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Free Content Language in tuberculosis services: can we change to patient-centred terminology and stop the paradigm of blaming the patients? [Perspectives]

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The words ‘defaulter’, ‘suspect’ and ‘control’ have been part of the language of tuberculosis (TB) services for many decades, and they continue to be used in international guidelines and in published literature. From a patient perspective, it is our opinion that these terms are at best inappropriate, coercive and disempowering, and at worst they could be perceived as judgmental and criminalising, tending to place the blame of the disease or responsibility for adverse treatment outcomes on one side—that of the patients.

In this article, which brings together a wide range of authors and institutions from Africa, Asia, Latin America, Europe and the Pacific, we discuss the use of the words ‘defaulter’, ‘suspect’ and ‘control’ and argue why it is detrimental to continue using them in the context of TB. We propose that ‘defaulter’ be replaced with ‘person lost to follow-up’; that ‘TB suspect’ be replaced by ‘person with presumptive TB’ or ‘person to be evaluated for TB’; and that the term ‘control’ be replaced with ‘prevention and care’ or simply deleted. These terms are non-judgmental and patient-centred.

We appeal to the global Stop TB Partnership to lead discussions on this issue and to make concrete steps towards changing the current paradigm.
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Keywords: TB; control; defaulter; language; loss to follow-up; suspect

Document Type: Research Article

Affiliations: 1: Medical Department, Médecins Sans Frontières, Operational Centre Brussels, MSF–Luxembourg, Luxembourg 2: International Union Against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene & Tropical Medicine, London, UK 3: International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India 4: Fiji National University, Suva, Fiji 5: Secretariat of the Pacific Community, Nouméa, New Caledonia 6: Dignitas International, Zomba, Malawi 7: Instituto Nacional de Salud, Lima, Peru 8: Health Services Department, PSI/Myanmar, Yangon, Myanmar 9: Revised National Tuberculosis Control Programme, Delhi, India 10: National Tuberculosis Control Programme, Lilongwe, Malawi 11: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, University of Stellenbosch, Cape Town, South Africa 12: Academic Model Providing Access to Healthcare (AMPATH)/Moi Teaching & Referral Hospital, Eldoret, Kenya 13: Centre for International Health, University of Bergen, Bergen, Norway 14: International Union Against Tuberculosis and Lung Disease, Paris, France

Publication date: 01 June 2012

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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