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Shifting the paradigm in tuberculosis control: illustrations from India
1Department of Public Health & Policy, London School of Hygiene & Tropical Medicine, UK. j.ogden@lshtm.ac.uk
Summary
Treatment failures in tuberculosis (TB) are not patient failures. Effective TB control requires addressing social determinants and improving patient access to care, shifting focus from diseased individuals to community health.
Area of Science:
- Public Health
- Social Medicine
- Health Services Research
Background:
- Tuberculosis (TB) control programs often face challenges with treatment adherence and failure.
- Existing approaches may overlook the social and economic factors influencing patient compliance.
- Understanding the patient's context is crucial for effective TB management.
Purpose of the Study:
- To investigate the root causes of tuberculosis treatment failures.
- To identify barriers to care and explore strategies for improving patient access and adherence.
- To propose a reorientation of TB control programs towards patient-centered care.
Main Methods:
- Literature review drawing on Indian and social science research.
- Analysis of social and economic burdens associated with TB diagnosis and treatment.
- Examination of successful non-governmental projects and comparison with directly observed treatment approaches.
Main Results:
- Tuberculosis control is ineffective when isolated from social processes that facilitate spread and create barriers to care.
- Economic and social burdens significantly impact patient compliance, particularly for disadvantaged populations.
- Patient access to care is a central issue in maintaining appropriate TB therapy.
Conclusions:
- Tuberculosis treatment failures are systemic, not individual patient failures.
- TB control programs must address the social dimensions of the disease and prioritize patient enablement.
- A paradigm shift towards community health enablement, rather than solely focusing on diseased patients, is recommended.