HIGH in the hills of Nepal, communities have a new weapon in the fight against tuberculosis. It isn鈥檛 an expensive drug or vaccine 鈥� it is simply using family support to make sure that someone with TB completes the six-month course of medicine necessary to cure the disease.
Until now, health workers have had to watch patients to check that they take their drugs on a daily basis, or risk them having a relapse or even developing a drug-resistant form of TB.
However, a trial in Nepal led by James Newell of the University of Leeds, UK, proves that the regime works just as well when a family member takes responsibility for ensuring that the drug treatment is completed. Of 358 patients 鈥渙bserved鈥� by family members, 89 per cent were cured. That鈥檚 a 4 per cent improvement on the cure rate for the 539 patients overseen by health workers in the same trial (The Lancet, vol 367, p 903). 鈥淧eople say they preferred it,鈥� says Newell. 鈥淭here鈥檚 no stigma, and they don鈥檛 want to feel indebted to others.鈥�
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鈥淢ore patients were cured when overseen by family rather than health workers鈥�
The result could provide the key to curing TB in remote areas like Nepal, or in regions where health workers are overstretched, although it may not work equally well everywhere. The WHO has taken this on board and made family and community involvement a key part of its new $56 billion strategy to halve annual TB deaths by 2015, also in The Lancet this week (p 952).
