Evaluation of community-based treatment for drug-resistant tuberculosis in Bangladesh.
OBJECTIVE
Drug-resistant tuberculosis (TB) threatens global TB control because it is difficult to diagnose and treat. Community-based programmatic management of drug-resistant TB (cPMDT) has made therapy easier for patients, but data on these models are scarce. Bangladesh initiated cPMDT in 2012, and in 2013, we sought to evaluate programme performance.


METHODS
In this retrospective review, we abstracted demographic, clinical, microbiologic and treatment outcome data for all patients enrolled in the cPMDT programme over 6 months in three districts of Bangladesh. We interviewed a convenience sample of patients about their experience in the programme.


RESULTS
Chart review was performed on 77 patients. Sputum smears and cultures were performed, on average, once every 1.35 and 1.36 months, respectively. Among 74 initially culture-positive patients, 70 (95%) converted their cultures and 69 (93%) patients converted the cultures before the sixth month. Fifty-two (68%) patients had evidence of screening for adverse events. We found written documentation of musculoskeletal complaints for 16 (21%) patients, gastrointestinal adverse events for 16 (21%), hearing loss for eight (10%) and psychiatric events for four (5%) patients; conversely, on interview of 60 patients, 55 (92%) reported musculoskeletal complaints, 54 (90%) reported nausea, 36 (60%) reported hearing loss, and 36 (60%) reported psychiatric disorders.


CONCLUSIONS
The cPMDT programme in Bangladesh appears to be programmatically feasible and clinically effective; however, inadequate monitoring of adverse events raises some concern. As the programme is brought to scale nationwide, renewed efforts at monitoring adverse events should be prioritised.
United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
Joseph S
JS
Cavanaugh
United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
Ekaterina
E
Kurbatova
United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
Negar N
NN
Alami
United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
Joan
J
Mangan
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Zinia
Z
Sultana
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Shahriar
S
Ahmed
Bangladesh Country Office, World Health Organization, Dhaka, Bangladesh.
Vikarunessa
V
Begum
Bangladesh Country Office, World Health Organization, Dhaka, Bangladesh.
Sabera
S
Sultana
University Research Company, Dhaka, Bangladesh.
Paul
P
Daru
United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
Julia
J
Ershova
United States Agency for International Development, Washington D.C, USA.
Alexander
A
Golubkov
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Sayera
S
Banu
United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
James D
JD
Heffelfinger
Bangladesh; Tuberculosis drug-resistance community treatment Bangladesh; résistance aux médicaments; traitement communautaire; tratamiento comunitario; tuberculose; tuberculosis resistente a medicamentos