INTERNATIONAL (MDGs). It was aimed to provide

INTERNATIONAL
GUIDELINESS FOR MANAGRMENT OF TUBERCULOSIS – WORLD HEALTH ORGANIZATION (WHO)

 

DOTS
(1994-1995)

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Designed based on five
essential components of any typical response to TB. This strategy made a way to
an effective treatment for 17 million patients by 2003 approximately in 180
countries.2

1) Political
commitment with increased and sustained financing;

2) Case detection
among people presenting with symptoms in clinics through quality-assured
bacteriology;

3) Standardized and
supervised treatment along with patient support;

4) Effective drug
supply and management system;

5) A standard
monitoring and evaluation system Framework-WHO, 1994, IUATLD, 19963

 

GLOBAL PLAN TO STOP TB (2001–2005)

The first Global Plan
to Stop TB was launched to raise investments both domestically and internationally.
In 2002, Global Fund was established to strengthen national programmes by
giving access to international financing. As of latest update, about 4.6
billion US$ has been mobilised for TB care and control in eligible countries.4  

 

1st STOP TB STRATEGY (2006)

A boosted global
strategy to escalate efforts towards fulfilling targets set for Millennium
Development Goal (MDGs). It was aimed to provide high quality health services
and patient-centred care for all individuals with TB with the assurance of
universal access. 

Five additional
components of DOTS principles were incorporated:-

1) To address TB/HIV,
multiple-drug resistance (MDR-TB) and the needs of vulnerable populations;

2) To contribute to
health system strengthening based on primary health care;

3) To engage all care
providers;

4) To empower TB
patients and encourage community engagement;

5) To enable and
promote research

 

THE POST-2015 GLOBAL TB STRATEGY -END TB STRATEGY (2006-2035)

This intensified
strategy was approved by the 67th World Health Assembly (WHA) in May 2014, aiming at “ending the
global TB epidemic” by 2035. TABLE 1 shows the summarised plan for the
strategy.

·        
TARGETS:5

1.     
To end the
global TB epidemic, with targets to reduce TB deaths by 95%

2.     
To ensure that no family
is burdened with catastrophic expenses due to TB.

3.     
To set interim milestones
for 2020, 2025, and 2030.

 

·        
RESOLUTIONS:

1.     
A call for the
governments to adapt and implement this strategy with efficinat financing and
tremendous commitment.

2.     
Emphasizes to serve
highly vulnerable populations to infections and those having minimal health
care access especially refugees and migrants.

3.     
An urge of engagement
within health sectors and other parties especially from the fields of justice,
social protection, immigration and labour.

4.     
A call for the WHO
Secretariat to help Member States adapt and execute the strategy, taking
account of the significance of skirting around the problem of
multidrug-resistant TB and promoting international collaboration. 

 

 

 

 

The strategy stands
on three pillars to promote integrated patient-centred care and prevention;
foster bold policies and supportive systems; encourage intensified research and
innovation.

 

·        
PRINCIPLES

       1. 
Monitoring and evaluation of government stewardship and accountability.

       2. 
Strong coalition with civil society organizations and communities

       3. 
Human rights, equity and ethics protection and promotion

       4. 
A global collaboration with adaptation of the strategy and targets at
country level

 

·        
PILLARS
AND COMPONENTS

      1. 
INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION

Ø  Early
diagnosis of TB including universal drug-susceptibility testing, and systematic
screening of contacts and high-risk groups

Ø  Treatment
of all people with TB including drug-resistant TB, and patient support

Ø   Collaborative TB/HIV activities, and
management of comorbidities

Ø  Preventive
treatment of persons at high risk, and vaccination against TB

 

       2. 
BOLD POLICIES AND SUPPORTIVE SYSTEMS

Ø  Political
commitment with adequate resources for TB care and prevention

Ø  Engagement
of communities, civil society organizations, and public and private care
providers

Ø  Universal
health coverage policy, and regulatory frameworks for case notification, vital
registration, quality and rational use of medicines, and infection control

Ø   Social protection, poverty alleviation and
actions on other determinants of TB

 

     

 

3.  INTENSIFIED RESEARCH AND INNOVATION

Ø  Discovery,
development and rapid uptake of new tools, interventions and strategies

Ø  Research
to optimize implementation and impact, and promote innovations

 

The End TB Strategy “at a
glance” is shown in Box 1. The overall goal is to “End the global TB epidemic”,
and there are three high-level, overarching indicators and related targets (for
2030, linked to the SDGs, and for 2035) and milestones (for 2020 and 2025). The
three indicators are:

-the number of TB deaths
per year;

-the TB incidence rate
per year; and

-the percentage of
TB-affected households that experience catastrophic costs as a result of TB
disease

 

 

BOX
1
THE END TB STRATEGY – adapted from
WHO, Global Tuberculosis Report 2017

 

 

 

 

 

VISION

A world
free of tuberculosis

–zero deaths, disease and
suffering due to tuberculosis

GOAL

End
the global tuberculosis epidemic

MILESTONES
FOR 2025

–75% reduction in
tuberculosis deaths (compared with 2015);
–50% reduction in
tuberculosis incidence rate (compared with 2015)

(less
than 55 tuberculosis cases per 100 000 population)

–No affected families
facing catastrophic costs due to tuberculosis

TARGETS
FOR 2035

–95% reduction in
tuberculosis deaths (compared with 2015)
–90% reduction in
tuberculosis incidence rate (compared with 2015)

(less
than 10 tuberculosis cases per 100 000 population)

–No affected families
facing catastrophic costs due to tuberculosis

TABLE 1 The post-2015 global TB strategy adapted from WHO, Global
strategy and targets for tuberculosis prevention, care and control beyond 2015, http://www.who.int/entity/tb/post2015_TBstrategy.pdf?ua=1

 

 

 

 

NATIONAL GUIDELINESS FOR MANAGEMENT OF TUBERCULOSIS – MALAYSIAN HEALTH
MINISTRY 6

The aim of the TUBERCULOSIS – CLINICAL PRACTICE GUIDELINES is to
standardise the management of TB at all levels of care in Malaysia with a view
to improving patient care and preventing the emergence of MDR-TB. Below are
some recommendations outlined in the 3rd Edition of Tuberculosis
Management published by the Malaysian Health Technology Assessment Section
(MaHTAS)

Recommendation 1

• High risk groups should be considered to be screened for active
tuberculosis.

• HIV screening should be offered to all patients with tuberculosis.

Recommendation 2

• Light emitting diode-based fluorescence microscopy (LED FM) should be
used as the

preferred method over the conventional Ziehl-Neelsen light microscopy in
diagnosing

pulmonary tuberculosis in both high and low volume laboratories.

•  In  implementing 
LED  FM,  the 
need  of  laboratory 
staff  training,  standard 
operating

procedures and appropriate quality assurance should be addressed.

Recommendation 3

• Nucleic  Acid  Amplification 
Tests  (molecular  methods 
endorsed  by  World 
Health

Organization) can be performed for the detection of Mycobacterium
tuberculosis from

clinical specimens.

Recommendation 4

•  Commercial  serological 
assay should not be usedto diagnose pulmonary and

extrapulmonary TB.

Recommendation 5

• Sputum induction should be considered to establish the diagnosis in
patients suspected

to have pulmonary tuberculosis who are smear negative or unable to
produce sputum,

whenever appropriate.

• Gastric lavage or bronchoscopy may be considered in patient who is not
suitable for

sputum induction.

Recommendation 6

• Fixed-Dose Combinations (FDCs) are preferred to separate-drugs
combination for the

treatment of tuberculosis.

 • In patients who develop
toxicity, intolerance or contraindication to specific component

drugs, FDCs can be substituted with separate-drug regimens.

Recommendation 7

•  All extra pulmonary
tuberculosis should be treated with anti-tuberculosis treatment for a

minimum of six months except for bone (including spine) and joint
tuberculosis for 6 – 9

months and tuberculous meningitis for 9 – 12 months.

•  Streptomycin should be used
instead of ethambutol in adult TB meningitis.

Recommendation 8

•  Screening  for 
tuberculosis  should  be 
done  among  all 
close  contacts  (especially

household contacts) and high risk group.

Recommendation 9

•  All healthcare facilities
should have administrative, engineering and personal protective

measures  in  place 
to  reduce  tuberculosis 
occupational  risk  of 
healthcare  workers.

 

 

 

 

MANAGING TB –
INDIVIDUAL PERSPECTIVES IN PREVENTING THE SPREAD OF INFECTION

Tuberculosis is fatal, dreadful and has high potential to cause dire
consequences if it is not carefully managed. This scenario analogues an adage
which depicts prevention is better than cure. People suffering from pulmonary
TB normally will be contagious up to about two to three weeks into their course
of treatment. It is not mandatory for isolation during this time, however, some
basic preventive measures are vital to avoid TB spreading to family and friends
in our surroundings. Some ways are being outlined below: 

·        
keep a distance or minimize mingling
in public or crowd

·        
take an off from work, school or
college until you are advised safe to resume by your TB treatment team

·        
always remember to cover your
mouth when sneezing, coughing or laughing, it is feasible to use a
disposable tissue in such circumstances

·        
bear in mind that it is crucial to
dispose any used tissues – preferably in a sealed plastic bag 

·        
if possible, open windows  at the areas you spend time  to ensure a good ventilation of fresh air

·        
try to avoid sleeping in a shared
room – you may cough or sneeze in your sleep without your knowledge – opt
for a separate room

·        
if you experience persistent coughs
or blood in sputum, immediately consult a doctor or a physician and strictly
avoid self-medication or OTC drugs

·        
know your medications well- consult
your TB treatment team to get enlightened about the basic info on interactions
of certain drugs before commencing any treatment course

·        
plan a balanced nutritious diet to
avoid side-effects of a medication and to ensure a healthy and destressed
lifestyle

·        
be disciplined when it comes to
taking your medicines – take your medications exactly according to doses
prescribed by the physician and it is mandatory to complete the whole course of
antibiotics

·        
basically, taking medication for six
months is the best way to ensure the TB bacteria are killed, however it is
always the best to follow what is prescribed

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