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Tuberculosis Control Programme Guyana

Tuberculosis Control Programme Guyana. Epidemiological Situation of TB in Guyana. Historically one of the 5 most important infectious diseases in Guyana Devastating impact on many, mainly indigenous communities in colonial period Progressive decline in prevalence in 1970’s and 1980’s

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Tuberculosis Control Programme Guyana

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  1. Tuberculosis Control ProgrammeGuyana

  2. Epidemiological Situation of TB in Guyana • Historically one of the 5 most important infectious diseases in Guyana • Devastating impact on many, mainly indigenous communities in colonial period • Progressive decline in prevalence in 1970’s and 1980’s • Re-emerged as major public health threat in early 1990’s • Closely linked to poverty, economics and HIV

  3. Epidemiology • Annual rate of infection (estimated) = 3.2 • Annual Risk of infection = 0.92 • TB infection (estimated) = 14% (105,000) • Current prevalence = 0.3% (2,400 active cases) • Annual incidence (reported) = 79/100,000 • Mortality Rate (reported) = 3.25

  4. Reported Tb Cases in region 4,6,3,101995- 2004

  5. Reported TB cases in Region 1,7,8,9 and 10

  6. Tuberculosis in Guyana – 2004Age Group and Gender Distribution

  7. Case Detection - 2003

  8. Tuberculosis in Children

  9. TB in Guyana Treatment Outcome

  10. Development of the New national TB Program Situational Analysis • Estimate the TB burden in Guyana • Describe the program resources and program structure • Analysis program services, achievements • Identify challenges

  11. Aim of the National TB Control Programme • To reduce the rate of occurrence of TB in Guyana to a state where it ceases to be a major public health threat.

  12. Objectives of the Programme • To detect at least 75% of all infectious TB cases from among the Guyanese populace. • To effectively treat and cure at least 80% of all TB cases identified by the health services. • To prevent the emergence of MDR-TB in Guyana.

  13. Early Programme Changes • Adoption of DOTS principle. • Formulation of Guidelines. • Development of first manual (TB control in the community). • Develop training plan/commence training • Standardizing drug regimen. • Pilot DOTS in Regions 1,8 and 9.

  14. Summary of 1994 DOTS Pilot • Reduction of TB cases seen. • Main strategy was to FIND and TREAT TB cases. • Some educational intervention with focus on case findings. • No specific screening and preventative treatment programme implemented. • Rebound of cases following pilot.

  15. Lessons Learnt from DOTS Pilot • General Health Service was not equipped to implement DOTS. • Health Workers (CHW, Nurses, Medex) did not have enough time to implement DOTS. • DOTS was a “Labour intensive” activity • Some amount of active case finding must be done. • Need for much more IEC for DOTS to be successful. • Gains cannot be sustained without primary and secondary prevention programme.

  16. Implementation of DOTS in Georgetown • Government commitment to TB Control • Case Detection • TB Drug Supply • Standardized Treatment • Recording and Reporting • Training • Supervision

  17. Government commitment to TB Control • Restructuring programme to allow for the employment of TB outreach workers: • TB Case Managers • Regional Supervisor • Updated National Tb Manual • National reference laboratory • Central TB Unit • National TB Budget • External Financing ( CIDA Global Fund)

  18. Case Detection • Active Case finding • Updated Laboratory Manual • Improvement in Laboratory Services • Culture of Sputum • Collection of sputum samples • Reliance on Sputum Smears (x3) • Maintenance of Laboratory quality control

  19. Drug Supply • Standard Drug Regimen according to Tb categories 1,2,3 and 4. • Adequate Drug propriety and efficacy • Adequate Drug supplies • Shelf life • Accountability and drug forecasting

  20. Standardized Treatment • Standard Drug Regimen according to Tb categories 1,2,3 and 4. • Phase One (first 2 months) • Daily Supervision (Monday – Friday) • Total of 40 days treatment needed • 80% observed = 32 doses observed in 60 days • Phase Two (three to six/eight months) • Three times per week ( Mon, Wed, Fri) • Total of 48 days treatment needed • 70% observed = 33 doses needed in 120 days

  21. Treatment Outcome- DOTS

  22. Recording and Reporting • Central Register • Regional Registers • TB report forms • TB treatment cards • TB ID Cards • Laboratory registers • TB Laboratory request forms • TB notification books/forms • New contact tracing • Monthly DOTS reports • DOTS Notes

  23. Training • Development of DOTS training. (Module for Medical Students, Medex, Health Visitors, Nurses and CHW) • Retraining of Health Staff (Doctors, Nurses) • Training of TB Staff. (Doctors, Nurses, Laboratory Staff, DOTS Workers)

  24. Supervision • Monthly supervision of all Chest Clinics. • Monthly supervision of treatment areas. • Weekly supervision by case managers. • Daily supervision of DOTS Worker

  25. TB Control in Prisons • Improved case finding • Register for respiratory symptomatic • Investigation of TB Suspects (sputum/x-ray) • DOTS • Training of Prison staff • Assignment of treatment regimen • Supply medication • DOT by prison health workers • Infection Control (isolation unit) • Screening/IPT for prison workers

  26. Challenges • Patients in Denial • Patient’s family education • Stigma and discrimination • Drug addiction • Loss of Financial support • Working in dangerous neighborhoods • Inaccurate patient information • Cultural beliefs • Level of education • Transportation • TB/HIV co-infection

  27. Lessons Learnt • DOTS is a 24 hour commitment • DOTS workers need to be equipped with knowledge and skills to provide: • Emotional, physical and psychological support • Social, Economic, Cultural and Psychological implications of DOTS • Other diseases impacting on the application of DOTS e.g. HIV, Diabetes

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