To make matters worse, drugs are being given to people who cannot afford a complete course of treatment. Farmer and his colleagues may have discovered a silver lining to this darkening cloud. Like DOT, the approach depends on carefully supervised injections and ingestions of medicine. But whereas the DOT approach often administers standardized short-course chemotherapy, Farmer and his colleagues have combined longer individualized chemotherapy with a novel program of nutritional support and daily community health worker home visits. Curing the less resistant patients costs a few hundred dollars, Farmer says.
More resistant patients cost a few thousand dollars.
The costs are multiplied when the disease has been allowed to spread. Typically, Peruvian patients who failed standard TB therapy were automatically put on another standard chemotherapy regimen. Persuading the local authorities that the standard approach was not working, and that in fact, it was breeding even more resistant disease, Farmer and his colleagues embarked with them on a pilot treatment program. They began treating their first patients in August 1996. Patients will be treated for two years, which means the first patients treated still have six months to go on their chemotherapy.