Social support a key factor for adherence to multidrug-resistant tuberculosis treatment.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is emerging as a major public health problem globally. Treatment success rates in MDR-TB across the globe are not encouraging as completing MDR-TB treatment successfully is challenging due to high proportion of lost to follow up. METHODS: Using qualitative methods and grounded theory approach, in-depth interviews were conducted with MDR-TB patients and treatment providers. The social cognitive framework was explored as a way to guide understanding of the factors affecting treatment adherence among MDR-TB patients. RESULTS: Multiple factors influenced patient's decision to adhere to MDR-TB treatment. Self-motivation, awareness about disease and treatment, counselling support, family support, nutritional support and social support were important drivers for successful treatment. Providers related that motivational counselling, nutritional support, family support and social support encouraged treatment adherence. CONCLUSION: To improve MDR-TB treatment adherence, a patient-centric approach should be considered at the programmatic level. There is a need to formulate strategy that includes motivational counselling, nutritional supplementation and social support mobilisation for treatment adherence. Participants suggested a Patient Support Group led treatment care model for better adherence and treatment success rates in MDR-TB treatment.

Scaling up of HIV-TB collaborative activities: Achievements and challenges in India.

India has been implementing HIV/TB collaborative activities since 2001 with rapid scale-up of infrastructure across the country during past decade in National AIDS Control Programme and Revised National TB Control Programme. India has shown over 50% reduction in new infections and around 35% reduction in AIDS-related deaths, thereby being one of the success stories globally. Substantial progress in the implementation of collaborative TB/HIV activities has occurred in India and it is marching towards target set out in the Global Plan to Stop TB and endorsed by the UN General Assembly to halve HIV associated TB deaths by 2015. While the successful approaches have led to impressive gains in HIV/TB control in India, there are emerging challenges including newer pockets with rising HIV trends in North India, increasing drug resistance, high mortality among co-infected patients, low HIV testing rates among TB patients in northern and eastern states in India, treatment delays and drop-outs, stigma and discrimination, etc. In spite of these difficulties, established HIV/TB coordination mechanisms at different levels, rapid scale-up of facilities with decentralisation of treatment services, regular joint supervision and monitoring, newer initiatives like use of rapid diagnostics for early diagnosis of TB among people living with HIV, TB notification, etc. have led to success in combating the threat of HIV/TB in India. This article highlights the steps taken by India, one of the largest HIV/TB programmes in world, in scaling up of the joint HIV-TB collaborative activities, the achievements so far and discusses the emerging challenges which could provide important lessons for other countries in scaling up their programmes.

Efficient, quality-assured data capture in operational research through innovative use of open-access technology.

Ensuring quality of data during electronic data capture has been one of the most neglected components of operational research. Multicentre studies are also challenged with issues about logistics of travel, training, supervision, monitoring and troubleshooting support. Allocating resources to these issues can pose a significant bottleneck for operational research in resource-limited settings. In this article, we describe an innovative and efficient way of coordinating data capture in multicentre operational research using a combination of three open access technologies-EpiData for data capture, Dropbox for sharing files and TeamViewer for providing remote support.

La garantie de la qualité des données au cours de la capture des données électroniques a constitué une des composantes les plus négligées de la recherche opérationnelle. De plus, les défis des études multicentriques comportent des problèmes concernant les logistiques du voyage, la formation, la supervision, le suivi et le soutien au dépannage. Une allocation de ressources à ces problèmes peut constituer un goulot significatif pour les recherches opérationnelles dans les contextes à ressources limitées. Dans cet article, nous décrivons une façon innovatrice et efficiente pour la capture des données de coordination dans la recherche opérationnelle multicentrique au moyen d'une combinaison de trois technologies libres d'accès­EpiData pour la capture des données, Dropbox pour le partage des dossiers et TeamViewer pour procurer un soutien à distance.

Garantizar la calidad de los datos durante la captura electrónica ha sido uno de los componentes más desatendidos de la investigación operativa. Los estudios multicéntricos afrontan además dificultades relacionadas con la logística del desplazamiento, la capacitación, la supervisión el seguimiento y de la asistencia técnica para la resolución de los problemas. La atribución de recursos a estas esferas puede representar un cuello de botella de la investigación operativa en los entornos con escasos recursos. En el presente artículo se describe un método innovador y eficaz de coordinar la captura de datos en investigación operativa mediante la aplicación de tres tecnologías de acceso abierto, a saber: EpiData en la captura de datos, Dropbox en la puesta en común de los archivos y TeamViewer en la prestación de asistencia técnica a distancia.