Module 11: Community TB Care Image source: Pierre Virot, World Lung Foundation.
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Transcript of Module 11: Community TB Care Image source: Pierre Virot, World Lung Foundation.
![Page 1: Module 11: Community TB Care Image source: Pierre Virot, World Lung Foundation.](https://reader035.fdocuments.in/reader035/viewer/2022062620/551a87c3550346761a8b53a5/html5/thumbnails/1.jpg)
Module 11:Community TB Care
Image source: Pierre Virot, World Lung Foundation
![Page 2: Module 11: Community TB Care Image source: Pierre Virot, World Lung Foundation.](https://reader035.fdocuments.in/reader035/viewer/2022062620/551a87c3550346761a8b53a5/html5/thumbnails/2.jpg)
Learning Objectives
• Explain what is community TB care • Explain the rationale and benefits of a TB
treatment supporter• Describe effective characteristics and tasks
of a TB treatment supporter• Describe how to train a TB treatment
supporter• Describe the process for monitoring
community TB care
![Page 3: Module 11: Community TB Care Image source: Pierre Virot, World Lung Foundation.](https://reader035.fdocuments.in/reader035/viewer/2022062620/551a87c3550346761a8b53a5/html5/thumbnails/3.jpg)
What is Community TB Care?
• Community TB care is one of the efforts of the DOTS expansion strategy
• Trained and supervised community members provide DOT and TB treatment support to patients
• Objective is to decentralise TB services beyond health facilities and into the communities
– does not replace health-facility DOTS
– embraces primary health care approach of community involvement of TB care
– makes care more accessible to patients and their families
![Page 4: Module 11: Community TB Care Image source: Pierre Virot, World Lung Foundation.](https://reader035.fdocuments.in/reader035/viewer/2022062620/551a87c3550346761a8b53a5/html5/thumbnails/4.jpg)
Rationale for Community TB Care (1)
• Africa has some of the highest TB case rates in the world
• TB facility and “professional” health worker-based treatment have led to
– congestion in hospital and medical departments
– overstretching of human, material, and logistic resources
• Need for efficient and cost-effective strategies to deliver TB services under these conditions
Image Source: World Lung Foundation
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Rationale for Community TB Care (2)
• Many patients prefer to have care in home-setting
• Attending daily TB services at health facility can be difficult for– patients who are too sick
– patients who live far away • Community participation can help
foster ownership of TB care and
– support for TB patients
– reduce stigma towards TB
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Rationale for Community TB Care (3)
• Piloted in Botswana with conclusion that it is
– feasible– acceptable– cost-effective
• Community TB care can expand upon existing Home Based Care services
• Strategy has potential to increase compliance and improve treatment outcomes
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Who is Eligible for Community TB Care?
• Community TB care is optional
• Eligible patients include those
– who are very sick – who live in remote
areas
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Patients NOT Eligible for Community TB Care
• Children (except school aged children who could be taken care of by teachers)
• Re-treatment cases– these patients are normally put on a
reserve regimen which contain injectable streptomycin
• Patients who have a history of non-adherence
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Services Treatment Supporters Can Provide (1)
•Give patients daily supervised treatment
• Educate and support TB patients
• Educate and support the community
– reduce stigma
• Assist with case finding and detection
– referral of patients for diagnosis
– may bring sputum specimens to health facility
– collect results
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Services Treatment Supporters Can Provide (2)
• Recognition of adverse effects
• Tracing patients interrupting treatment and helping them return to treatment
• Support patients throughout entire treatment
– support and motivation of patients– direct observation of treatment
• TB education for patient, family, and community
– increase community awareness– use both formal and informal ways– help reduce of stigma
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Implementing Community TB Careand Roles and Supervision
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What is Needed to Implement Community TB Care
• Collaboration and cooperation between BNTP, health facilities, communities, and NGOS
• Clear roles and guidelines for all service providers including community volunteers
• Education and counseling of TB patients and families
• Identification and training of community volunteers
• A effective system of supervision and monitoring of community volunteers
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Roles and Supervision (1)
The District TB Coordinator
• Overall responsibility for supervision and coordination of TB community care in the district
– train health facility staff on identifying, supervising, and training TB treatment supporters
–monitor progress of community TB care
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Roles and Supervision (2)
Health Facility Staff
• Identify TB treatment supporters
• Train TB treatment supporters
• Meet with and supervise TB treatment supporters
Image source: Pierre Virot, World Lung Foundation
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Identifying TB Treatment Supporters
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Identifying Potential Community TB Treatment Supporters (1)
Health facility staff should ask patient • Where and when they work• Who do they see each day• Available transport• Is their family supportive or disapproving• Do they have suggestions for a convenient and
acceptable treatment supporter – a neighbour? a co-worker or supervisor? a
community health worker? a village leader?
• Where and when the patient could meet regularlywith a community TB treatment supporter
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Identifying Potential Community TB treatment Supporters (2)
• A community health worker who is already trained to be a TB treatment supporter
• A trained volunteer where patient works
• A shopkeeper in a local store
• A former TB patient, living in the same community, who has successfully completed treatment
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Characteristics of an Effective Treatment Supporter (1)
• Accessible and acceptable to the patient
• Willingness to be trained
• Ability to attend every appointment during regimen (initial phase and, for some regimens, continuation phase)
• Interest in patient’s welfare and treat patient kindly
• Carefulness in administering drugs and writing on the TB Treatment Card
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Characteristics of an Effective Treatment Supporter (2)
• Respectful of confidentiality
• Willingness to follow up if any problems occur or if the patient does not come for an appointment
• Ability to come to the health facility for monitoring and to obtain a re-supply of drugs (or a health worker will need to visit and deliver the drugs)
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Meet with TB Treatment Supporter
• Explain basic information about TB and importance of directly observed treatment
• Review the tasks of a community TB treatment supporter
• Explain that supporter will be needed duration of regimen
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Training TB Treatment Supporters
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Train the Community TB Treatment Supporter
• Use good teaching methods
– Provide information (tell)
– Provide examples (show)
– Allow for practice
Image Source: Sarah England, World Lung Foundation
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Training: Provide Information
Use “A Guide for Tuberculosis Treatment Supporters” to provide
• Basic TB Information
• Treatment Supporter’s Tasks
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Training: Use Examples
• Demonstrate how to perform tasks
• Show how to handle drugs
• Show how to write on patient’s TB Treatment Card cards
Image source: World Lung Foundation
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Training:Allow Practice
• Ask the TB community supporter to perform the tasks as you watch
• Give guidance when treatment supporter makes a mistake or is unsure
• Give praise when TB treatment supporter performs a task well
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Health Facility Roles for Supervising Treatment Supporter
• Give patient’s first month of drugs to TB treatment supporter
• Supervise and re-supply treatment supporter with drugs
• Copy patient’s TB Treatment Card for treatment supporter– keep original card at health facility– give duplicate card to treatment supporter – update original card with entries from treatment supporter
• Identify problems and discuss • Check when patient is due for follow-up sputum exam
or visit to clinic• Thank and support treatment supporter• Take action if treatment supporter fails to collect drug
supply
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Monitoring Community TB Care
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How is Community TB Care Monitored?
• Monitored through the Botswana National TB Programme system
• Community volunteers complete data collection forms and submit to health facility
• Health facility completes monthly reporting
• District TB Coordinator completes Community TB Care Quarterly Reporting Form
Image source: Gary Hampton, World Lung Foundation
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Community TB Care Treatment Supporter Compliance Register
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Community TB Care Monthly Reporting Form From Facilities
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Community TB Care Quarterly Reporting Format For Districts