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• W1590897692 abstract "It is estimated that 8.5 million new tuberculosis cases occurred in the year 2001and that 1.8 million people died of TB. Operational research to improve the use ofexisting tools is vital. Studies in Manila, Philippines were carried out to exami ne TBillness experience and help seeking of TB patients. Apart from patient interviews,focus group discussions with non-affected urban poor residents and group discussionswith public health care providers were carried out. The TB illness burden was foundto be substantial; ill-defined suffering, such as emotional and social distress as well associal stigma, was common. Non-affected urban poor residents expressedambivalence towards TB patients: fear of getting infected contrasted with feelings ofconcern and support. Interaction with the health care providers was found to beproblematic. Misconceptions have the potential to increase the burden of TB. Givinghealth information, interpersonal skills and other aspects of clinical care need to beimproved. The patient interviews also inquired about case finding. Only 29% of therespondents had gone first to a health centre after onset of TB-related symptoms, and53% had initially consulted a private doctor. Two-thirds of the patients (66%) hadreceived a prescription for drugs, and 29% had purchased and taken anti-TB drugs forat least three weeks before they came to a public health centre. The health seekingdelay after symptom onset was relatively short – 64% of the respondents said theywent to a health facility within one month. With these findings as a background, we examined the TB-related practices ofthe private practitioners and approaches to public-private collaboration and assessedthe feasibility, acceptability and effectiveness of thrice-weekly therapy in comparisonto daily therapy. Forty-five private practitioners of Malabon who treat adult TB patients were interviewed in their clinics. For diagnosis, most private practitionersrelied on clinical presentation and result of an X-ray and 96% used X-ray as a tool tomonitor treatment. Sixty percent of the respondents prescribed in accordance tointernational guidelines a regimen consisting of isoniazid, rifampicin, pyrazinamide,and ethambutol. However, over-dosage was common and length of treatment notalways correct. For re-treatment cases, none prescribed the recommended retreatmentregimen. The private practitioners perceived the main reasons for patientnon-adherence to be the patients' lack of finances to buy drugs and patients' perceivedwell-being after a certain period of treatment. Patients' lack of money was seen as themain obstacle to treatment adherence. The only case holding mechanism mentionedwas occasional visits of the TB patients to the clinic. Our findings of the privatepractitioner's unsatisfactory quality of care and of the limitations of the public sectorindicate the need for collaboration between public and private sectors. The privatepractitioners were therefore asked about their felt needs for additional knowledge onclinical management of tuberculosis and their views on the public TB programme andcollaboration with the public health sector. And discussions with personnel of thepublic health centres inquired about collaboration with private practitioners. Theprivate practitioners' most frequently mentioned needs for updated clinical knowledgewere about appropriate use of sputum microscopy, how to tell patients that householdcontacts need a check-up, and motivating the patients to adhere to treatment. Therewas considerable interest to receive and follow the national TB guidelines. The mainperceived problems they identified with the public TB programme were insufficientdrug supply, poor quality of the TB drugs, and lack of health education. Twosuggestions on how to establish public-private collaboration (mandatory referral ofpoor TB patients to the public TB programme and allowing private practitioners touse the governmental TB drugs) were generally welcome, but they expressedreservation concerning feasibility of the latter suggestion. The personnel of the public health centres were positive about mandatory referral of poor TB patients to thepublic TB programme but sceptical about allowing private practitioners to use thegovernmental TB drugs. Our findings suggest steps to facilitate public-privatecollaboration. The public programme needs to be strengthened and collaborationprioritised. Public-private collaboration has great potential to make TB care that isbased on the principles of DOTS, the internationally recommended treatmentstrategy, accessible to more people with TB. While our studies on the private practitioners and public-private collaborationaimed to see DOTS being used more widely, the randomised controlled trial thatcompared thrice weekly with daily therapy aimed to make the main tool of DOTS,namely short-course chemotherapy, more efficient and patient- as well as providerfriendly.Intermittent regimens (twice weekly and thrice weekly regimens) arerecommended, but the evidence base regarding their effectiveness in comparison todaily therapy is not very strong. We carried out a randomised controlled trial: thriceweeklytherapy was randomly assigned to 10 of the 20 health centres of amunicipality in Manila. All TB patients of the other 10 health centres received dailytherapy. Patients were interviewed three times. Drug susceptibility tests wereperformed. A total of 806 patients (451 under thrice-weekly and 355 under dailytherapy) were interviewed shortly after treatment start. 18.5% were re-treatmentcases. Multidrug-resistant TB was found among 2% of the new and 26% of thepreviously treated patients. Under thrice-weekly therapy, directly observed therapy inthe health centres was more common than when treatment was daily. Thrice-weeklytherapy was more popular among patients and health personnel and resulted insavings of about 40% of the cost of drugs. There were also some disadvantages ofthrice-weekly therapy compared to daily therapy: gastro-intestinal disturbances werereported more frequently. And sputum conversion rate assessed after two months of treatment was lower (74% vs. 81%; p = 0.03). Treatment outcome was similar, buttreatment failure and default due to side effects was more common among thosetreated thrice weekly (p = 0.08 and p = 0.04, respectively). In a multivariate model,adverse treatment outcome (failure and relapse) was not associated with mode oftreatment (p = 0.7). In the light of the potential benefits of intermittent therapy, itsequivalence to daily therapy should be established more firmly and if confirmed,fully thrice-weekly therapy should be used more widely. Our research indicated approaches of how to improve TB control in terms ofmore appropriate practices in the private sector, better access to proper TB care, andmore efficient and patient-friendly use of treatment. Resources and commitment forfurther operational research and for pilot projects are needed to further test andimplement outlined approaches to public-private collaboration and to clarify the roleof intermittent therapy." @default.
• W1590897692 created "2016-06-24" @default.
• W1590897692 creator A5032185928 @default.
• W1590897692 date "2003-01-01" @default.
• W1590897692 modified "2023-09-27" @default.
• W1590897692 title "Strategies for tuberculosis control from experiences in Manila : the role of public-private collaboration and of intermittent therapy" @default.
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