Sustained Benefit of Community-based Tuberculosis Interventions after 30 Years

Abstract

In 1985, the overall rate of tuberculosis (TB) in Peru was 145 per 100,000 people, with higher rates seen in isolated regions in the greater Lima area. Between 1985 and 1990, the Peruvian economy shrank 10.1%; the rate of inflation rose, reaching 7,650% in 1990; health care expenditures fell to 0.5% of gross domestic product; and the armed struggle with the Shining Path resulted in more than 70,000 dead and missing. As a result, only 40% of patients with TB in Peru had access to free treatment. Two communities, Leticia Hill and Providence, had some of the highest rates of TB, at 2,570 and 1,950 per 100,000 people, respectively. We undertook a community-based intervention in these areas, which consisted of TB screening with sputum analysis and chest radiography, supervised direct observed treatment for patients with TB, and chemoprophylaxis in patients with latent TB. By combining our physician-directed TB program with community resources, we were able to reduce TB rates by 75% in Leticia Hill and 81.5% in Providence. Here we report sustained benefit of these interventions after 30 years...