||Failure of tuberculosis control: a prescription for
||JAMA 1994, 271, 708-709.
This article presents some studies to depict the
dramatic increase in TB incidence in the United States due to its
failure to co-ordinate the medicare care provision, disease surveillance
and societal will to consistently provide TB therapy and monitor
TB control. The author considers that the collective apathy has
led to increase in multi-drug resistance. Using incidence rates
to track TB (thus failing to track the completion of therapy) and,
having no systematic national reporting of completion rates are
regarded as evidence of institutionalised apathy. Maintaining a
prevalence registry is administratively labor-intensive, therefore,
it is suggested that local health departments must enter data into
computers as reports arrive rather than perform batch entry, three
months later. Generating monthly reports for field workers identifying
non-compliant patients or non-reporting physicians, offering non-compliant
patients, DOT, education and appropriate incentives are other steps
to curb TB. Having automated laboratory surveillance of antibiotic
susceptibilities of mycobacterial isolates is essential to produce
timely reports to enable physicians to adjust their prescribing
practices, to facilitate outcome research, to suggest useful regimens
for study and allow for the creation of infrastructure necessary
for organising countrywide clinical therapy trials.
|KEYWORDS: COMPLIANCE; DEFAULT; USA.