Georgia-Abkhazia: Home-care for patients suffering from multiple drug-resistant tuberculosis

Definition: Multiple drug-resistant tuberculosis (TB-MDR) describes a case where the infected patient displays resistance to at least two of the most powerful molecules employed in first-line treatment (Rifampicine and Isionazide). Resistance is caused by:
  • the administering of inadequate or incomplete treatments,
  • the prescribing of poor-quality medicines,
  • direct infection by a resistant strain of the illness. MSF's MDR-TB Programmes: Zugdidi (Georgia): 81 patients Soukhoumi (Abkhazia): 51 patients In its two programs in Georgia and Abkhazia, MSF has introduced a new approach in care for patients suffering from multiple drug-resistant tuberculosis (MDR-TB) in order to alleviate what are particularly fastidious treatment conditions, our staff are now offering patients home-care. Multiple drug-resistant tuberculosis remains a difficult illness to treat, for several reasons:
  • hospitalisation time,
  • treatment duration (two years on average),
  • confinement of the infectious patient in a closed space,
  • gravity of secondary effects. Around one-half of patients fail to tolerate all of the stated constraints, therefore interrupting their treatment before it is complete. The inability to offer patients less poisonous and less coercive treatment led our staff to explore means of alleviating treatment conditions; whence home-care, which constitutes a pertinent alternative solution. Reducing hospitalisation time Treatment of multiple drug-resistant tuberculosis necessarily commences with hospitalisation. It is a difficult period for the patient, with factors such as bad secondary effects, emotional separation, decreased income at home... In the new approach employed in Georgia and Abkhazia, MSF cuts down this initial isolation phase: the patient remains hospitalised until the MDR-TB bacillus is no longer detectable in sputum. With the reduced contagion risk, the treatment may thereafter continue at home: the patient is isolated from his family for a shorter period. In many cases he feels more motivated to continue the treatment. Continuing treatment at home Continuation of the treatment can take place at home, if the patient's dwelling conditions so allow, such as a separate room is available, and proper ventilation, appropriate heating… If required, MSF will perform certain rehabilitation works. Our teams provide several kinds of day-to-day patient-support, including regular home visits by psychologists and social workers. These give the opportunity for patients to air their problems. Patients also receive material or financial aid: firewood, clothes, proper nutrition etc. The improvement of patients' living conditions has an impact on treatment-continuation. At Zugdidi, since commencement of the project in November 2006, none of the 81 patients has abandoned his treatment... Research and Development. Although caring for patients at home ensures better treatment-discipline, it changes nothing in terms of medical follow-up. Currently, suitable diagnostic and therapeutic tools are not available in every case, and this situation can only be improved by investment in research and development. Nevertheless, home-care for patients leads to fielding of new methods, the results of which must be evaluated. Depending on the findings, MSF may consider replicating the scheme on a larger scale.