MODULE A
Below is a table that shows the similarities and differences between the DOTS strategy and MDR-TB management.
Element
DOTS Strategy
DOTS expanded framework as applied to MDR-TB management
Sustained political commitment
4
4
Case finding strategy
quality assured direct smear microscopy (DSSM)
quality assured DSSM, culture and DST
Supervised treatment
Standardized treatment with first-line drugs under supervised treatment, with patient support
Appropriate treatment strategies using first- and second-line drugs under supervised treatment and proper case management conditions with more comprehensive patient support
Uninterrupted supply of drugs
quality assured first-line anti-TB drugs
quality assured first- and second-line anti-TB drugs
Standardized records and reports
4
4 (designed for DR-TB control)
Health Care Delivery System for MDR-TB Management The DOTS-Plus pilot project in the country has moved to a programmatic approach through PMDT, under a privatepublic mix collaboration. The structure of the health care delivery system for MDR-TB management differs from that for the regular DOTS strategy. In the DOTS structure, the service delivery area needed is a functioning DOTS facility while for MDR-TB management in the Philippines the following types of facilities are required: • •
Treatment Centers Treatment Sites
In general, Treatment Centers are DOTS facilities, public or private, providing comprehensive management for more than 10 MDR-TB patients at one time. Treatment Centers are specialized referral centers which through their link with Culture and DST Centers, are able to detect and confirm MDR-TB cases. Diagnosed patients are registered in Treatment Centers where treatment is initiated with a complete package of services while these patients are sputum-positive. Once sputum-negative and stable, the patients are endorsed to community-based DOTS facilities called Treatment Sites which are nearer patients’ places of residence through a programmatic process of patient decentralization. Treatment Sites, on the other hand, are DOTS facilities, public or private, providing a basic or limited package of services for MDR-TB management for fewer than 10 patients at one time, although the exact number depends on the capacity of each Treatment Site. These facilities provide continuing care to patients endorsed by Treatment Centers until treatment completion. However, even during this time, patients continue to visit Treatment Centers at least monthly and remain to be under their supervision and overall responsibility. While there are differences in the scope of services available at the two service delivery areas for PMDT, there are also common functions such as supervised treatment of all doses which is a must whether at the Treatment Center or at the Treatment Site, health education and counseling, active tracing of interrupters and defaulters, etc.
8 INTRODUCTION
