C/Can City Engagement Process: An Implementation Framework for Strengthening Cancer Care in Cities in Low- and Middle-Income Countries.

The effective implementation of locally adapted cancer care solutions in low- and middle-income countries continues to be a challenge in the face of fragmented and inadequately resourced health systems. Consequently, the translation of global cancer care targets to local action for patients has been severely constrained. City Cancer Challenge (C/Can) is leveraging the unique value of cities as enablers in a health systems response to cancer that prioritizes the needs of end users (patients, their caregivers and families, and health care providers). C/Can's City Engagement Process is an implementation framework whereby local stakeholders lead a staged city-wide process over a 2- to 3-year period to assess, plan, and execute locally adapted cancer care solutions. Herein, the development and implementation of the City Engagement Process Framework (CEPF) is presented, specifying the activities, outputs, processes, and indicators across the process life cycle. Lessons learned on the application of the framework in the first so-called Key Learning cities are shared, focusing on the early outputs from Cali, Colombia, the first city to join C/Can in 2017. Creating lasting change requires the creation of a high-trust environment to engage the right stakeholders as well as adapting to local context, leveraging local expertise, and fostering a sustainability mindset from the outset. In the short term, these early learnings inform the refinement of the approach in new cities. Over time, the implementation of this framework is expected to validate the proof-of-concept and contribute to a global evidence base for effective complex interventions to improve cancer care in low- and middle-income countries.

Study of drug resistant cases among new pulmonary tuberculosis patients attending a tuberculosis center, Yangon, Myanmar.

A cross-sectional descriptive study was carried out at a tuberculosis center, Yangon, Myanmar from October 2003 to July 2004 to analyze the drug susceptibility of new sputum smear positive pulmonary tuberculosis patients. A total of 202 Mycobacterium tuberculosis isolates were tested for resistance to isoniazid, streptomycin, rifampicin and ethambutol. Resistance to at least one anti-tuberculosis drug was documented in 32 (15.8%) isolates. Monoresistance (resistance to one drug) was noted in 15 (7.4%) isolates and poly-resistance (resistance to two or more drugs) was noted in 17 (9.4%) isolates, including 8 (4.0%) multi-drug resistant isolates (resistance to at least isoniazid and rifampicin). Total resistance to individual anti-tuberculosis drugs were: isoniazid (29, 14.3%), streptomycin (11, 5.4%), rifampicin (10, 4.9%) and ethambutol (1, 0.5%). The demographic data and possible contributing factors of drug resistance were evaluated among the drug resistant patients. Poly-resistant cases had significantly longer intervals between symptom appearance and achieving effective anti-tuberculosis treatment than mono-resistant cases (p = 0.015).