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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
PERU: Doctors in Peru Battle Increasingly Drug-Resistant TB
Francine Uenuma
March 3, 2010
Washington Post (03.02.10) - Wednesday, March 03, 2010

Residents of one poor neighborhood north of Lima have been hit hard by TB, which is fueled by poverty, poor nutrition, and limited access to health care. The residents live close together in ramshackle housing, so it is common for one family member to transmit TB to the rest of the household.

"Incidence of disease absolutely follows the poverty map," said Carole Mitnick, a Harvard-based epidemiologist who works with the Peruvian nonprofit Socios en Salud. "You take central Lima, and rich and poor districts have inversely proportional incidence." Drug-resistant TB was sparked by Peru's reliance on one treatment regimen during the 1980s. The country's sluggish response to the problem in the 1990s made it worse, said Oswaldo Jave, head of Peru's national TB program.

Many area TB patients are taken to the Hospital Sergio Bernales in the north part of Lima, where the cure rate is 85 percent. Its patient load is stretching available resources, though the hospital receives support from the government and private entities.

Of 20 TB patients seen at the hospital each day by pulmonologist Epifanio Sanchez, one-third have multidrug- resistant TB (MDR TB). "We see often that colleagues use treatment patterns that are too weak and therefore strengthen the resistance," said Sanchez.

Poor areas lag in terms of access to MDR TB drugs, Mitnick said. "There is a perception it's not a disease where the victims can pay, unlike HIV, which has victims in North America and Europe who pay very, very high prices - their insurance companies can - that makes up for the inability of populations in poor countries to pay," Mitnick said. "But that option doesn't exist for TB." "This disease requires health- system strengthening, not just getting drugs in the patients' mouths," she added.