Hello Ms. Cat Oettinger and DR TB Community Members,
I am posting the message below on behalf of Dr. Ruben Encarnacion, clinical psychologist, which he submitted in response to a discussion Cat Oettinger posted in the community last month:
From Dr. Encarnacion:
Greetings from Manila. I am cutting & pasting material I wrote about the Group Discussions (GDs) that we have been doing at Tropical Disease Foundation (TDF) Philippines:
In an effort to promote treatment adherence and decrease the default rate, TDF instituted psychosocial interventions in late-2005 by hiring a Consultant Clinical Psychologist who introduced and facilitated group discussions (GDs) among MDR-TB patients. Initial sessions focus on the patients’ thoughts and feelings about their MDR-TB diagnosis; perceptions of stigma by family, friends, and co-workers; and factors that affect their adherence to MDR-TB treatment. Additional sessions discuss self-awareness, communication, and problem-solving. The group sessions are intended to provide a basis for patient-to-patient support and a sense of belonging to a community of patients who can understand the issues they face related to their disease and its impact on their role at home and in the workplace.
The clinical psychologist trained eight social workers from three outpatient treatment centers, MMC, LCP, and Kasaka (Kabalikat sa Kalusugan) in Quezon City, from February to June 2008. In July 2008, group discussions were formally implemented as part of the routine programmatic management of drug-resistant TB (PMDT) at the three centers. A standardized three-month program of group discussions was prepared in January 2009. The clinical psychologist trained 17 more health care workers, so that by March 2009, the standard 3-month program was implemented not only in these 3 centers but in two other treatment centers that opened in 2008 (Tala and Tayuman).All MDR-TB patients are eligible and encouraged to attend group discussions throughout the course of their MDR-TB treatment. Each session averages 45 minutes in duration, and sessions are offered once weekly. Patients can attend all four sessions offered each month. Attendance is recorded for each GD session.
I am currently in the data gathering phase of a research studying "The Effectiveness of
group discussions improving treatment adherence among MDR-TB patients." Hopefully, results can show that the GDs do make a difference in treatment management.
Summary: Dr. Daniel Chemtob (Director, Dept. of TB & AIDS in Jerusalem, Israel) provided the following resource for the discussion on psychosocial interventions in drug-resistant tuberculosis care and control programs.
It is a draft of an article that will be published soon in the journal "Substance Use and Misuse" . This article is describing the first step of integrating a "therapeutical milieu" model within the main TB ward in Israel, and the self-evaluation of this program by the staff.
The article is titled "Treatment: Therapeutic Milieu Rationale and Staff Evaluation of Using a "Therapeutic Milieu" for Substance Users Within a Tuberculosis Ward".
Source: National TB Program, Israel
Keywords: DR-TB, Israel, psychosocial support, Publications & Research, support groups, therapeutical milieu