Items tagged with TB programs

Guidelines for Tuberculosis Control in New Zealand (document)

This control document outlines the problem of TB in New Zealand and addresses ways to combat it. The following topics are discussed: epidemiological trends, type, management and outcome of notified TB cases, surveillance of TB and recommendations for future developments are made.

Guidance for national tuberculosis programmes on the management of tuberculosis in children (document)

The strategy document aims to redress the chronic neglect of childhood TB. This document complements existing national and international guidelines and standards for managing TB. It fills the gaps in the existing materials and provides current recommendations based on the best available evidence. This document reflects two important recent policy changes: (1) NTPs should record and report two age groups for children (0–4 years and 5–14 years) using the quarterly reporting form and (2)the revised recommended dose of ethambutol is now 20 mg/kg (range 15–25 mg/kg) daily.

Technical and Operational Guidelines for Tuberculosis Control (document)

This document outlines the objectives of the Revised National Tuberculosis Control Programme (RNTCP). The document discusses: the use DOTS for treatment, organizational structures and functions, diagnosis, management of HIV patients, pediatric TB, extra-pulmonary TB, special initiatives such as public-private and drug resistant, and TB control in health care settings.

Framework Action Plan to fight tuberculosis in European Union (document)

This framework plan is an EU unified approach aiming at achieving integrated care of patients with tuberculosis, while respecting the different needs of each country. The plan also describes the different ways countries can contribute to the common fight against TB. Some of these are crucial in tackling specific threats (e.g. multi-drug resistance) and will help a country not only to protect its own citizens but also contribute to the reduction of the international spread of TB cases.

National Strategic Plan for TB Control in Australia (document)

This document summarises the current Australian picture for TB, identifies strategies to provide for continued improvements and outlines performance indicators to monitor progress.

Revised National Tuberculosis Control Programme DOTS-Plus Guidelines (document)

These updated guidelines add components to current DOTS programme to include MDR-TB diagnosis, management and treatment. These guidelines promote full integration of DOTS and DOTS-Plus activities under the RNTCP, so that patients with MDR-TB are both correctly identified and properly managed under the recommendations set out in this document. Also, the guideline introduces new standards for registering, monitoring and reporting outcomes of multidrug-resistant TB cases. This uniform information management system will allow systematic, consistent data collection and analysis which will facilitate appropriate supervision and monitoring of the DOTS Plus activities and will play an important role in shaping future policies and recommendations.

What killed Vedavalli (post with simple image)

58 years is no age to die. Yet Radha Rangaswamy’s mother Vedavalli died of tuberculosis (TB) in the last week of October 2012 precisely at that age. Her only fault seemed to be her undaunted faith in the public health system of India (the Government DOTS programme) which proved to be her undoing. Radha recalls that when Vedavalli had bouts of cough and fever in 2010, she went to the government TB centre in Puducherry where she was diagnosed with TB. The doctors there put her on category 1 (CAT1) regimen for TB treatment of alternate day therapy--Monday, Wednesday and Friday. But even after 4 months of treatment her sputum still tested positive (3+) for TB. So they gave her Streptomycin injections. She took 30 injections along with the weekly three doses of medicines like before. After 3 months of this regimen her sputum was negative. So she was put on continuation phase regimen. But within a month she developed complications. After three months of treatment her sputum tested positive again (3+). A drug sensitivity test was done and her medication was stopped by the doctors till the time the drug sensitivity report came. At that point of time, while searching for information on TB through the internet, Radha came across a website edited by Mr Nathan Jeff who put her in touch with Ms Blessina Kumar-- a Public Health Consultant, and Vice Chair- Stop TB Partnership, who went all out to help her. When Ms Blessina contacted the RNTCP people they sent them back to the State TB Officer and got the patient admitted in the Government Chest Clinic Puducherry for a month. Meanwhile the drug sensitivity report showed that she was sensitive to all drugs. Again she was put back on CAT1 regimen for the third time-- injections along with medicines on alternate days. But even after 4 months of this treatment, when the sputum test was taken it was still positive. Finally, with Ms Blessina’s help Radha got her mother admitted in the TB Research Centre at Chennai for proper investigations and treatment. There Dr.Soumya Swaminthan and her team did many tests and found out that that though Vedavally had been on DOTS therapy repeatedly, there was a negligent amount of drugs in her blood. In fact they found no trace of rifampicin in her blood. They put her on a daily regimen of their own drug supply including Oflaxcin. Just after one month of this treatment her sputum tested negative. But alas! it was too late. Her lungs had already been damaged beyond repair and just as everyone thought she was getting better she died in the last week of October 2012. Radha is too distraught at her mother’s untimely death, and rightly so. She said to Citizen News Service (CNS): “My mom took medicines and injections for one and a half years regularly as instructed and yet she died. The doctors at Puducherry should have tried to check as to why she was not responding to the drugs despite being sensitive to them. If they were not able to find out the problem, they could have at least told us to take her to Chennai. Instead they repeatedly put her on the same regimen to which she was not responding. For them it was just one of their many cases, but for me she was my mother. Will they ever realise that it is because of their negligence that I have lost my mother today? Will they ever realise the pain? It has been almost 10 days since I called and informed the hospital. But till today nobody has turned up to find out what happened. I had already lost my father and now I have lost my mother. I can never absolve myself of the guilt of not taking her to Chennai earlier, because then she would have lived. This is a nightmare for me. Who is responsible for my mother's death? Is it my fault in believing in the Government health system? I trusted the Government, and what did I get in reward for this faith? I saw my mom dying in front of my eyes and this thought will haunt me for the rest of my life.” There must be many more such untold stories of neglect and utter callousness. We always make a hue and cry about controlling and regulating the private TB sector, which of course is necessary. But then it is equally important for the government health system to mend its own house of glass and set it in order rather than keep on throwing stones at others. There have been other cases too where the quality of medicines given out at public health centres was found to be suspect. Pushpa Narayan reported the issue of empty capsules of rifampicin in an article in Times of India which quotes a female DOTS provider of Trichy who has found several empty capsules of rifampicin while doling out antibiotics to TB patients. In Tamilnadu itself nearly 7% of the over 4000 drugs tested in 2012 were found to be of substandard quality and did not have the prescribed strength of the active ingredients—which could be fatal in the case of TB patients as has already been proved. As if this were not enough, misdiagnosis of TB is also rampant. Recently it was reported in the media that Dr Yacha, Head, department of gastro paediatrics at SGPGI, Lucknow lamented that 20% of children brought to SGPGIMS for advance treatment had been wrongly diagnosed and treated for abdominal tuberculosis even though they never had TB but were suffering from some other ailment. This not only left the main disease untreated, but caused severe side effects and made them more prone to DR TB. Radha wishes that her mother’s death should have some meaning and should not go unsung. She wants to do something, so that no other daughter or son suffers her fate. And Radha cannot be more right. There has to be an end to unnecessary deaths from a treatable disease. Should we as civil society members remain silent? The government owes her an answer. We all owe an answer to the likes of Radha. Radha is not alone in her sorrow. We are all with her. We have to seek answers to these human lapses at the forthcoming 43rd Union World Conference on Lung Health to be held in Kuala Lumpur, and seek justice from the many government officials who would be attending the meet. They will have to own up responsibility (rather than just pass the buck) and ensure that the state health system mechanisms of diagnosing and dispensing proper medication are there to save lives and not snuff them out.

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*Shobha Shukla is the Managing Editor of Citizen News Service (CNS). She is currently providing on-site news coverage from 43rd Union World Conference on Lung Health, with kind support from the Lilly MDR TB Partnership and Global Alliance for TB Drug Development (TB Alliance). She is a J2J Fellow of National Press Foundation (NPF) USA. She received her editing training in Singapore, has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also authored a book on childhood TB (2012), co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" and a report on Hepatitis C and HIV treatment access issues in 2011. [www.citizen-news.org](http://www.citizen-news.org)* **Source: [http://www.citizen-news.org/](http://www.citizen-news.org/)**

Call for a patient-centered approach to TB diagnostics (post with simple image)

To prioritize an agenda for implementing TB diagnostics that centers upon the patient with TB symptoms and highlights patient well-being and cure.

Point-of-care diagnostics for tuberculosis elimination? (post with simple image)

The projected epidemiological effect of Xpert MTB/RIF might be overestimated, so this fascinating and promising new tool is unlikely to be the magic bullet that paves the way towards tuberculosis elimination.

Publication: A framework for integrating childhood tuberculosis into community-based health care (post with simple image)

The document outlines community-based strategies for integrating childhood TB activities with other maternal and child health care services through existing diagnosis and management algorithms.