Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: Cambodia has one of the highest
global burdens of tuberculosis (TB).1 In
1994, the Cambodian Health Committee (CHC), a nongovernmental organization,
developed a community-based approach to the treatment of TB using microfinance
and food supplementation in Svay Rieng, one of Cambodia's poorest provinces.
The program comprised 2 components: a health center–based component
(hospital/health care center [HHC]) and a home-based component (Home Directly
Observed Therapy Short Course [Home DOTS]). The mean annual target population
was 149 577 for the HHC component and 11 557 for the Home DOTS component.
Between 1994 and 2001, 2780 patients with TB were treated in the HHC protocol
involving DOTS (with 2 months of forced hospitalization during the period
1994-1999, per the national protocol), followed by 6 months of outpatient
therapy with monthly drug pick-up at the HHC. After 1999, daily health center
visits were offered as an alternative to hospitalization during the intensive
phase. From 1999 to 2001, a separate Home DOTS protocol used mobile health
teams to actively detect patients in 2 districts not served by HHC and to
provide TB therapy to 219 patients in their homes. Compliance strategies in
both components expanded on those pioneered in refugee camps at the Thai-Cambodian
border2 and included: pretreatment patient
education, patient supporters to supervise treatment, a treatment contract,
nutritional supplementation, and surprise home visits. Beginning in 1994,
a novel linked microfinance project established a network of village banks.3
Thim S, Sath S, Sina M, et al. A Community-Based Tuberculosis Program in Cambodia. JAMA. 2004;292(5):566–568. doi:10.1001/jama.292.5.566-c
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