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5 Experiences with MDR TB in Other Countries
Pages 45-54

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From page 45...
... Three speakers at the workshop provided descriptions of experiences in addressing MDR TB in countries other than China. (Specific issues are discussed in detail in the following chapters in the context of pediatric populations, infection control, rapid diagnosis, treatment across the spectrum of drug resistance, and SLDs.)
From page 46...
... Tomsk is in western Siberia and has a population of about 1 million spread over a 1  This section is based on the presentation by Salmaan Keshavjee, Director, Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School. 2  At the time that DOTS became a global program, international advisors were advising the Russians not to treat MDR TB.
From page 47...
... In the nonincarcerated sector, TB rates also had risen, to more than 100 per 100,000. And for all of Tomsk Oblast -- including the prison population, the nonincarcerated population, new cases, and retreatment cases -- about 41 percent of TB patients had MDR TB.
From page 48...
... These incentives for patients were part of a comprehensive package of medical and social assistance. Among the prisoners in the first cohort of patients, the cure rate for MDR TB cases was approximately 81 percent, with 12 percent default ing, 4 percent failing treatment, and 3 percent dying.
From page 49...
... Community-Based Care in South Africa3 Among the 11 districts in KwaZulu-Natal province, the rate of XDR TB in the district that includes Tugela Ferry was 10 times the rate in any other district, with more than 50 percent of MDR TB cases being XDR, said Kristina Wallengren, K-RITH, University of KwaZulu-Natal, and THINK. Furthermore, the prevalence of MDR was very high, at 30 MDR TB cases per 100,000 population, with the actual number likely to be at least twice as large because of sampling deficiencies.
From page 50...
... Once discharged, patients were treated in their own communities, in clinics where health care providers had no training in MDR TB treatment or its side effects. In addition, patients were expected to return to the central hospital once a month to collect their medication for the 2 years of total treatment, at times from distances of several hundred kilometers.
From page 51...
... A second evaluation looked at the performance of the health care system and how it affected the outcomes of MDR TB treatment (Loveday ­ et al., 2013)
From page 52...
... 52 Figure 5-2 Bitmapped FIGURE 5-2  Many factors have compromised MDR TB treatment for a typical patient in KwaZulu-Natal province. NOTE: ART, antiretroviral treatment.
From page 53...
... Its community DOTS approach has been scaled up to the entire country of 15 million people and is a major reason why new cases have plummeted in Cambodia -- recently recognized by WHO as a global achievement. As part of this program, the Cambodian Health Committee developed an MDR TB treatment program in 2006 based on the same communitybased strategies, with a strong emphasis on case finding.
From page 54...
... It demonstrates that rapid scale-up of MDR TB treatment is possible and effective, said Goldfeld. However, the program continues to face challenges, including a lack of laboratory capacity; the need for funding from international donors; and XDR TB, which remains very expensive to treat in Ethiopia.


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