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DOTS in the Philippines

The DOTS (Directly Observed Treatment Strategy) Clinic of the Lung Center of the Philippines was established in early 2000. it was a self-installed
Public-Private Mix DOTS clinic certified by the Department of Health, and accredited by the Philhealth Insurance Corp. It became a Satellite DOTS
Plus Clinic in 2004 through a tripartite coordination between the Department of Health, Tropical Disease Foundation Inc., and the Lung Center of
the Philippines.
DOTS Short-course Program
Directly observed treatment short-course of DOTS is considered as one of the most effective methods of ensuring patient compliance and has been
recommended by the World Health Organization (WHO).
With DOTS we can achieve a higher cure rate and expand our services to detect more of our TB cases. The program is open for all suspected TB
patients regardless of ones status in life.
OBJECTIVES:

Political commitment

Identifying cases as quickly as possible based on smear microscopy

Providing a secure drug supply

Effective delivery of the 6th to 8th month course with directly observed treatment and program monitoring

All patients with tuberculosis enrolled into our program are required to attend health education provided by a trained individual which consist of
the following instructions:
1.

A brief review of the disease, including how the disease is contracted and spread.

2.

Basic principles of treatment.

3.

Monitoring of adverse effects/reactions.

4.

Signs of favorable response to treatment.

5.

Consequences of failure of treatment.

6.

Mechanics of the DOTS program including schedule of drug intake, filling up of the daily drug diary and schedule of follow-up visits.

Once instructions are completed, the treatment period can be started. Patients receive their drugs daily under the direct supervision of a health
worker.
The treatment outcome of patients treated for pulmonary tuberculosis at the Lung Center of the Philippines has seen a remarkable success. Eightyeight percent (88%) of our cases were cured of their tuberculosis in 2004 and partial result for 2005 (first quarter) revealed a success rate of 100%
among our smear positive new cases. These results has surpassed the expected global outcome of curing at least 85% of TB cases detected. By
implementing the DOTS program, tuberculosis can be treated effectively and it should be made available to everyone with pulmonary tuberculosis.
DOTS-PLUS Program for Multi-Drug Resistant Tuberculosis (MDRTB)
The problem of multi-drug tuberculosis is a global concern. It is likely to affect tens of millions worldwide due to the infectious nature of the
disease. In the Philippines, an estimated 4.3% among smear positive TB cases are considered multi-drug resistant TB. MDRTB is a case of
tuberculosis excreting bacilli resistant to at least Isoniazid and Rifampicin, the main anti-tuberculosis drugs. It is harder to cure with a treatment
duration of at least 18 months. Treatment is expensive and often unsuccessful. A WHO publicity in 1997 considered MDRTB to be more deadly
than AIDS. Once unleashed, we may never be able to stop it.
Some important factors contributing to the development of drug resistance are the following:
1.

Directly observed treatment short-course (DOTS) is not being used.

2.

Failure to recognize risk factors for development of drug resistance like diabetes.

3.

Adding a single new drug to a failing regimen.

4.

Wrong dosages and number of drugs.

5.

Non-compliance and non-adherence with therapy.

6.

Lack of patient education.

Drug resistant tuberculosis is the consequence of human error through poor case management by the doctor, poverty, and poor management of
drug supply in programs offering treatment for TB. Indeed it is an indicator of failure in TB control.
Prescription of inadequate chemotherapy may be due to the physician's lack of knowledge or ignorance. Common mistakes on the part of the
physician is to treat TB cases with only a single drug. The use of 2-3 drugs during the initial phase of treatment in a new smear positive patient
initially resistant to Isoniazid as well as the addition of one drug to a failing regimen can lead to MDRTB. Inadequate explanation by the doctor
before starting treatment can also lead the patient to discontinue treatment when he feels better.
Patients undergoing TB treatment discontinue treatment partially or completely during adverse drug reactions leading to non-adherence with
therapy. Because of poverty, patients buy only 1 or 2 kinds of drugs in the regimen. Another practice is to buy drugs in installment depending on
available budget. Due to the hard times, patients are seen to prioritize on their basic needs such as food, shelter, etc.

Frequent or prolonged shortages of the anti-TB drugs due to financial constraints in developing countries can lead to poor management of a TB
program. The use of drugs or drug combinations of unproven bioavailability will also lead to the emergence of multi-drug resistant TB>
The MDRTB Program of the Lung Center of the Philippines started in 1995 to systematically address the situation. The objectives of the program
are:
1.

To establish a registry of patients with proven MDRTB disease.

2.

To provide follow-up and treatment services for patients in the MDRTB registry.

3.

To develop a treatment protocol for newly diagnosed MDRTB.

4.

To spearhead, facilitate and coordinate researches in MDRTB.

5.

To establish a data bank on MDRTB.

Over the past 10 years of treating MDR-TB in the country, the treatment outcome was dismal wiht only less than 30 percent cured with a significant
number of these patients having the disease again attesting to the enormity of the problem. Unavailability of most of the second line drugs to
treat MDRTB was the main weakness of the program. By the year 2004, the Lung Center was considered as a partner of the Tropical Disease
Foundation DOTS-Plus Center, a private organization headed by DR. Thelma Tupasi. Funds from the Global Fund to fight AIDS, Tuberculosis and
Malaria have been supporting the DOTS-Plus pilot project ensuring steady supply of quality second line drugs for our MDR-TB patients.
The MDRTB support group, inspired by the spirit of compassion, is committed to the act of empowering patients undergoing treatment for
TB. It aims to help improve their well-being, and enable them to assist other TB patients and/or act as the case provider for the TB programs.
The Support Group
The MDRTB support group of the Lung Center of the Philippines started in June 2005 in a tertiary government treatment center for
Programmatic Multi-drug Resistant TB Management (PMTM). The support group is composed of MDRTB patients from all walks of life, undergoing
treatment with second line drugs. It is based at the LCP DOTS Center in the Public Health Domiciliary unit (PHDU) of the Lung Center of the
Philippines , located in Quezon Avenue , Quezon City .
Objective
To establish an organization of current MDRTB patients who will advocate the treatment compliance of multi-drug TB patients for a period at
least 18 months to achieve complete health restoration.
Roles and Responsibilities of Support Group Members:

Act as counselors to newly-enrolled MDRTB patients in the DOTS clinic for treatment compliance
other patients taking anti-TB drugs, or act as the treatment partner of another patient

Assist in addressing the psychosocial problems among MDRTB patients

Share experiences and serve as advocates during socialization

Assist the staff of LCP-DOTS center in retrieving defaulters

Refer or report patients who experience an adverse reaction or side effect from medications

Assist the clinic staff in watching

Activities
The Support Group:

Has a set of officers acting as leaders for all patients enrolled at the DOTS clinic
Conducts monthly general meetings/socializations
Organizes group discussions at least twice a month
Plans income generating projects for livelihood purposes

Self-Help Support Group Project:

Income generating projects are initiated by volunteers who work to earn some money for their basic needs while undergoing treatment.

Volunteers support other less fortunate patients in working for a living.


Share Your Blessings. Help Sponsor an MDRTB Patient.
The Challenge:
Patient involvement in the empowerment of oneself and of others in controlling TB, in collaboration with health care providers