Muhammad Kashif Munir, Sana Rehman, Rizwan Iqbal.
Meeting the challenge, making a difference: multidrug resistance tuberculosis in Pakistan.
Pak J Med Res Jan ;57(1):1-2.

National TB Control Program (NTP) has provided GeneXpert for early diagnosis of DR TB. Case detection has been increased and none of the patient is refused to serve treatment on Programed Management of DR TB (PMDT) site. Although diagnosis and treatment of MDR TB is totally free and the program relays on Global funding. Many patients remain undiagnosed, untreated, continues to spread DR bacilli and poses potential threat to community. These issues include poor vigilance of healthcare workers, poor level of trainings, bad response to patients, lack of infrastructure for maintenance and repair of machinery and lack of communication with program officials etc. There are many attractive incentives for MDR TB patients provided at PMDT sites by NTP Pakistan in collaboration with donors. These include social support to each patient and one treatment supporter, fare charges, free diagnostic, treatment and follow up facilities and same day provision of drugs for one month. Moreover home visits to collect sputum specimen from suspicious MDR TB house hold contacts. Still there are number of MDR TB treatment defaulters and undiagnosed MDR TB cases waiting for not only their deaths but also probable risk for healthy contacts. National TB Control Program (NTP) of Pakistan has defined five principal ways to prevent TB particularly the drug resistant TB. These includes early detection of both kinds of TB, effective treatment, implementation of infection control measures, strengthening and regulation of health system, addressing underlying risk factors and social determinants.6 Diagnosis and treatment of drug resistant TB has been remained the top priority of NTP. Keeping in view an enrolment of 2881 new drug resistant TB cases, introduction of Bedaquilline and Delamanid as new drugs on four PMDT sites, provision of social support and transport, increase in PMDT sites from 3 to 29 remained the key achievements of NTP during 2016.7 On an average around 1-1.2 million rupees are spent on treatment of one MDR TB patient by NTP.8 Despite that, inability of hospital management authorities to provide proposed space for commencement and up gradation of facilities remained major constrain.7 In conclusion, NTP remained successful to meet most of the major challenges in diagnosis and treatment of MDR TB patients while public awareness about the disease, infection control measures among target groups and healthcare workers surveillance are way forward. Information is necessary to reach the target group and vulnerable people and the best sources in this regards are lady health workers. On the other hand, implementation of guidelines and strengthening of infrastructure could be upgraded by proper monitoring, provision of quick services, in time release of desired funds and professional training of healthcare staff.

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