Unfortunately, a substantial number of the people who contract tuberculosis (TB) turn out to be homeless individuals. Treating such cases of TB (that is, the cases of TB in homeless people) can be a huge challenge. Often, these homeless people turn out to be individuals who are also struggling with various mental health issues. A good number of them are individuals with very low levels of education. As such, they may not see the need to seek treatment. And even when they are pushed by the symptoms to finally seek treatment, they may not stick to the whole treatment courses. So there is a risk of them dropping out of treatment midway, potentially leading to TB drug resistance. It doesn’t help matters that many of these people are individuals who are down and out, individuals who don’t seem to place much of a premium on their lives. Yet, knowing the high mortality rates associated with tuberculosis infections, every effort has to be made to ensure that such individuals are put on treatment. This way, the lives of the patients are saved, and the chances of them spreading the TB to other members of society are reduced.
While treating tuberculosis in homeless patients, it is very important to get them to first understand the seriousness of the condition. So the idea would be to get them to understand that they are suffering from a very serious illness (one with a mortality rate above 50%), and that their chances of survival would be very low without treatment. On the other hand, it is important to get them to understand that if they stick to their treatment, they would almost certainly get cured.
Secondly, it is important to create incentives for them to stick to the treatment. Thus, for instance, the TB clinics where homeless people are treated can be designed in such a manner that they also offer food. We can even go to the extent of offering monetary incentives for the patients who stick to their treatment courses.
Thirdly, it is important to make them aware of the fact that TB is a public health issue. And that as such, they would be at risk of being arrested (and forcefully treated), if they refuse to go through the whole courses of treatment voluntarily.
Fourth, the TB patients need to be educated on the common side effects of TB drugs, and how to cope with them. It is important to get them to a point of understanding that the side effects of the drugs are nothing compared to the risks of not going for treatment/dropping out of treatment midway.
It has been noted, with a great deal of concern, that the number of drug resistant TB cases is on the rise. So these are cases of TB that can’t be cured with ‘first line’ drugs like Isoniazid and Rifampcin. People with such strains of tuberculosis often have to be put on ‘second line’ drugs such as streptomycin. That often means having to go through longer — and more expensive– treatment courses. And the people put through such treatment courses also often have to deal with more severe (and sometimes lifelong) side effects.
Unsurprisingly then, one of the key discussions whenever infectious disease experts meet is as to how these drug resistant TB cases can be dealt with. The objective is to eliminate the drug resistant TB cases as soon as possible. In fact, the ultimate objective is to eradicate tuberculosis altogether – which is actually an achievable goal, given that are many other diseases that have been virtually eradicated in the past.
So, how can the war against TB drug resistance be won?
Well, the most important thing is to ensure treatment adherence for people who are diagnosed with the normal strains of TB (that is, the strains of TB that are not drug resistant). It is worth noting that many of the drug resistant TB cases started as ‘normal TB’ cases. Then, due to improper treatment (like where people quit treatment before completing the doses) the TB bacteria eventually became drug resistant.
In more specific terms, patients who are diagnosed with normal TB cases need to be supported fully, to ensure that they adhere to treatment guidelines. Ideally, TB should be viewed as a public health issue, and treatment offered free of charge. The moment you start demanding that people pay directly for their treatment is the point you will start having treatment failures. If you expect a struggling worker to, say, go to the mypepsico login page, sign in there, get a paycheck and then use the money for treatment, you may be courting failure. The person in question may not be able to afford the full dose of drugs necessary for proper treatment of TB: potentially leading to drug resistance.
Besides giving free treatment to TB patients, there should be proper follow up on the people who are diagnosed with the illness (to ensure that they stick to their treatment plans). Remember, some of the individuals who are diagnosed with TB may be individuals who have no fixed abodes or means of livelihood. It is very easy for such people to get ‘lost’ before they complete their treatment courses – potentially leading to TB drug resistance.