Lived experience of Filipino DOTS treatment partners

The Directly Observed Treatment Shortcourse (DOTS) chemotheraphy as a means to eradicate tuberculosis (TB) has been proven in the past. However, emergence of more resistant and virulent strains increase throughout the years. As response to this trend, the World Health Organization (WHO) had started initiatives which prompted country-specific approaches to stopping TB. In the Philippines, one of the strategies adopted by the Department of Health (DOH) is to empower the community health worker (CHW) to be the treatment partner of a TB patient. The CHW, being the indigenous counterpart of the professional health manpower in communities, remain as an important factor that may affect the treatment process. The main purpose of this study was to explore, understand and describe the lived experience of TB-DOTS treatment partners using a phenomenological approach. A triangulation of methods for data gathering was used to capture the meaning of their experiences: focus group discussions, key informat interviews, and observation. The experiences and practices of the CHW's were explored and documented for a period of six weeks solely devoted to field work. Shared meanings of their joy and pain, as well as their practices, are investigated. As stories were told, four themes have merged: 1) battle against TB as a socioeconomic problem; 2) volunteerism 3) transcending role of the indigenous treatment partner, and; 4) spiritually at work. These led to several assertions which focus on the how and why CHWs make DOTS treatment regimen successful in achieving positive outcomes. This was evident through their constant communication, empowering practices and provision of social support to the patients.

Performance of a Non-Government Institution, working as a 'District Tuberculosis Centre' under RNTCP.

Background: The RNTCP has envisaged the role of non-governmental organizations (NGOs) in the control of tuberculosis in India, and five schemes have been developed. The RK Mission Free TB Clinic, as an exceptional case, was included under Scheme- 5, known as the ‘tuberculosis unit model’, with additional independent status of a District Tuberculosis Centre (DTC), to provide all RNTCP services. Aim: To assess the performance of the RK Mission Free TB Clinic as a full-fledged independent DTC over a 4-year period from 1999 to 2002. Material and Methods: A total of 5209 patients were initiated on anti-tuberculosis therapy under DOTS during 1999-2002. The yearly data in terms of case detection, follow-up and treatment outcome of new and retreatment cases were compiled. Results: Of the 5209 patients initiated on ATT under DOTS, 4125(79%) were new patients and 1084(21%) were retreatment cases. Of the 4125 new cases, 3049(74%) had pulmonary tuberculosis while 1076(26%) were treated for extra-pulmonary tuberculosis. In the newly detected pulmonary tuberculosis cases, the ratio of smear positive to smear negative patients was 1:0.65. The sputum conversion rates at 3 months in the new smear positive patients were 86% (1999), 85% (2000), 88% (2001) and 91% (2002). The cure and treatment completion rates in the new smear positive patients with pulmonary tuberculosis were 79% and 81% respectively in 1999. These rates were comparable for the years 2000, 2001 and 2002, with the respective values being 83%, 86% and 87%. The treatment completion rates in the new smear negative pulmonary tuberculosis cases as well as in the new extra-pulmonary tuberculosis patients were always greater than 85% in the study period. Conclusion: These results serve as a successful example of an NGO functioning within the parameters of the RNTCP.