TB Infection Control
Community-based treatment of MDR-TB - for discussion from the Infection Control perspective
By request, please see below a brief list of resources related to Partners In Health’s model of community-based MDR-TB treatment. While these resources do not focus on IC issues, they may serve to inform the discussion in this community regarding various models of care for MDR-TB.
1. Treatment supporters and treatment literacy: Lessons from Lesotho http://www.ghdonline.org/drtb/resource/treatment-supporters-and-treatment-lit...
This presentation looks at accompaniment/treatment supporters in a socio-economic context, and discusses adherence issues in Lesotho.
Accompaniers, or Community Health Workers/Treatment Supporters, have been a core component at Partners In Health Lesotho from the inception of the project. They help programs to ensure that the patient will complete an adequate course of treatment while facilitating the prevention and management of side effects. Full adherence to treatment results in a shorter infectious phase for the patient, which leads to reduction in transmission.
2. Principles of out-patients MDR-TB Treatment & Management http://www.ghdonline.org/drtb/resource/principles-of-out-patients-mdr-tb-trea...
This presentation includes several cases from Tomsk, Peru, and Lesotho which illustrate the basic principles of MDR-TB out-patient treatment in those sites.
Some information from this presentation:
Directly Observed Therapy (DOT) is more than just observation:
- It is the direct observation of patients taking their medicines
- It is the documentation of the visit
- It allows a daily rechecking of the patient medications
- It is the control of side effects
- It involves home visits if patients do not come to the clinic
- It involves looking for patients who are non-adherent or are defaulting
- DOT is an extension of the clinic into the patients community
- The system of DOT can be used to find programmatic solutions to patient barriers
- Food assistance for patients
- Choice of treatment site
- Improved side effect management (provision of ancillary medications)
- Improvement of working hours at medical facilities to make it more convenient for patients
- Treatment at home for patients who are unable to ambulate or who live too far
- Use of volunteers (e.g. neighbors) for DOT
- Rapid search for non-adherent patients and defaulters
- The use of enablers and incentives
Incentives for patients:
- Improved nutrition in the hospital with snacks
- Hot meals at the day hospital
- Food packets monthly for adherent patients
- Travel vouchers (government provided)
- Small gifts for adherence
- Help with passports, access to pensions, etc.
Incentives for staff:
- Hot meals at the day hospital
- Food packets monthly for rural health workers and nurses
3. Article in the New England Journal of Medicine: Comprehensive Treatment of Extensively Drug-Resistant Tuberculosis http://www.ghdonline.org/drtb/resource/comprehensive-treatment-of-extensively...
This article offers a description of the management of extensively drug-resistant tuberculosis and treatment outcomes among patients who were referred for individualized outpatient therapy in Peru.
4. Training: MDR TB Curriculum, Facilitators' and Participants' Materials http://www.ghdonline.org/drtb/resource/mdr-tb-curriculum-facilitators-and-par...
This is a set of interactive training materials on MDR-TB treatment. These materials were created by Partners In Health in partnership with the Lesotho Ministry of Health. The Ministry has since adopted them as their official training curriculum for TB coordinators, TB officers, ART nurses and doctors.
Structured for presentation in three four-day sessions, the curriculum covers a number of topics, including MDR-TB diagnosis and treatment; case discussions; infection control; and referral system plans. Short pre- and post-training tests are included to evaluate the effectiveness of the training.
Some additional materials on the topic:
Training plan for a new DOTS-Plus treatment supporter: http://model.pih.org/files/mdr-tb/Training-plan-new-DOTS-Plus-treatment-suppo...
Session 2, Day 2: Community-based Care for MDR-TB http://model.pih.org/files/mdr-tb/day-2-training.zip
5. DOT-Plus Handbook: Guide to the Community-Based Treatment of MDR-TB
The chapters can be downloaded independently in PDF format at this link: http://www.pih.org/inforesources/pihguide-dotstb.html
6. Article: Community-based therapy for children with multidrug-resistant tuberculosis by Drobac PC, Mukherjee JS, Joseph JK, Mitnick C, Furin JJ, del Castillo H, Shin SS, Becerra MC Pediatrics. 2006;117(6):2022-2029 http://www.pih.org/inforesources/Articles/Pediatrics%202006%20Drobac%20et%20a...
7. The Training Manual on TB and MDR-TB published in May 2008 by the International Hospital Federation addresses community participation in MDR TB treatment.
http://www.ghdonline.org/drtb/resource/ihf-training-manual-on-tb-and-mdr-tb-2/
Best Regards,
Tom Nicholson
