Palliative care and symptom relief for people affected by multidrug-resistant tuberculosis
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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extensively drug-resistant tuberculosis;
primary health care
Document Type: Research Article
Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
University of Cape Town, Rondebosch, South Africa
Forschungszentrum Borstel, Borstel, Germany
Riga East University Hospital, Riga, Latvia
London School of Hygiene & Tropical Medicine, London, UK, Addictions Research Group, Goa, India
National Tuberculosis Control Program, Hanoi, National Lung Hospital, Hanoi, Vietnam
Albert Einstein College of Medicine, New York, NY
Partners In Health, Boston, MA, USA
Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
Stop TB Department, World Health Organization, Geneva, Switzerland
Publication date: August 1, 2019
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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.
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