Strategies to address the TB in Resource Poor Communities
Jaime Bayona and colleagues at Partners in Health (PIH) in Peru have created innovative programs that demonstrate ways to treat multi-drug resistant tuberculosis (MDR-TB) in resource poor communities. The PIH-Socios En Salud community-based treatment program for multidrug-resistant tuberculosis was initiated in 1996 when a community screening turned up a number of residents from Carabayllo, Lima who did not respond to therapy for tuberculosis. Over the subsequent years, PIH and Socios en Salud have persisted in their commitment to provide the sick with treatment. With support from the Bill & Melinda Gates Foundation and the Harvard Medical School, they have been developing community based MDR-TB treatment strategies appropriate to local circumstances by proving that MDR TB patients can be cured in resource-poor settings. DRCLAS is working with PIH to disseminate the results of their work throughout Latin America.
Participating Harvard faculty: HMS faculty and instructors, Jamie Bayona, Arachu Castro, Mercedes Becerra, Paul Farmer.
Collaborating Institutions: Socios en Salud, Lima, Perú.
Improving Detection and Treatment of Tuberculosis in High-Risk Children
Experience specifically in the clinical management of pediatric tuberculosis is needed to improve outcomes in children. In Peru, children at highest risk of tuberculosis are seen at public-health centers, where medical and nursing staff have large case loads of adult patients and often do not have the expertise to properly evaluate the children. In some children, additional tests such as gastric aspirates and computed tomography are needed. It is imperative to validate strategies that will bring to bear pediatric tuberculosis expertise on the routine evaluation of high-risk children, in order to increase the detection of tuberculosis and improve access to curative treatment. Thanks to a DRCLAS collaborative research grant, a pilot intervention is being deployed and evaluated in an urban district of Lima to improve the capacity of local staff and systems to detect and manage children between ages of 0-14 years who have active tuberculosis. Detection rates and outcomes in these children will be compared to children screened during the previous four months in the same region and a neighboring district. The project is expected to improve the detection and outcomes of treatment of active tuberculosis in poor children in Lima, and inform an improved intervention that can be deployed in other countries.
Participating Harvard Faculty: Mercedes Becerra, ScD, Department of Global Health and Social Medicine, Harvard Medical School
Collaborators: Leonid Lecca, MD, Partners In Health/Socios En Salud, Lima, Perú; J Keith Joseph, Division of Global Equity, Brigham and Women´s Hospital, Boston, MA