Interestingly, In the case study “The Peruvian National Tuberculosis Control Program” it seems what got President Fujimori’s attention in terms of the need to reduce rates of Tuberculosis (TB) in Peru was not so much the need to help the people as it was the threat of negative media attention¹. Pedro Guellermo Suarez was able to use this threat in his favor to create and implement a national program to reduce rates of TB in Peru¹. The program seems to have been incredibly successful as the rates of TB dramatically plummeted even within the first year. It seems the success of this program was due to the multi level approach which included community level methods (community organizations provided workshops to educate the people, home visits for those that tested positive etc.); organizational level methods (regional programs responsible for carrying out the NTP program in their districts); data management level (introduced case cards to document every TB case) and treatment level methods (first country to effectively initiate the DOTS). In retrospect however, it seems more should have been more forethought in terms of preventing treatment resistance.
In 1992 the National Tuberculosis Control Program (NTP) report noted that dug resistance was expected to occur for many reasons (i.e. if there were inadequate drug regimens, if the patients abandoned their medication regimen, if the dosing was too low etc.). By 1995 between 12 and 25% of Peruvian patients treated for TB failed treatment¹. These patients who failed treatment were either given retreatment or were told their condition was chronic. Those who rejected the diagnosis of chronic TB were able to obtain partial doses of second line TB treatment from pharmacies creating even more of a treatment resistance¹. It is somewhat disturbing that given the prescient knowledge of the possibilities of drug resistance that these second line drugs were so readily available to chronic patients and even more disturbing that these patients were taking drugs without oversight and only at doses they could afford.
Today Peru has one of the highest rates of multidrug resistant and extensively drug resistant TB cases.² Is there more that could have been done to avoid the current situation? It seems that the NTP took drastic measures to ensure patients were compliant with first line treatment, even so far as sending nurses to their homes to prevent abandonment. In addition, it seems from the case study that many measures were put in place to ensure that the physicians were well trained and that there was proper oversight. The NTP educated the public and took pride in their work so much so that there was a kind of competition between regional programs. Is the resulting high rate of drug resistance in Peru a result of a flawed national program or is it to be expected as the rates of TB were so high in Peru before the program was implemented? It seems to me that additional measures could have been taken such as policies disallowing chronic TB patients to buy from pharmacies and treat themselves with insufficient doses.
¹ Talbot, J.R., Rhatigan, J. and Kim J.Y. (2011) The Peruvian National Tuberculosis Control Program. Harvard Business Publishing. http://cb.hbsp.harvard.edu/cb/library/allMaterials
² Thompson, B. Q&A: Tackling TB in Peru. Retrieved November 29, 2011, from http://www.wellcometrust.wordpress.com