title: Programmatic management of multidrug-resistant tuberculosis: models from three countries.
abstract: BACKGROUND
  Although multidrug-resistant tuberculosis (MDR-TB) is a major global health problem, there is a gap in programmatic treatment implementation.
  
  
  METHODS
  This study describes MDR-TB treatment models in three countries--Peru, Russia and Lesotho-- using qualitative data collected over a 13-year period.
  
  
  RESULTS
  A program analysis is presented for each country focusing on baseline medical care, initial implementation and program evolution. A pattern analysis revealed six overarching themes common to all three programs: 1) importance of baseline assessments, 2) early identification of key collaborators, 3) identification of initial locus of care, 4) minimization of patient-incurred costs, 5) targeted interventions for vulnerable populations and 6) importance of technical assistance and funding. Site commonalities and differences in each of these areas were analyzed.
  
  
  CONCLUSIONS
  It is recommended that all programs providing MDR-TB treatment address these six areas during program development and implementation.
authors.affiliation: Department of Social Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. jjf38@case.edu
authors.forename: J
authors.initials: J
authors.lastname: Furin
authors.forename: J
authors.initials: J
authors.lastname: Bayona
authors.forename: M
authors.initials: M
authors.lastname: Becerra
authors.forename: P
authors.initials: P
authors.lastname: Farmer
authors.forename: A
authors.initials: A
authors.lastname: Golubkov
authors.forename: R
authors.initials: R
authors.lastname: Hurtado
authors.forename: J K
authors.initials: JK
authors.lastname: Joseph
authors.forename: S
authors.initials: S
authors.lastname: Keshavjee
authors.forename: O
authors.initials: O
authors.lastname: Ponomarenko
authors.forename: M
authors.initials: M
authors.lastname: Rich
authors.forename: S
authors.initials: S
authors.lastname: Shin
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D003153:Community Health Services / Q000458:organization & administration; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D024901:Drug Resistance, Multiple, Bacterial; D005382:Financing, Personal; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000191:economics / Q000458:organization & administration*; D054625:Healthcare Disparities; D006801:Humans; D007927:Lesotho / Q000453:epidemiology; D017146:Models, Organizational; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D009937:Organizational Objectives; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D010348:Patient Care Team / Q000458:organization & administration; D010568:Peru / Q000453:epidemiology; D016730:Program Development; D015397:Program Evaluation; D012426:Russia / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D035862:Vulnerable Populations
chemical_list: D000995:Antitubercular Agents