Optimizing outcomes for drug resistant tuberculosis patients through provision of a comprehensive care package

Aurangzaib  Quadir; Abdul  Ghafoor; Syed Karam  Shah; Shahid H.  Khokhar; Hussain  Hadi; Ghulam Nabi  Kazi; Kinz ul  Eman; Sher Afghan  Raisani; Zaeem ul  Haq

doi:10.32413/pjph.v12i1.958

Authors

Aurangzaib Quadir Former Deputy National Coordinator (Tuberculosis) CMU, Islamabad, Pakistan
Abdul Ghafoor National Adviser (USAID) on MDR-TB, Islamabad, Pakistan
Syed Karam Shah Stop TB Pakistan, Islamabad, Pakistan
Shahid H. Khokhar Stop TB Pakistan, Islamabad, Pakistan
Hussain Hadi Former Policy Advisor National TB Control Program
Ghulam Nabi Kazi Dopasi Foundation, Islamabad, Pakistan
Kinz ul Eman Dopasi Foundation, Islamabad, Pakistan
Sher Afghan Raisani Provincial TB Control Program
Zaeem ul Haq Independent Consultant

DOI:

https://doi.org/10.32413/pjph.v12i1.958

Keywords:

DR-TB, Pakistan, drug resistance, Comprehensive care package, PMDT, NTP, USAID, STP, second line TB drugs, side effects

Abstract

Background: The paper presents the salient features of a comprehensive treatment package for drug resistant tuberculosis (DR-TB), its adaptation and implementation in two indoor care hospital settings in Pakistan, and lessons learned from this implementation.

Methods: A pilot study was undertaken on a group of 100 patients at two Programmatic Management of Drug-Resistant TB (PMDT) sites. Fifty patients each were selected from the Samli Sanatorium Murree and the Lady Reading Hospital, Peshawar by the National Tuberculosis Control authorities, and delivered a comprehensive package of services, including psychosocial and food support. Data were collected using standard TB tools and surveillance indicators. The results were compared between intervention and a historical cohort of DR-TB patients.

Results: Among the total 100 patients, the treatment success rate was 88%, the failure rate was 4%, while there were 7% deaths. A patient was transferred out while none were lost to follow-up, indicating much improvement over the historical cohort. Patients ranked the economic support, free medicines and nutritional support as most helpful, while majority of providers found the intervention sustainable.

Conclusion: A comprehensive package including the psychosocial support can be crucial in enhancing DR-TB outcomes. Regular interaction with patients and improved nutrition leads to improved treatment adherence, while capacity building of psychologists and home visits can further benefit the DR-TB patients leading to their cure.