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3 Catching Up with the Microbe
3 Catching Up with the Microbe
Pages 23-30
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From page 23... ...
• Novel diagnostics and therapeutics can be introduced equitably through "care delivery platforms" linking hospitals and clinics to patients in their homes. • Sustained and substantial investments, and also new tools, are key in the strategy for catching up with microbial drug resistance and strengthening TB control.
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From page 24... ...
"Are we going to win this struggle, or is the mycobacterium? " MDR TB IN NEW YORK CITY In the past, increasing wealth has had the effect of helping to reduce the burden of TB.
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From page 25... ...
DR TB: By 1990, almost one in five patients with TB in New York City had MDR TB, accounting for 61 percent of the MDR TB cases in the United States. After peaking in 1992, the number of TB cases, both drug-susceptible and DR, dropped rapidly in New York City and today is lower than it was before the increase (Figure 3-2)
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From page 26... ...
26 FIGURE 3-2 TB rates in New York City rose to a peak in 1992 and then fell rapidly as new interventions were implemented. SOURCE: Data from the New York City Department of Health and Mental Hygiene.
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From page 27... ...
Community-based care relying on community health workers has not evolved much in the United States, but recent developments designed to improve health outcomes, increase coverage, and decrease costs should make such models much more common in the treatment of chronic disease, regardless of etiology. Nor has community-based care taken hold in the BRICS countries, with a few notable exceptions entailing DR TB programs.
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From page 28... ...
But the idea that patients often refuse effective treatment, even if difficult, is "a fiction," said Farmer. "The great majority of patients want to be treated, but they do not want another neffective and prolonged regimen, which is what most of them received i prior to initiating care for laboratory-proven MDR TB." The intensive treatment regimen for MDR TB was scaled up to thousands of patients in Peru, which was then reporting the largest number of new TB cases in Latin America, most of them caused by drug-susceptible strains.
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From page 29... ...
These same debates have recurred not only for DR TB but also for other pathologies, including most cancers, held to be "untreatable" in settings of poverty long bereft of robust health infrastructure and skilled personnel and the resources to build and train and support them. False "competitions" have hobbled TB control for many decades, Farmer said -- prevention versus treatment, research versus delivery, domestic versus international, HIV positive versus HIV negative, drug-susceptible versus drug-resistant.
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From page 30... ...
"A lot of the answers for this global challenge are likely to come from China and from some of other countries we are calling the BRICS countries," Farmer predicted. "I am confident that these problems, including drug-resistant TB and rising health disparities, must and will be addressed here, and that the rest of the world will learn." TB can be addressed effectively, Farmer concluded, only by "significant and sustained investments in protecting public health, not just in one corner of the global economy, but everywhere."
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