The effectiveness and feasibility of hospital and community-based care delivery for MDR-TB in Pakistan

This study aims to enable the National TB Programme in Pakistan to effectively implement multi-component, Multi-Drug Resistant TB (MDR-TB) care using Public-Private Partnerships.
There are approximately 13,000 cases of MDR-TB diagnosed in Pakistan each year. Treatment of MDR-TB requires 18-24 months of medication, support and supervision at a significant cost. Guidelines developed for managing MDR-TB are supported by the National TB Programme (NTP) in Pakistan and help deliver high quality care for patients with MDR-TB.
Currently patients diagnosed with MDR-TB are hospitalised for their initial phase of treatment, until they are at a lower risk of further transmitting the bacteria. Pilots show that community based care is an acceptable alternative to patients being hospitalised, which suggests that this could be a more effective way to deliver MDR-TB care in Pakistan.
The study will assess 2 types of service delivery models for their effectiveness and cost-effectiveness in low resource settings in Pakistan. These care models are:
1. community-based care (early discharge to peripheral care); and
2. hospital-based care (late discharge to peripheral care).
The primary objective is to determine the difference between the proportions of MDR-TB patients successfully treated using community-based care, compared to patients treated using hospital-based care.
Secondary objectives include:

  • comparing the intermediate outcome (smear and culture conversion rate) in community-based care vs. hospital-based care
  • comparing the health services and the patient costs of the two care models
  • assessing the affordability of these interventions in the context of the TB control programme in Pakistan
  • assessing the social feasibility of implementing hospital-based and community-based MDR-TB care in Pakistan

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