Bangladesh, USAID DR TB treatment project shows impacts of community-based approach

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A project that shifted treatment for drug-resistant tuberculosis from overburdened Bangladesh hospitals to patients’ homes saw time between diagnosis and treatment initiation drop from more than three months to less than a week, reducing risks of the continued spread of the disease, a study reported in Global Health Science and Practice found. In the process, researchers found rates of treatment success climbed from 70 percent in 2011 to 76 percent in 2015, while death rates among patients treated for drug-resistant tuberculosis dropped from 14 percent to 9 percent.

Driven by the demonstrated need to treat increasing numbers of patients diagnosed with drug-resistant tuberculosis with the advent of GeneXpert diagnostic technology, the project was launched in 2012 by Bangladesh’s Ministry of Health with support from USAID.

Cutting the amount of time patients spent in hospitals upon starting treatment for drug-resistant tuberculosis from as long as eight months to as little as four weeks, the project put care management in the hands of local health offices, which in turn identified and trained community health workers who delivered and observed treatment. In addition to daily, directly observed treatment, the workers also monitored patients for side effects, provided support addressing the psychological and social impacts of the disease, screened household members for the disease, and guided infection prevention measures.

While the project, and the support provided by USAID has ended, the authors, led by Paul Daru of University Research Co. in Dhaka, write, the need for the community-based services continues and will require support from international donors, as well as local private sector donors.

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