includes the breadth of topics: from the natural history of TB, through to strategies for its elimination.Aside from the large number of people affected, the epidemic in Daru is made all the more challenging by high rates of drug resistant TB, including the most difficult to treat infectious strains, multi-drug resistant and extensively-drug resistant TB (MDR- and XDR-TB).Being a small town of 16,500 people in a remote and under-served part of the world, this slow-burn humanitarian crisis is not very well known, especially in comparison to the much larger scale of the epidemic in more populous parts of the world.
In contrast with this perception, patients who missed treatment usually had genuine, understandable reasons for doing so – sometimes a consequence of the treatment regimen itself.
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So, wherever you are on the 24th, remember that our discussions, publications, tweets and actions in this field should be oriented towards the patients and communities affected by TB.
Know that patients are committed, know that people want treatment, and remember that policies to support scale up of case finding, diagnosis, treatment and prevention should respond to that – this is true of the largest scale epidemics, the smaller but focused burden in Daru, and everything in between.