Tuberculosis: Beyond hospitals and towards a more effective patient care
Inaccessibility to treatment and drug resistant bacteria are not the only factors that make tuberculosis challenging to address.
This is what I’ve learned when I was deployed in 2017 to Zhytomyr Region, Ukraine as Project Medical Referent for Doctors Without Borders or Medecins Sans Frontieres (MSF). Zhytomyr is one of the regions in Ukraine with the highest rate of tuberculosis. Ukraine, meanwhile, ranks second in Europe in Multi-Drug Resistant TB (MDR-TB) cases.
Among my tasks has been to implement a comprehensive care model for MDR-TB patients at the Zhytomyr Regional Tuberculosis Hospital in cooperation with the Ukraine’s Ministry of Health.
What is MDR-TB?
When patients are given drugs or antibiotics that are incomplete, or are of poor quality, or when patients stop treatment before they are cured, this becomes an opportunity for bacteria to mutate and become drug-resistant.
This is how MDR-TB has developed. In the worldwide fight against antimicrobial resistance, the increase in resistance to TB drugs is especially worrisome. MDR-TB is difficult to cure because resistance has rendered the two most common TB drugs ineffective.
As a consequence, the treatment for MDR-TB is longer, up to two years, compared to six months for drug-sensitive TB. The traditional treatment also includes drugs that are not as effective and have proven severe side effects like permanent deafness and psychosis.
Diagnosis of MDR-TB also takes time. It involves drug culture and susceptibility testing: techniques that can only be done in specialized laboratories using stringent procedures that take at least six weeks to receive results.
The delay in diagnosis stalls treatment prescription, and in the meantime, the patients worsen, and transmission of TB continues in the community.
Ignored Aspects of TB
Aspects of the disease often neglected are social and psychological. TB is highly stigmatized. Patients fear seeing a doctor, and some deny their condition. This prevents early diagnosis and treatment of the disease.
The monotony and isolation of hospital confinement meanwhile puts patients in despair. They end up feeling depressed and hopeless. As a result, some opt to leave treatment even before it is complete. Once out of the hospital, they suffer other problems like unemployment, rejection by family and friends, and maladaptive coping by excessive alcohol drinking.
The mission of Doctors Without Borders is to go beyond the confines of centralized hospital treatment and apply a better model for treatment and care of MDR-TB patients. This model involves ambulatory treatment, integrated management of co-morbidities such as HIV co-infection, and the provision of psychosocial support as an integral part of the program.
In early ambulatory care, patients begin treatment at the Zhytomyr Regional Tuberculosis Hospital. Once they are ready to continue care at home, they receive treatment as an out-patient through the nearest local medical facility in their community.
A support team made up of social workers, mental health professionals, and nurses assists and guides patients in their struggles throughout this process to make sure that patients complete the treatment successfully. This practice, so far, has increased treatment retention.
In April, MSF will begin a four-year research study into the effectiveness of MSF’s treatment model, which combines the use of a shorter treatment that spans nine to 12 months, more effective drugs, ambulatory care and psychosocial support, in treating MDR-TB in Ukraine.
By the end of this year, MSF also will put up a Biosafety Level 3 Laboratory in the Zhytomyr regional TB hospital that will be able to quickly test for various drug-resistant TB bacteria. This will hopefully provide a faster turn-around time for diagnosing MDR-TB.
What we must realize
In the yearly commemoration of World TB Day, we have always focused on reminding people to get screened, diagnosed and treated.
For this year, let us also call on people to help break the stigma against TB. People have to realize that anyone can contract TB or MDR-TB. In places where there is a high prevalence of TB, like in the Philippines, the chances of becoming infected are especially high.
When we accept this fact, it is easy to imagine how it feels to be sick and how we would want to be treated if we were a patient.
Let us also bear in mind that TB is curable.
Dr. Marve Duka is a Filipino doctor who joined Médecins Sans Frontières or Doctors Without Borders in 2010. She has worked on TB, HIV, and Hepatitis C in Kenya, Zimbabwe, Malawi, and India. Dr. Duka is now in Ukraine.
First published in Subselfie.com on 31 March 2019