Objectives: The Pharmacy DOTS Initiative (PDI) was relaunched on a larger scale in 2014 through the Innovations and Multi-Sectoral Partnerships to Achieve Control of Tuberculosis (IMPACT) project. This paper aimed to assess the PDI program through IMPACT by identifying the facilitating and hindering factors in its implementation. The identified factors are classified as to the affected stakeholders or processes.

Methods: Semi-structured interviews were conducted with the PDI Program Manager and four NTP coordinators from selected project sites. Thematic analysis was done to determine the recurring facilitating and hindering factors as identified by the key informants.

Results: Facilitating factors identified include cooperation of the stakeholders, capability-building and a good referral system. The barriers to the implementation were grouped into patient-related, pharmacy-related, health center-related, program-related as well as external factors.

Conclusion: The referral system created through PDI facilitated the flow of referrals starting from the pharmacy. This enabled presumptive patients to have access to health facilities for TB. Hindering factors contributed to the inability of the engaged pharmacies to sustain their consistency and commitment in conducting the PDI interventions.

Key Words: barriers, facilitators, tuberculosis, directly observed therapy, program evaluation, pharmacy

Tuberculosis ; Directly Observed Therapy ; Program Evaluation ; Pharmacy

Antitubercular Agents ; therapeutic use ; Directly Observed Therapy ; methods ; Humans ; Patient Compliance ; Tuberculosis ; drug therapy

Directly Observed Therapy ; Humans ; Medication Adherence ; Prejudice ; Prevalence ; Singapore ; epidemiology ; Tuberculosis, Multidrug-Resistant ; epidemiology

Preventive treatment has an essential effect on latent tuberculosis infection (LTBI) [purified protein derivative (PPD) induration ⋝ 15 mm]. Between 2010 and 2013, there were 6 tuberculosis (TB) outbreaks in the universities in Dalian, China. So far, in Dalian, the directly observed therapy (DOT) and full course management (FCM) were widely used in the preventive treatment of LTBI. However, it is yet to be determined which one of them has better efficacy. Therefore, the purpose of our study was to explore the performance of these two strategies for LTBI preventive treatment. The chi-square test and exact test were used to perform statistical analysis. In total, 794 LTBI patients were enrolled in this study, of which 443 were included in the DOT group and 351 in the FCM group. In 287 students who said ditto to take prophylactic treatment (DOT 149 and FCM 79), the compliance rate for the DOT group was 90.3% (149/165), while that for the FCM group was 64.8% (79/122). This difference between the two groups was statistically significant (χ²=28.03, P=1.19E-07). The DOT group showed an effective intervention rate of 81.5%, while that for the FCM group was 28.5%. Again, this difference was significant (χ²=56.17, P=6.63E-14). Further, in 228 students who truly started taking treatment, 26 cases exhibited various adverse reactions (11.4%, 26/228), the most frequent one being elevated liver enzyme levels (6.6%, 15/228). In addition, the major reason for the treatment interruption was adverse reactions in the DOT group, and 6 (28.6%) LTBI patients discontinued treatment due to the adverse reactions of the anti-TB drugs. We also performed a one-year follow-up after the completion of the 3-month treatment. Out of the 794 close contacts, a total of 9 cases (1.1%) developed active TB. These results show that DOT is an effective preventive treatment for LTBI and would play an irreplaceable role in improving preventive treatment adherence and treatment outcomes.
Adult ; Antitubercular Agents ; therapeutic use ; China ; Directly Observed Therapy ; Female ; Humans ; Latent Tuberculosis ; drug therapy ; Male ; Patient Compliance ; Young Adult

INTRODUCTIONAs of 2001, the Philippines ranks 7th among the world's 22 countries with a heavy tuberculosis (TB) burden. As the country accelerates its campaign to control the global epidemic, the Philippine Tuberculosis Initiatives for the Private Sector (PhilTIPS) joined the efforts to combat it through the Directly Observed Treatment Short-course (DOTS) strategy and brought it to the level of medical schools. PhilTIPS commissioned this work to develop an evidence-based medical curriculum with strong and conscious integration of TB-DOTS.

MATERIALS AND METHODSIn the needs assessment, curricula, sample tests, and syllabi were reviewed. Deans and curriculum committee chairs were also asked to answer a questionnaire dealing with how TB, TB control and DOTS were taught. Based on the needs assessment, the TB control-DOTS core curriculum was developed. Ten months after its implementation, a monitoring evaluation was conducted through questionnaires, review of records and key informant interviews.

DISCUSSIONRepresentative samples of 18 out of 32 schools participated in the needs assessment and monitoring phase. Data revealed that the biomedical and clinical aspects of TB are emphasised in all schools. But only 7 out of 18 (38.89%) actually dealt with DOTS. A competency-based, integrated, and interactive TB-DOTS curriculum was then developed. The competencies around which the curriculum was designed were: (1) a thorough understanding of TB as a biomedical and social phenomenon; (2) the management of TB patients; and (3) an adherence to DOTS in managing TB patients. The curriculum was reviewed by local and international panelists, and implemented in 2003 to 2004. Monitoring evaluation 10 months later revealed that this curriculum was minimally to moderately integrated by medical schools. The study exhorts all medical schools to empower their graduates with competence in TB-DOTS.

Curriculum ; Directly Observed Therapy ; Humans ; Philippines ; Population Surveillance ; Program Development ; Public Health ; Schools, Medical ; Surveys and Questionnaires ; Tuberculosis ; prevention & control

The total number of new tuberculosis (TB) cases notified in Singapore among citizens, permanent residents and foreigners rose by 46% from 2004 to 2010. During this period, the proportion of foreigners increased from 29% to 47% of the total case burden. In 2008, the TB incidence rate among Singapore citizens and permanent residents increased for the first time in ten years, despite the on-going efforts of the Singapore TB Elimination Programme. Additional measures and resources are clearly needed to curb this rising trend. Pivotal to this is to address TB among foreigners. The political will to battle TB in Singapore must result in action to remove barriers to diagnosis, to enable all TB patients to undergo treatment under directly observed therapy (DOT), and to ensure that all healthcare providers who manage TB patients are responsible and accountable to the public health system.
Directly Observed Therapy ; Emigrants and Immigrants ; statistics & numerical data ; Humans ; Infection Control ; methods ; Singapore ; epidemiology ; Tuberculosis ; epidemiology ; ethnology ; prevention & control

China ; epidemiology ; Directly Observed Therapy ; Humans ; Patient Compliance ; Prevalence ; Tuberculosis, Pulmonary ; epidemiology ; prevention & control ; World Health Organization

OBJECTIVETo explore the socio-behavioral risk factors on acquired drug resistance of tuberculosis (ADR-TB).

METHODSUsing pair matched case control study, 316 ADR-TB samples from 949 cases and 316 controls (pair matched for age and sex) were selected by systematical sampling method and studied through questionnaires. All the study subjects were selected from outpatients of the institute of TB control and prevention,between June 2002 and June 2005 in Sichuan province. Socio-behavioral risk factors were analyzed with conditional logistic regression and estimated with adjusted odds ratios (OR) and confidence interval (CI).

RESULTSData showed that the major socio-behavioral risk factors were associated with low economic status, incomplete DOTS, poor compliance and interruption during treatment with adjusted OR and CI as 5.623 (3.462-9.386), 8.875 (6.136-15.442), 6.467(3.942-10.622) and 4.906 (2.477-10.654) respectively.

CONCLUSIONADR-TB could be controlled by taking effective measures against the socio-behavior risk factors.

Case-Control Studies ; China ; epidemiology ; Directly Observed Therapy ; Female ; Humans ; Male ; Odds Ratio ; Patient Compliance ; Risk Factors ; Social Class ; Tuberculosis ; drug therapy ; epidemiology ; prevention & control

Antitubercular Agents ; economics ; therapeutic use ; Directly Observed Therapy ; Drug Resistance, Multiple, Bacterial ; Humans ; Singapore ; epidemiology ; Tuberculosis, Multidrug-Resistant ; drug therapy ; economics

OBJECTIVETo evaluate the effectiveness of directly observed treatment (DOT) implementation in tuberculosis (TB) control in China.

METHODSSystematic literature review was carried out for published and unpublished articles regarding DOT, and meta analysis was used to compile results from selected papers. Also, sensitive analysis was carried out to explore the potential factors influencing the effectiveness of DOT.

RESULTSTwo hundred and four articles were identified from China National Knowledge Infrastructure, Wanfang and Medline databases during 1994 - 2004 in which 120 articles were eligible according to our selection criteria. (1) Regarding TB case management: TB patients managed under DOT was compared to cases managed under the whole course treatment management (WCM). The combined RD of cure rate was 0.14 (95% CI: 0.06 - 0.22) and the two case management methods were significantly different (P < 0.00001). Data from stratified analysis showed that strict implementation of WMC had similar effectiveness with DOT (P = 0.06), and with RD 0.02 (95% CI: 0.00 - 0.03). However, the cure rate of DOT management was significantly better than that under un-strict WCM management (P < 0.05) with RD 0.16 (95% CI: 0.07 - 0.24). The cure rate of DOT was significantly better than those patients under self-administration (RD was 0.24 with 95% CI: 0.10 - 0.38 and P = 0.002). (2) Chemotherapeutics: when short-course and long course-treatments were compared, the combined RD became 0.04 (95% CI: 0.01 - 0.07) and P = 0.003.

CONCLUSIONSIf the implementation was under strict management, the different models of patient management showed similar adherence rates. However, the effect of adherence would depend on the regimen, pattern of intake of the drugs and the methods of supervision being used.

China ; Directly Observed Therapy ; methods ; Humans ; Patient Care Management ; methods ; Patient Compliance ; statistics & numerical data ; Treatment Outcome ; Tuberculosis ; drug therapy ; prevention & control