Abstract
Background: Multidrug resistant tuberculosis (MDR-TB) is expensive to diagnose and treat, and requires a high degree of expertise by the laboratory and medical team, resources that may be scarce in regions with the highest rates of MDR-TB. Baja California, a Mexican state that shares the international border with California, United State of America (USA) has the highest rate of tuberculosis in the country.
Methods: A binational consortium constituted by USA and Mexico partners started a program dedicated to the diagnosis and treatment of MDR-TB in the region. All regimens were individualized according to drug susceptibility tests with a mean of 5.38 drugs used per regimen. Strict directly observed therapy was enforced in every case.Funding from USAID, Rotary International and private donors has augmented existing program funds
Results: From June 2006 through December 2010 forty patients started treatment. The lapse between their initial diagnosis and the referral to the program was 43.6 months; they had received 2.15 treatment regimens in the past. Their strains were resistant to 4.15 drugs; 2 patients (5.1%) had an XDR-TB strain.
All patients converted their culture on treatment, on average after 4.0 months. Nineteen patients (47.5%) have been discharged as cured (mean follow-up after discharge 6.8 months), 3 patients died (7.5%) and one patient abandoned (2.5%).
Conclusions: Highly resistant cases can be cured under a well organized, outpatient program. In this consortium the USA partner introduced program elements that have been gradually integrated into the state TB program. After 5 years, the consortium continues to fine-tune sustainable interventions and provides quality control.
- © 2011 ERS