A new report from Lima, Peru, offers hope for tackling extensively drug-resistant tuberculosis (XDR-TB) in the developing world, says Mario C. Raviglione in the New England Journal of Medicine.
The report shows that with "aggressive and appropriate" management, XDR-TB can be cured in most cases.
Raviglione highlights some of the factors that may have contributed to Peru's success in treating the disease. All patients were given systematic drug-susceptibility tests and were treated with powerful second-line drugs, including a fluoroquinolone and an injectable drug. Where necessary, treatment regimens were reinforced with known effective drugs.
Strict community-based supervision was enforced, comprising psychological support, nutritional support and financial incentives. Additionally, intense bacteriological and clinical monitoring allowed for readjustments where necessary.
Raviglione believes that applying such an approach on a more global scale would help minimise, and effectively manage, drug resistance.
"In 2008, scaling up is indeed the major challenge faced by most complex health interventions worldwide … Effectiveness of a complex intervention depends on coordinated work among all forces."