Partners In Health representatives from four continents traveled to Paris, France, for the 37th World Conference of the International Union Against Tuberculosis and Lung Disease (The Union) from October 31 through November 4, 2006. PIH affiliates from Peru, Russia, Rwanda, and Boston presented their experience integrating community-based care for tuberculosis and HIV and using innovative technologies to test for drug resistance and manage patients' medical records.

The PIH delegation included clinicians, public health researchers, and medical information technology developers involved in diverse aspects of care for people living with tuberculosis (TB). Collaborators from the Peruvian Ministry of Health also presented at the Union conference.

Key presentations by PIH affiliates included the importance of utilizing community health workers to integrate TB and HIV care, strategies for early detection of drug-resistant tuberculosis, and evaluation of electronic record systems to maintain comprehensive records of patient care and streamline medication supply orders. 

PIH also presented findings from its work with patients suffering from strains of tuberculosis that are resistant to two or more of the most common medications used to treat TB, termed multidrug-resistant TB (MDR-TB). A poster presentation by the PIH Russia team examining risk factors for developing MDR-TB in Tomsk, Russia, drew attention at the conference.

“Our presentation showed that hospitalization was the greatest risk for acquisition of MDR-TB,” explained Dr. Salmaan Keshavjee, a physician at Brigham and Women’s Hospital who works with PIH projects in Russia and Lesotho.

“The policy implications of this work—especially in the countries of the former Soviet Union, where hospital-based treatment is the standard—are great,” concluded Dr. Keshavjee.

The theme of the Union conference was “Strengthening human resources for better lung health,” to address what conference organizers called “a human resource crisis” in the health care systems of many developing countries.

“Without building health infrastructures, it will be very difficult to build successful programs and reach out to the peripheries where the patients stay,” affirmed Dr. Amsa El Sony, President of the Union in an interview for the Kaiser Foundation. 

Eliminating poverty is also a key factor in retention of medical staff and supporting health infrastructure in developing countries, Dr. El Sony added.

One way Partners In Health addresses the shortage of professional health personnel in developing countries is by employing a network of community health workers, who accompany patients during treatment for complex illnesses, including TB and HIV/AIDS.

“PIH's approach has been to develop a cadre of health workers, drawn from the communities themselves,” said Dr. Keshavjee. “The idea of accompaniment builds on the widely-used community health worker model, adding the dimension of solidarity with the patients.”

In several conference sessions, representatives from Partners In Health, as well as Doctors Without Borders, emphasized the importance of paying community health workers adequately.

Other issues raised at the conference included the recent emergence of extensively drug-resistant tuberculosis, or XDR-TB, and the role of HIV/AIDS in fueling the spread of tuberculosis globally, particularly in sub-Saharan Africa. 

As drug-resistant strains of tuberculosis continue to spread, developing a research agenda for clinical trials of new TB medications is critical, noted Dr. Carole Mitnick, a researcher with PIH projects in Peru and Russia and instructor at Harvard Medical School.

“PIH’s community-based model can accelerate the delivery of promising new agents through clinical trials, routine care and compassionate use,” Mitnick added. “Our presence and that of the HIV activist community has helped pressure TB drug developers to consider creative, rapid approaches to increasing access to new agents.”

The mission of the Union is to prevent and control tuberculosis, lung disease, and related health problems, with a particular emphasis on low income countries.  The Union’s World Conference aims to gather and disseminate knowledge on tuberculosis and other lung diseases, and to link researchers, national governments, civil society groups, and the World Health Organization.

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