Comprehensive care and support significantly boosts MDR-TB successful treatment completion

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A Taiwan program of comprehensive support and care centered on the needs of patients being treated for multidrug-resistant tuberculosis — at a cost of from $25,000 to $30,000 per patient, per year over the costs of medicines — substantially improved cure rates and drastically reduced rates of patients whose outcomes were unknown, according to a study reported in Clinical Infectious Diseases.

Globally in 2013, the challenges facing patients being treated for tuberculosis that doesn’t respond to the most effective, least toxic drugs used first to treat TB led to only slightly more than half being cured, and the outcomes of close to a quarter being unknown. Cure rates in Taiwan reflected those global challenges, with just 51 percent of patients successfully completing treatment for multidrug-resistant tuberculosis between 1992 and 1996, and just 61 percent between 2000 and 2007.

In response, Taiwan’s Centers for Disease Control and Prevention funded the Taiwan MDR-TB Consortium, to address patients’ needs and address their barriers to care. The consortium assigned case managers and directly observed therapy providers to each patient, community-based directly observed therapy throughout the course of treatment, counseling and support to address stigma and stress associated with the illness, financial support, and regular tests to monitor treatment effectiveness at no cost, as well as monitoring, reporting and reviewing adverse effects of treatment regimens, which were modified when necessary and possible.

While more than 82 percent of nearly 700 patients tracked in a study of the consortium’s outcomes were cured, the authors say the most dramatic improvement came in the decline of the rate of patients lost to follow up care, with unknown outcomes, which dropped 90 percent.

The report on the study, led by Ming-Chih Yu of Taipei Medical University was published Jan. 31 in Clinical Infectious Diseases.

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