Multidrug-resistant tuberculosis (MDR-TB) is an urgent but neglected problem in certain settings around the world. The development of effective treatment and management strategies is essential to contain the disease. Such specialized treatment strategies, to be used in conjunction with the WHO TB-control protocol, DOTS, have been termed DOTS-Plus.
This paper presents clinical outcomes on the first 74 MDR-TB patients to complete four or more months of individualized treatment regimens under a community-based DOTS-Plus protocol in northern Lima, Peru.
The patient population is young, with a mean age of 28.4; 51% are male; 59% had received three or more previous treatments for TB; and only 32% of the population had comorbid conditions diagnosed at the initiation of therapy.
Nearly 90% of the cohort were sick with strains of M. tuberculosis documented to be resistant to four or five first-line drugs; 3% of patients had disease caused by strains resistant to isoniazid and rifampin only.
Outcomes were encouraging: more than 90% of the cohort had two consecutive monthly negative culture results after four months of therapy. At their last monthly assessment, 85% of patients had either been cured or were culture negative. Only 1% failed and 7% abandoned therapy; 7% died.
This DOTS-Plus strategy, which combines transnational public-private collaboration with a sustainable community-based approach, has ensured directly observed therapy throughout individualized treatment for MDR-TB. This strategy has also addressed social, economic, and clinical barriers to effective.