TB Treatment, Studies and World TB Day Activities

March 24, 2004 — As Directly Observed Therapy (DOTS), the WHO recommended treatment for tuberculosis, is introduced in the Central Asia region, a growing public health concern is the large numbers of non-compliant patients participating in DOTS.

As the entire treatment is over six months long, getting people to finish all their medication is sometimes a problem because it once you start feeling better, it becomes very tempting to stop.

Non-compliance (or not finishing) treatment is suspected to be one of the major causes of the spread of multi-drug resistant (MDR) forms of TB in the region. MDR forms of TB are quite difficult and costly to treat and can create a huge burden for health care systems in developing countries.

In KyzylOrda, Kazakhstan, this lesson is particularly important. KyzylOrda is located in the environmentally degraded Aral Sea Zone, site of one of the planet's worst ecological disaster and a tuberculosis epidemic.

To address the public health crisis there, the American Red Cross and Kazakh Red Crescent Society (KRCS) are partnering with CDC, USDA and USAID to implement an operational research study on the efficacy of multiple forms of low cost, patient oriented incentives for improving patient compliance rates with DOTS. The incentives being tested for improving compliance rates include:

• a hot meal
• a small cash payment
• visits from specialized Red Cross nurses who support patients with education and
• advice during the entire treatment period
• a Comparison Group who receive no incentive

According to WHO, "in areas of minimal or no MDR-TB, DOTS achieves cure rates of up to 95%; rates high enough to dramatically reduce the TB burden while preventing the emergence of drug-resistant TB."

The study in rural and urban areas of KyzylOrda Oblast of Kazakhstan will contribute to public health knowledge of effective strategies for ensuring that TB patient take their drugs regularly, on schedule and for the full duration of their treatment thus adding to the tools that public health officials have to combat the disease.

One of the problems that increase DOTS treatment non-compliance is poverty-a widespread condition in some areas of Central Asia. "DOTS treatment is intensive and requires on-going commitment and responsibility of each patient". During the Intensive phase we keep patients at hospital, provide them with necessary medication and food.

"Often patients don't want to leave the hospital after two months of Intensive phase to return to their poor living conditions. Sometimes if the hospital has an opportunity, it keeps them institutionalized because people don't have money to buy food or to keep their houses warm," said the Chief Doctor of Kazalinsk TB Hospital Dr.Yskakov K.I.

Because the study provides incentives to continuing their treatment , people are more likely to finish their treatment, become cured and are better equipped to help their families.

"Now I can have at least one hot meal after the medication intake, I live alone and it is hard for me to cook. The food is very good, tasty and always hot," said Aliakbarov Farkhad , the participant of the study in hot meal group.

Giving out 50 tenge ($0.30 USD) to a patient per each visit to the DOTS corner mainly helps to cover transportation expenses. Kozhatmekhkyzy Aliya , who lives close to the polyclinic says that she uses money for buying products (bread, rice, noodles etc).

"It is so unusual to receive money for your own treatment. We should be very thankful for the treatment that is free of charge," she said.

To prevent patient's treatment interruption the American Red Cross, together with Red Crescent Society of Kazakhstan, provides a "Visiting Nurse" service for those who are homebound and can not visit the DOTS Center themselves to take their medication.

The Visiting Nurse brings medication home and observes its intake, gives educational or moral support and reminds a patient when it is time for medical examination and analysis. The Visiting Nurse also provides psychological counseling to patients and their families who often have to endure months of hardship while members of their family undergo treatment.

It is becoming increasingly popular in Central Asia to conduct World TB Day activities to make the public aware of the danger of TB in the region and how people can cure the disease and help prevent others from being infected.

American Red Cross together with the Red Crescent Society of Kazakhstan (RCSK) announced a poster competition among the students of all the high schools of KyzylOrda city.

The students will present their poster and express their understanding of the disease and how to prevent it. The winners will be awarded after the quiz show that will take place on the Mar. 26. Each of 40 schools of the city will have representatives at that event. Four schools from the city districts with the high TB rate will develop their own show about the disease and make a live performance.

The main event of the World TB Day celebration in KyzlOrda Oblast will take place in Bekezhanov village of Shiely rayon. As far as 2004 is the "Year of the Village" in Kazakhstan, local village residents, together with the Oblast TB hospital and local mayors are developing a community event about TB including: speeches from various health authorities and community members; testimonials from former TB patients and games and contests to test general knowledge about TB. Additionally, the Red Cross and the RCSK will finish the day by providing a nutritious meal for about 300 participants and TB patients of the village.

Village residents will not be the only ones to participate in World TB Day activities. City commuters will also be reminded about TB, its cure and its prevention every day when they go to work. "Breath is Life! Stop TB now!" - is a slogan that will be posted on each mini bus (marshrutka) of the city.

During the whole month, all people who use the public transportation and simple passer-bys will read the message and be reminded about the burden of the disease.

"It is through public awareness and understanding of the disease, that we can mobilize the community to reduce its impact," said Olga Kim, American Red Cross TB Study Manager.