Treating drug-resistant tuberculosis in a low-intensity chronic conflict setting in India

• Published in: Conflict and health Vol. 8; no. 1; p. 25
• Main Authors: Armstrong, Edward, Das, Mrinalini, Mansoor, Homa, Babu, Ramesh B, Isaakidis, Petros
• Format: Journal Article
• Language: English
• Published: London BioMed Central 01.12.2014; BioMed Central Ltd
• Subjects: Analysis; Case Study; Conflict Studies; Emergency Medicine; Epidemiology; Health aspects; Health Promotion and Disease Prevention; Health Services Research; Medicine; Medicine & Public Health; Mycobacterium; Nurses; Public Health; Refuse and refuse disposal; Resource-limited settings; Operational research; Mobile clinic; Internally displaced populations
• ISSN: 1752-1505; 1752-1505
• DOI: 10.1186/1752-1505-8-25

Introduction The eastern part of India has been affected by an ongoing low-intensity conflict between government forces and armed Maoist groups, known as Naxalites. Since 2006, Médecins Sans Frontières (MSF) has been providing primary health care services in the conflict-affected region along the Andhra Pradesh-Chhattisgarh border. In 2011, treatment for drug-resistant tuberculosis (DR-TB) was included in the services provided. This report aims to describe MSF experiences of providing treatment to DR-TB patients in a mobile primary health care outpatient clinic, in a low-intensity conflict setting in India. Case description A total of thirteen patients were diagnosed with drug-resistant TB (DR-TB) between January 2011 and October 2013. An innovative treatment model was developed which delegated responsibility to non-TB clinicians, including primary-care nurses and nurse-aids who were remotely supported by a TB-specialist from the MSF DR-TB project in Mumbai. Individualised regimens were designed for each patient based on WHO guidelines. Of these 13 patients, 10 patients had an outcome, of whom seven (70%) patients were cured. One patient became lost to follow-up prior to treatment initiation, one patient died prior to starting treatment and one patient refused treatment. Three patients were on-treatment, were clinically improving and were culture-negative at the end of their intensive phase of treatment. Discussion and evaluation Drug-resistant tuberculosis diagnosis and treatment is a highly specialised and technical subject which requires continued patient follow-up. However, our study demonstrates that it is feasible to manage DR-TB patients in a conflict setting, using a primary-care model with remote expert support. Long-term commitment and sustainability are essential for continued care, even more so in similar conflict settings. Loss to follow-up in patients remains a programmatic challenge and community involvement may play a key role. Conclusion Managing DR-TB in a primary health care programme is feasible in a low-conflict setting with an appropriate treatment model. Ambulatory strategies and standardised treatment regimens should be considered to further simplify treatment delivery and allow for scale-up when needed.