According to Global Tuberculosis Report 2020 (1), the global treatment success rate for multidrug-resistant tuberculosis (MDR-TB) is 57%, far below the World Health Organization (WHO) target of curing at least 75% of MDR-TB patients. China — with a treatment success rate of 54% in 2019 — is no exception; nearly half of all treated MDR-TB patients are lost to follow-up, treatment failure, or death. Failure to support patients throughout the treatment process leads to incomplete treatment, treatment failure, and associated morbidity and mortality, and it also wastes significant financial resources the health system invested in MDR-TB diagnosis and treatment (2-3). More importantly, patients continue to suffer. They are not only at risk of developing extensive drug resistant tuberculosis (XDR-TB), but also of transmitting MDR-TB to their families and communities, increasing the incremental burden of MDR-TB patients, and fueling a growing public health crisis.
The WHO proposes that providing patient care services improves treatment adherence, helps patients complete treatment, and improves overall cure rates (4-5). However, the WHO guidelines have not provided detailed guidance or tools for national tuberculosis control programs and health services providers to implement comprehensive patient care (6-7). In 2017, China CDC and the United States Agency for International Development-funded Control and Prevention of MDR-TB program implemented by Family Health International (FHI360), introduced a differentiated and personalized comprehensive and supportive care services (CSC). The CSC framework, which was based on global MDR-TB guidelines but adapted to China’s context, and included 4 thematic areas and 11 elements (8) which were piloted in selected sites in China to explore how to provide practical care services for MDR-TB patients (Table 1).
Thematic areas Elements Respect for patient autonomy and support of self-efficacy strengthened Patient intake assessment and individual care plan
Patient and family education on treatment
Support treatment and care accessible to patients
Maximizing physical comfort, safety, and wellness among MDR-TB patients Monitoring and treatment of adverse drug effects and co-morbid physical conditions
Strenghtening psycho-emotional support and protection
from social isolation or discrimination
Patient-centered counselling throughout care
Monitoring and treatment of mental health conditions
Support for reducing social isolation
Protect patient and family from stigma and discrimination
Preventing catastrophic costs to patient and family strengthened Patient cost saving or reduction activities
Table 1. The supportive care services framework – thematic areas and elements.