ASD - PAKISTAN

Multi-drug resistant TB guidelines in Pakistan

The management of MDR-TB is complex, with multiple technical and programmatic challenges. The treatment is long, usually about 18 - 24 months, with use of relatively toxic and expansive drugs that generally requires continued inputs of a health care provider. The hospitalisation of MDR-TB patients for the first few months of their treatment has been found not very feasible in many countries. The current preference is to find ways of effectively delivering community-based care to MDR cases. This implies linking the hospitals with the primary health care network in the country. The patients generally also need social support to cope with the health, social and economic challenges related with MDR-TB.

In Pakistan, the current load of MDR cases is estimated to be 12,000 cases per year. The programme, through its Technical Working Group, is already working on developing national technical guidelines for diagnosis and treatment of MDR-TB cases in Pakistan. These technical guidelines are planned to be a reference booklet in conventional text, covering various components of MDR-TB diagnosis and care. However, these technical guidelines would leave many unanswered operational areas that could potentially lead to errors in the medical management of MDR-TB. There is limited experience and/or research information on the ways and means to effectively implement community-based MDR-TB care delivery in programmatic conditions. Without addressing these operational issues systematically there will be inevitable variation in the quality of care to be delivered through collaborative efforts of the hospitals and the primary health care networks in districts.

The project will provide an opportunity to study, develop, implement and evaluate a TB MDR case management desk-guide and training materials. The desk guide will help to make the care delivery process more structured and simpler and also address the gaps to diagnose and follow-up MDR TB. The research will be implemented in 2-3 selected hospitals of Pakistan. The evaluation will assess the effectiveness and feasibility of use, and will use a combination of qualitative and quantitative research methods. The operational guidelines will be refined in collaboration with tuberculosis programmes for future implementation in other districts of the country.