title: Treatment of multidrug-resistant tuberculosis in a remote, conflict-affected area of the Democratic Republic of Congo.
abstract: The Democratic Republic of Congo is a high-burden country for multidrug-resistant tuberculosis. Médecins Sans Frontières has supported the Ministry of Health in the conflict-affected region of Shabunda since 1997. In 2006, three patients were diagnosed with drug-resistant  TB (DR-TB) and had no options for further treatment. An innovative model was developed to treat these patients despite the remote setting. Key innovations were the devolving of responsibility for treatment to non-TB clinicians remotely supported by a TB specialist, use of simplified monitoring  protocols, and a strong focus on addressing stigma to support adherence. Treatment was successfully completed after a median of 24 months. This pilot programme demonstrates that successful treatment for DR-TB is possible on a small scale in remote settings.
authors.affiliation: Médecins Sans Frontières, Amsterdam, The Netherlands. leslie.shanks@amsterdam.msf.org
authors.forename: L
authors.initials: L
authors.lastname: Shanks
authors.forename: E W
authors.initials: EW
authors.lastname: Masumbuko
authors.forename: N M
authors.initials: NM
authors.lastname: Ngoy
authors.forename: M
authors.initials: M
authors.lastname: Maneno
authors.forename: S
authors.initials: S
authors.lastname: Bartlett
authors.forename: S S
authors.initials: SS
authors.lastname: Thi
authors.forename: T
authors.initials: T
authors.lastname: Shah
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001431:Bacteriological Techniques; D040421:Cell Phone; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D003906:Developing Countries / Q000191:economics; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D055118:Medication Adherence; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010865:Pilot Projects; D011237:Predictive Value of Tests; D019114:Remote Consultation; D019035:Rural Health Services / Q000191:economics; D057545:Social Stigma; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents