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Free Content Palliative care and symptom relief for people affected by multidrug-resistant tuberculosis

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The World Health Organization (WHO) defines palliative care as the prevention and relief of the physical, psychological, social and spiritual suffering of adults and children with life-threatening illnesses and psycho-social support for their families. Palliative care and symptom relief (PCSR) also addresses suffering in nonlife-threatening situations such as after cure. PCSR should never be considered a substitute for tuberculosis (TB) prevention and treatment, but should be accessible by everyone in need. PCSR can reduce suffering and improve quality of life of patients with end-stage chronic illnesses while reducing costs for health care systems and providing financial risk protection for patients' families. It also may help enable patients to adhere to long and noxious treatments and thereby reduce mortality and help protect public health. Basic PCSR can be taught easily to TB specialists as well as primary care clinicians and delivered in hospitals, clinics or patients' homes combined with infection control. For these reasons, integration of PCSR into multidrug-resistant (MDR) and extensively drug-resistant TB (XDR-TB) treatment programs is medically and morally imperative. We propose an essential package of PCSR for people with M/XDR-TB that includes a set of safe, effective and inexpensive medicines and equipment, social supports for patients and caregivers living in extreme poverty, and necessary human resources. The package aligns with WHO guidance on programmatic management of drug-resistant (DR) TB and should be universally accessible by people affected by M/XDR-TB. We also describe the ethical practice of PCSR for people with M/XDR-TB and identify needed areas of research in PCSR for people with M/XDR-TB.
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Keywords: MDR-TB; extensively drug-resistant tuberculosis; human rights; palliative care; primary health care

Document Type: Research Article

Affiliations: 1: Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA 2: University of Cape Town, Rondebosch, South Africa 3: Forschungszentrum Borstel, Borstel, Germany 4: Riga East University Hospital, Riga, Latvia 5: London School of Hygiene & Tropical Medicine, London, UK, Addictions Research Group, Goa, India 6: National Tuberculosis Control Program, Hanoi, National Lung Hospital, Hanoi, Vietnam 7: Albert Einstein College of Medicine, New York, NY 8: Partners In Health, Boston, MA, USA 9: Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus 10: Stop TB Department, World Health Organization, Geneva, Switzerland

Publication date: August 1, 2019

More about this publication?
  • 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 lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

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

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