I found this in the Gainesville Times over the weekend written by Debbie GIlbert. It doesn't really focus on adherence, but it goes with my TB strand from before. The best adherence is the supervised therapy, but it only is the case with these types of diseases in the US.
Andrew Speaker, the Atlanta attorney who set off an international panic when he flew on commercial airplanes after being diagnosed with drug-resistant tuberculosis, now is living in Hall County, at least temporarily. But health officials say there's no reason for local folks to worry.
"Patients with TB, once they're past the contagious stage, are not a threat to anyone's health," said Dave Palmer, spokesman for District 2 Public Health in Gainesville. "But if they quit taking the medication, it's possible for them to become contagious again."
Speaker spent two months at a Denver hospital, where he underwent surgery July 17 to remove an infected lobe of his lung. He was released from the hospital Thursday, with orders to take antibiotics for two years to eliminate the infection.
Because TB is so difficult to cure, public health rules require patients to undergo directly observed therapy. They must report to their local health department every day, where a staff member watches them take their medication.
Speaker took his first dose at the Hall County Health Department Friday morning. Palmer said Georgia law allows patients to be on a five-day dosing schedule so they don't have to take the medicine on weekends when the department is closed.
April Majors, spokeswoman for the Fulton County Department of Health and Wellness, has said Speaker eventually intends to return to Fulton County, where he would then report to the department there for treatment.
Speaker apparently is spending time in Hall while he continues to recuperate from his surgery. Palmer said he does not know how long Speaker plans to stay. Even if Palmer did know, he said federal privacy laws would prohibit him from disclosing any information.
Palmer added that he did not know whether the health department is taking any special precautions to prevent Speaker from being recognized, since images of the attorney have been widely circulated in the media.
Though Speaker may be one of the most famous patients the Hall County Health Department has ever had, Palmer said his treatment regimen is not unusual.
"We've had other TB patients in District 2 who needed supervised therapy," Palmer said.
In the 13 Northeast Georgia counties comprising District 2, there are currently six patients with active TB, he said.
Palmer said patient compliance is typically not a problem.
"Most people work with us because they want to get well," he said. "If they move to another county, they're pretty up-front about notifying us."
Because of the importance of nonstop treatment in TB cases, Palmer said health officials are vigilant about monitoring the patient's whereabouts.
"If the patient stops coming in for treatment, the staff tries to locate that person and will even go to their home if necessary," he said. "We try to make sure people are where they're supposed to be when they're supposed to be."
Showing posts with label TB. Show all posts
Showing posts with label TB. Show all posts
Tuesday, July 31, 2007
Monday, July 16, 2007
XDR-TB in South Africa due to Noncompliance
Here is more news about the deadly new strain of TB - now in South Africa as well. This feels like something out of a doomsday movie. The increased strength of viral strains due to medication noncompliance.
From The Chronicle Newspaper (Lilongwe) by Moses Kaufa.
In Malawi, Tuberculosis (TB) is closely linked to the HIV epidemic. Of the 28,000 cases of TB reported in the year 2005, approximately 70% of the patients tested HIV positive.
Although TB can be cured, the recent surfacing of an Extensively Drug Resistant-TB (XDR-TB) in South Africa is cause for concern.
With the current official rate of 14% HIV infection in Malawi and the link between HIV and TB, the need to put TB firmly on the political agenda of the country has become more necessary and urgent.
The government, through the Ministry of Health and the National TB Control Programme has committed to making sure that there a plan in place to respond effectively should any cases of XDR-TB surface in Malawi.
Advocacy, Communication and Social Mobilization (ACSM) an initiated component of the Malawi National TB Control Programme, seeks to create awareness, facilitate community involvement and participation and promote activities that will inform the public on the importance of adhering to treatment and medical advice for Tuberculosis in an effort to avoid the possible development of the fatal, Extremely Drug Resistant TB (XDR-TB).
Henry Chimbali, the Communications Officer of the National TB Control Program, ACSM has embarked on an advocacy campaign involving activities designed to place TB high on the political and development agenda.
The campaign also aims to increase financial and other resources on a sustainable basis as well as hold authorities to account. Additionally, the campaign seeks to ensure that pledges are fulfilled at the local level.
A major and very important part of the campaign is to prevent the possible development of the deadly XDR-TB in Malawi.
Reports indicate that XDR-TB probably developed because cases of normal TB are not treated properly. TB that is not effectively treated will resurface with resistance to the drugs used in the treatment and become Multi Drug Resistant - TB (MDR-TB). Concerns are high that XDR-TB could develop if patients are not aware of the importance of following the strict medical regime necessary to treat MDR- TB.
Records indicate that no one knows yet exactly how many cases of XDR-TB exist but surveillance shows that countries most affected by TB are those that are poor.
Chimbali told Health Check that XDR-TB mostly develops in patients who at one time used the drugs for other ailments or if they had defaulted in the treatment of TB.
However, the infection of XDR-TB is transmitted in the same way as the standard TB.
He says the intervention embarked on by ACSM seeks to prevent any possible occurrence of XDR-TB in this country and the further spread of infections should it occur.
"The program will be looking at adherence and compliance of treatment. This will be achieved by ensuring that all TB patients are under closely supervised treatment and all health workers have adequate knowledge on TB treatment guidelines. There will be a need to engage more health care providers in TB treatment monitoring, strengthening treatment monitoring systems at all levels and intensifying proper diagnosis of all TB suspect cases," Chimbali said.
He said the program is also focusing on prevention and control of the transmission of XDR-TB to health workers and the public.
"This will be achieved through early diagnosis of all TB treatment failures, relapses and tracing of all treatment defaulters and the establishment of special treatment centers for XDR-TB," said the Communications Officer.
XDR-TB is said to be very difficult to treat as it involves a regime that lasts for a long period of time. Drugs to treat the infection are extremely expensive making access to treatment of XDR-TB impossible for many under-privileged people
From The Chronicle Newspaper (Lilongwe) by Moses Kaufa.
In Malawi, Tuberculosis (TB) is closely linked to the HIV epidemic. Of the 28,000 cases of TB reported in the year 2005, approximately 70% of the patients tested HIV positive.
Although TB can be cured, the recent surfacing of an Extensively Drug Resistant-TB (XDR-TB) in South Africa is cause for concern.
With the current official rate of 14% HIV infection in Malawi and the link between HIV and TB, the need to put TB firmly on the political agenda of the country has become more necessary and urgent.
The government, through the Ministry of Health and the National TB Control Programme has committed to making sure that there a plan in place to respond effectively should any cases of XDR-TB surface in Malawi.
Advocacy, Communication and Social Mobilization (ACSM) an initiated component of the Malawi National TB Control Programme, seeks to create awareness, facilitate community involvement and participation and promote activities that will inform the public on the importance of adhering to treatment and medical advice for Tuberculosis in an effort to avoid the possible development of the fatal, Extremely Drug Resistant TB (XDR-TB).
Henry Chimbali, the Communications Officer of the National TB Control Program, ACSM has embarked on an advocacy campaign involving activities designed to place TB high on the political and development agenda.
The campaign also aims to increase financial and other resources on a sustainable basis as well as hold authorities to account. Additionally, the campaign seeks to ensure that pledges are fulfilled at the local level.
A major and very important part of the campaign is to prevent the possible development of the deadly XDR-TB in Malawi.
Reports indicate that XDR-TB probably developed because cases of normal TB are not treated properly. TB that is not effectively treated will resurface with resistance to the drugs used in the treatment and become Multi Drug Resistant - TB (MDR-TB). Concerns are high that XDR-TB could develop if patients are not aware of the importance of following the strict medical regime necessary to treat MDR- TB.
Records indicate that no one knows yet exactly how many cases of XDR-TB exist but surveillance shows that countries most affected by TB are those that are poor.
Chimbali told Health Check that XDR-TB mostly develops in patients who at one time used the drugs for other ailments or if they had defaulted in the treatment of TB.
However, the infection of XDR-TB is transmitted in the same way as the standard TB.
He says the intervention embarked on by ACSM seeks to prevent any possible occurrence of XDR-TB in this country and the further spread of infections should it occur.
"The program will be looking at adherence and compliance of treatment. This will be achieved by ensuring that all TB patients are under closely supervised treatment and all health workers have adequate knowledge on TB treatment guidelines. There will be a need to engage more health care providers in TB treatment monitoring, strengthening treatment monitoring systems at all levels and intensifying proper diagnosis of all TB suspect cases," Chimbali said.
He said the program is also focusing on prevention and control of the transmission of XDR-TB to health workers and the public.
"This will be achieved through early diagnosis of all TB treatment failures, relapses and tracing of all treatment defaulters and the establishment of special treatment centers for XDR-TB," said the Communications Officer.
XDR-TB is said to be very difficult to treat as it involves a regime that lasts for a long period of time. Drugs to treat the infection are extremely expensive making access to treatment of XDR-TB impossible for many under-privileged people
MDR-TB in Pakistan Directly Linked to Noncompliance
From the Daily Times of Pakistan by Urooj Zia
KARACHI: Medication for Multi-Drug Resistant Tuberculosis (MDR-TB) is generally smuggled into Pakistan from parts of India, sources in the federal health department and medicine-vendors in Karachi told Daily Times.
MDR-TB is a “higher form” of TB, and is a lot more difficult to cure than regular TB, mostly because the bacteria in this case have become resistant to most drugs used in the first line of treatment for (regular) TB. Medication for regular TB is provided free by the government, under the WHO-sponsored DOTS programme, run by the National TB Control Programme (NTP).
MDR-TB develops mainly due to non-compliance with the first line of treatment, which lasts around six to eight months. A number of patients, however, stop taking medication after the first three months (around the same time that TB symptoms disappear). “The bacteria are still there, though. They just become dormant, which is why the symptoms disappear. People think they’re cured, and stop taking the medication. The treatment during the next few months, however, works towards killing these bacteria, so the disease doesn’t make a comeback,” doctors said.
Once a patient drops out mid-treatment, the disease comes back with a vengeance, in the form of MDR-TB. These bacteria are resistant to the first line of treatment, and a different combination of drugs has to be used to combat them. These drugs are extremely expensive in Pakistan. Treatment generally lasts around two- to two-and-a-half years, and the total cost of medication alone comes up to around Rs 200,000,” Sindh TB Control Programme director, Prof. Iqtedar Ahmed, said.
Moreover, even a patient who has never contracted TB before can contract the drug-resistant form of the disease, if infected directly by a person suffering from MDR-TB. Four major drugs are used to combat MDR-TB – Cycloserene, Oflobid (a wide-spectrum antibacterial), Pas, and Ethomid.
Each of these medicines costs less than Rs 10 in India. After being smuggled into Pakistan, however, the cost increases to between Rs 50 and Rs 75 per capsule. An MDR-TB patient is expected to take at least two of each daily for the duration of the treatment. The total cost of treatment depends on the combination of drugs being used – all four medicines are not used at the same time.
Interestingly three of the four medicines are also produced locally in Pakistan, “but they are produced by multi-national companies (MNCs), so the difference in cost isn’t much,” a shopkeeper at the Medicine Market in Katchhi Gali # 2 (behind M.A. Jinnah Road) told Daily Times. “MNCs have their own costs of production to look at too.” “Locally-produced” versions of Pas, however, cost Rs 375 for a box of 50 tablets (Rs 7 per tablet). Ethomid costs Rs 476.85 for a pack of 30 tablets (Rs 16 per tablet), and Oflobid costs Rs 115 for a pack of 10 tablets (Rs 11.5 per tablet).
A cheaper variant of Ethomid is sold under the trade name “Marbital.” These are available at Rs 175 for 100 tablets (Rs 1.75 per tablet). Both versions are “legal” – the more expensive Ethomid is produced in Lahore, while the cheaper Marbital is produced in Karachi.
Cycloserene is produced in Seoul, Korea, and is marketed by a firm in Karachi. It is available at Rs 59 for a pack of 30 tablets (Rs 2 per tablet).
These are the prices that are generally applicable. “Most of the time, the supply of the locally-produced medicines falls short in the market, and drugs smuggled in from India have to be used,” medicine-vendors said. “That is when prices shoot up. If a patient has to take these medicines for two years, he or she will find the cheaper versions readily available for merely three to four months out of a total of 24. The rest of the time, the patient’s family will have to search hard and long for even the Indian versions of the medicines. This is how the treatment costs for MDR-TB shoot up. The government should subsidise the production of these medicines, so they are readily available, at cheaper rates.”
Another factor pharmacy salespeople and owners brought up was the fact that the availability of these medicines in rural areas is next-to-zero.
The WHO has a programme for treating MDR-TB. This programme is referred to as DOTS+. It is yet to be implemented in Pakistan, however. “Right now, we are concentrating on implementing the DOTS programme completely. We have been advised by the WHO to not touch MDR-TB as a programme yet,” Sindh TB Control Programme director, Prof. Iqtedar Ahmed, told Daily Times. “Keeping our human resources, financial resources, and technical resources in mind, our first priority is the first line of treatment for TB (under the DOTS programme). Our next target is paediatrics (incidence of TB in children under the age of 12).”
The National TB Control Programme has started to work on a protocol for implementing a programme for MDR-TB too, Prof. Ahmed said, adding however, that implementation will take time. “It could take anywhere from two to six months, I can’t be sure at this time,” he said.
The incidence of MDR-TB is equal all over the country, he added. “According to WHO reports, the incidence of the disease in Pakistan is somewhere around two to three percent. It is higher in more populated areas, and lower in relatively more affluent suburbs, where a lesser number of people share the same living space.”
The problem with the government sponsoring MDR-TB treatment is that the prognoses (results) of the treatment are around 50 percent, Prof. Ahmed said. “At the end of the day, looking at financial constraints, it is more feasible to spend that money on the first line of treatment, so that the disease is nipped in the bud.”
He did agree, though, that some level of coverage should be given to MDR-TB by the federal and provincial health departments.
KARACHI: Medication for Multi-Drug Resistant Tuberculosis (MDR-TB) is generally smuggled into Pakistan from parts of India, sources in the federal health department and medicine-vendors in Karachi told Daily Times.
MDR-TB is a “higher form” of TB, and is a lot more difficult to cure than regular TB, mostly because the bacteria in this case have become resistant to most drugs used in the first line of treatment for (regular) TB. Medication for regular TB is provided free by the government, under the WHO-sponsored DOTS programme, run by the National TB Control Programme (NTP).
MDR-TB develops mainly due to non-compliance with the first line of treatment, which lasts around six to eight months. A number of patients, however, stop taking medication after the first three months (around the same time that TB symptoms disappear). “The bacteria are still there, though. They just become dormant, which is why the symptoms disappear. People think they’re cured, and stop taking the medication. The treatment during the next few months, however, works towards killing these bacteria, so the disease doesn’t make a comeback,” doctors said.
Once a patient drops out mid-treatment, the disease comes back with a vengeance, in the form of MDR-TB. These bacteria are resistant to the first line of treatment, and a different combination of drugs has to be used to combat them. These drugs are extremely expensive in Pakistan. Treatment generally lasts around two- to two-and-a-half years, and the total cost of medication alone comes up to around Rs 200,000,” Sindh TB Control Programme director, Prof. Iqtedar Ahmed, said.
Moreover, even a patient who has never contracted TB before can contract the drug-resistant form of the disease, if infected directly by a person suffering from MDR-TB. Four major drugs are used to combat MDR-TB – Cycloserene, Oflobid (a wide-spectrum antibacterial), Pas, and Ethomid.
Each of these medicines costs less than Rs 10 in India. After being smuggled into Pakistan, however, the cost increases to between Rs 50 and Rs 75 per capsule. An MDR-TB patient is expected to take at least two of each daily for the duration of the treatment. The total cost of treatment depends on the combination of drugs being used – all four medicines are not used at the same time.
Interestingly three of the four medicines are also produced locally in Pakistan, “but they are produced by multi-national companies (MNCs), so the difference in cost isn’t much,” a shopkeeper at the Medicine Market in Katchhi Gali # 2 (behind M.A. Jinnah Road) told Daily Times. “MNCs have their own costs of production to look at too.” “Locally-produced” versions of Pas, however, cost Rs 375 for a box of 50 tablets (Rs 7 per tablet). Ethomid costs Rs 476.85 for a pack of 30 tablets (Rs 16 per tablet), and Oflobid costs Rs 115 for a pack of 10 tablets (Rs 11.5 per tablet).
A cheaper variant of Ethomid is sold under the trade name “Marbital.” These are available at Rs 175 for 100 tablets (Rs 1.75 per tablet). Both versions are “legal” – the more expensive Ethomid is produced in Lahore, while the cheaper Marbital is produced in Karachi.
Cycloserene is produced in Seoul, Korea, and is marketed by a firm in Karachi. It is available at Rs 59 for a pack of 30 tablets (Rs 2 per tablet).
These are the prices that are generally applicable. “Most of the time, the supply of the locally-produced medicines falls short in the market, and drugs smuggled in from India have to be used,” medicine-vendors said. “That is when prices shoot up. If a patient has to take these medicines for two years, he or she will find the cheaper versions readily available for merely three to four months out of a total of 24. The rest of the time, the patient’s family will have to search hard and long for even the Indian versions of the medicines. This is how the treatment costs for MDR-TB shoot up. The government should subsidise the production of these medicines, so they are readily available, at cheaper rates.”
Another factor pharmacy salespeople and owners brought up was the fact that the availability of these medicines in rural areas is next-to-zero.
The WHO has a programme for treating MDR-TB. This programme is referred to as DOTS+. It is yet to be implemented in Pakistan, however. “Right now, we are concentrating on implementing the DOTS programme completely. We have been advised by the WHO to not touch MDR-TB as a programme yet,” Sindh TB Control Programme director, Prof. Iqtedar Ahmed, told Daily Times. “Keeping our human resources, financial resources, and technical resources in mind, our first priority is the first line of treatment for TB (under the DOTS programme). Our next target is paediatrics (incidence of TB in children under the age of 12).”
The National TB Control Programme has started to work on a protocol for implementing a programme for MDR-TB too, Prof. Ahmed said, adding however, that implementation will take time. “It could take anywhere from two to six months, I can’t be sure at this time,” he said.
The incidence of MDR-TB is equal all over the country, he added. “According to WHO reports, the incidence of the disease in Pakistan is somewhere around two to three percent. It is higher in more populated areas, and lower in relatively more affluent suburbs, where a lesser number of people share the same living space.”
The problem with the government sponsoring MDR-TB treatment is that the prognoses (results) of the treatment are around 50 percent, Prof. Ahmed said. “At the end of the day, looking at financial constraints, it is more feasible to spend that money on the first line of treatment, so that the disease is nipped in the bud.”
He did agree, though, that some level of coverage should be given to MDR-TB by the federal and provincial health departments.
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