Milestone: First MDR-TB patient supported by CAP-TB cured of disease

12 May, 2014

Mr. Luo Zhenglin is a 45 year old man, a migrant from Gui Zhou province who moved to Kunming City to find work.  He was diagnosed with MDR-TB in May 2012, having never been diagnosed with TB before to his knowledge, but he comes from a rural area in Yunnan Province with very high TB prevalence and significant resource limitations within the health system.  This perfect storm that is seen in many rural, hard-to-reach areas leads to high prevalence largely through low case detection and diagnosis, and poor treatment outcomes for those who are diagnosed, thus promoting a type of “chronic TB epidemic” and the likely development of MDR-TB. 

Mr. Luo was initiated on GFATM-funded second line drugs in May 2012, but struggled with serious drug side effects during the first several months of treatment, missing many doses of his drugs.  Through the support and education from CAP-TB’s peer counsellors and patient support groups, he was able to overcome these hurdles.  Looking back on the past two years, Mr. Luo now says that it was the “care and support from family and health care providers [that] empowered me to keep going.  Perseverance is very important for MDR-TB patients, who often suffer from adverse effects of the treatment.”  He will now be followed in the coming months by the Yunnan CDC TB team through clinical checks, routine sputum AFB smears and cultures, and chest X-rays to monitor for relapse or re-infection. 

Although MDR-TB has been treated for many years in Yunnan Province within the hospital system, the Programmatic Management of Drug-resistant Tuberculosis (PMDT) was only recently initiated two years ago in the province, with oversight by China’s National China Tuberculosis Bureau and second line drugs provided by the Global Fund to fight AIDS, TB, and Malaria (GFATM).  CAP-TB’s patient-centered, community-driven strategy to support MDR-TB patients on treatment was also initiated around the same time in 2012, thus enabling the project to provide patient support alongside GFATM-funded second-line drugs.  GFATM funding in China winds down within the coming year, and the National China TB Bureau plans to provide domestically procured and manufactured second-line drugs for MDR-TB patients.  A critical element to ensure treatment success, along with second-line drug treatment, is patient support.  In Yunnan, the project’s patient-centered support strategy will continue as funded by USAID in the coming year; continuation of CAP-TB’s initiatives beyond the project will require funding from the China government at both the provincial and national level.  Advocacy for government support will be strengthened should treatment outcomes for CAP-TB supported patients be higher than treatment outcomes for other patients—and these are indicators that the project will be monitoring as more patients in Yunnan province complete their MDR-TB treatment.  CAP-TB’s comprehensive package for MDR-TB patient support includes adherence counseling and advice from MDR-TB peer counselors; additional attention from the CAP-TB initiated patient support groups at Yunnan TB Clinical Center; and adherence counseling by doctors and nurses who have been trained by the IUATLD’s Dr. Chen-Yuan Chiang.