HERD - NEPAL

Assessing the effects of social and economic support for MDR TB patients in Nepal.

Multi-drug resistance TB patients receiving treatment using the DOTS-plus strategy need to take directly observed treatment (DOT) for a minimum of 24 months. This generally means they need to be near to the DOTS-plus centre, away from their usual financial and social support. In Nepal about 5% of DOTS-plus patients discontinue treatment in the first 12 months, and it is expected that the discontinuation rate in the second 12 months of treatment will be greater. Patients report financial difficulties and request financial support; and experience drug side effects, isolation from family and friends, loneliness and depression. These problems may contribute to treatment discontinuation and extremely drug resistant TB, which is virtually untreatable and a major threat to patients and communities. Financial and/or social support may help patients to complete treatment, but the effectiveness of such support and evidence on the effectiveness of such interventions is lacking. This study aims to compare the effectiveness of financial and social support and social support alone on preventing default from DOTS-plus treatment under routine programme conditions. The study will also identify and document the problems experienced by patients, and how they deal with them when support is not provided.

This intervention is providing financial and social support for all patients at two DOTS-plus centres; social support only at 2 more centres; and no additional support at a further 2 centres. All patients visiting these centres for 12 months commencing 1 November 2007 will be recruited for the study. The default rate (per person month observed) will be compared between the three groups to determine the effectiveness of providing financial and social support. Determining the feasibility and effectiveness of such measures would encourage governments and donors to consider changes in control policy.