Forget the Homeless—TB Drug Compliance in Nomads

Source: East Afr Med J 1997;74:348.

The african medical and research Foundation reports on a remarkable campaign to improve TB treatment rates among nomads in war-torn Somalia using DOT therapy. Patients in this area typically vanish after initial improvement in response to initiation of therapy. The authors attempted to select patients who would benefit the most from therapy, including children, adults with smear-positive disease, and those with smear-negative disease who were seriously ill. A total of 213 patients were selected, 192 of whom had pulmonary TB (81% were smear-positive). In order to participate in the program, patients had to find a guarantor to vouch for their desire to receive a complete course of therapy.

Overall, a 70% cure rate was achieved, and 93% of the pulmonary cases were smear-negative within two months of initiating therapy. Only 14.5% of the patients defaulted. This figure favorably compares to that from a recent study of DOT therapy in Denver, in which 18% of patients were non-compliant (Infectious Disease Alert 1997; 21:166-167). The African Medical and Research Foundation hopes to establish a sanctuary where patients can receive adequate nutritional support and housing during their treatment course.