Soapbox

Tuberculosis can be cured – if patients finish their treatment

An elderly patient sits on his bed Tuesday at a hospital in Srinagar, India, which has the highest incidence of TB in the world. The highly contagious bacterium responsible for TB still haunts the poorest communities of our planet.
An elderly patient sits on his bed Tuesday at a hospital in Srinagar, India, which has the highest incidence of TB in the world. The highly contagious bacterium responsible for TB still haunts the poorest communities of our planet. The Associated Press

Roughly 2 billion people – more than a quarter of the world’s population – are living with tuberculosis infection. The highly contagious bacterium responsible for TB still haunts the poorest communities of our planet as we marked World TB Day on Tuesday.

While the illness hasn’t changed much over the centuries, we as people have: We are more mobile, bringing our diseases with us. Modern drugs to treat TB are extremely effective, and most infections can be cured – if a patient completes treatment.

That’s a big “if.”

On an average day, 4,000 people will die from TB – 1.5 million a year. In the United States, we’ve done lots of work identifying new cases and beginning treatment, but we need to assure that treatment is completed. Otherwise, the patient isn’t cured.

Of the 11 million U.S. cases, the burden falls heavily on our migrant and immigrant communities – people who are often unable to access health care because of limited sites for care, their undocumented status, language or cultural differences, transportation issues or simply because they’re on the move.

Many doctors who see migrants are conflicted about starting treatment for a patient who may move prior to completion, recognizing that an incomplete treatment may worsen drug resistance and allow the patient’s TB to reactivate. Many newly diagnosed patients who need to move due to work or family concerns will have difficulty completing treatment, and doctors are often unequipped to provide continuity of care. It is imperative that we have resources to support those mobile patients in completing treatment.

We at Migrant Clinicians Network created a case management system to help connect patients to care as they move within the U.S. or to other countries by providing transfer of medical records and follow-up services.

And it works. Since 2005, the health network has an 84 percent treatment completion rate for patients with TB departing the U.S. The system assisted patients traveling to 91 countries, and it’s also proven cost-effective. But programs like ours are few and far between.

Today, health care has remained static while people and their diseases move around. Despite advances in electronic health records, patients struggle to find a new doctor, get their medicine and continue treatment. It isn’t enough to identify affected patients and begin treatment, as is the current strategy. We must make sure they can complete treatment, even if they decide to move.

With huge advances in technology comes the responsibility to use it effectively to improve health. It’s time to get the upper hand on this ancient disease.

Ed Zuroweste is chief medical officer of Migrant Clinicians Network and assistant professor of medicine at Johns Hopkins School of Medicine. Deliana Garcia is director of international projects, research and development for Migrant Clinicians Network.

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