Rwanda's experience in combating multi-drug-resistant tuberculosis (MDR-TB) offers lessons in using available tools wisely now, rather than waiting for the results of long-term scientific investment (Nature 493, 14–16; 2013).
Of 306 patients who began standardized 'second-line' drug regimens for MDR-TB through a Rwandan programme in 2005–09, 270 (88.2%) were successfully treated. Nearly half of the patients were HIV-positive and all lived in extreme poverty.
Crucially, Rwanda's Ministry of Health provided each patient with close follow-up care and with monthly support towards nutrition and transport. As a result, only six patients (2%) defaulted on their treatment.
Such common-sense interventions prevent disease progression and facilitate directly observed therapy. But they are seldom included in cost-effectiveness studies — much less in nationwide strategies.
Once drug-supply chains and comprehensive support for adherence to treatment are in place, such positive MDR-TB treatment outcomes will be possible all over rural Africa.
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Binagwaho, A. Resistant TB: Use the tools available. Nature 494, 176 (2013). https://doi.org/10.1038/494176a
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DOI: https://doi.org/10.1038/494176a
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