LCP DOTS Clinic
National Center for Pulmonary Research (NCPR)
Lung Center of the Philippines
The LCP-DOTS clinic is located at the National Center for Pulmonary Research (NCPR)which is within the KOICA grant building that has been constructed in 2009 and launched as NCPR last March 21, 2012. The facility is implementing the hospital based DOTS strategy program of the NTP DOH. It caters to adult afflicted with TB since early 2000 and children with TB in 2007. LCP-DOTS clinic is the first public health facility engaged in implementing Programmatic Management for Drug resistant TB(PMDT) in 2005 as a satellite treatment center under the Green Light Committee. In 2008, it became one of the 10 treatment centers implementing the DOH guidelines on PMDT as issued by DOH Administrative order 2008-0018. In 2010, LCP was designated as the implementing arm of PMDT by the NTP under the Global Fund.
In 2014, a transition occurred that most of the PMDT operation were now handled by the National TB Control Program DOH, except the training and research components of PMDT, which are handled by the NCPR, LCP, through the PMDT training unit and Research unit of the NCPR under the Global Fund. The Center for Health Development (CHD) in the region will facilitate the establishment of Treatment centers and Satellite Treatment centers and will oversee the implementation of PMDT at the regional level.
Components of PMDT:
All presumptive DRTB cases are to be referred for DRTB screening. Presumptive DRTB include the following based on hierarchy of suspicion. For retreatment cases, those who have failed in FLD-only containing regimens, Category 2 failed then Category 1 failed, those who have relapsed, Cat 2 relapse then Cat 1 relapse, those who are defaulters, those who are non converters (2nd month) during FLD containing regimens. For those who have had no previous anti TB treatment, household or close contacts of confirmed DRTB patients and those living with HIV are to be referred for screening.
All household contacts and if possible, close contacts of confirmed DRTB patients are to be investigated in the PMDT treatment facilities. Contacts are investigated for signs and symptoms of TB and are subjected to Chest X-ray. Patients with signs and symptoms of TB, and/or those with positive chest x-ray findings for TB (i.e. infiltrates, cavity, etc) are to be screened.
Presumptive DRTB cases including contacts, are to be screened and interviewed for treatment history, physical exam and bacteriological screening through Xpert MTB/Rif assay. Patients will be counseled primarily at the point of referral for the possible implications of DRTB diagnosis and treatment. Secondary counselling will be done at the screening proper. The screening form will be filled up completely, taking into account treatment history and detailing anti-TB treatment received by the patient. A review of co-morbidities and a physical exam will also be conducted.
B. Caseholding: MDRTB and XDRTB
For those who show resistance to Rifampicin through Xpert MTB/Rif, Standardized regimen to all rifampicin resistant patients. Baseline sputum is to be collected for conventional culture and baseline DST. Chest X-ray is done and collection for baseline blood chemistry is taken. Each enrolled DRTB patient is educated on his regimen, on what to expect out of treatment, on the problems of not adhering to treatment and the possible adverse drug reactions to expect.
For confirmed XDRTB patients, who is an MDRTB, resistant to any flouroquinolone and to any of the second line injectable second line anti TB drugs, an individualized regimen based on the history of previous treatment and quality assured first line and second line DST is prescribed for a minimum of 24 months.
Patient enablers are provided for by the program in order to promote treatment adherence. These include transportation allowances, halfway houses, hospitalization, surgery, ancillary medications, psycho-social activities, peer counselors, livelihood programs and others.
Decentralization is a very important part of treatment for the DRTB patient. It involves the patient being transferred from the TC/STC where the enrollment and initial treatment occurs, to a PMDT trained public or private health care center where his/her treatment can continue. The aim of decentralization to community DOTS health facilities is to promote treatment adherence by bringing the treatment closer to the patient.
This include psycho-social activities like focus group discussion among selected patients who interrupted treatment; general assembly to all patients once a month usually held every last Saturday of the month. Part of the general assembly are health teachings and updating patients and their family members on the basic knowledge on how to control TB/DRTB, and other important topics related to TB topics; as well as formation of ongoing patients with treatment as “Patient Support group” who are responsible in leading the group of patients as advisers or peer counsellors in the continuous treatment adherence. They are also responsible in organizing the patients in doing livelihood activities in-order to uplift their moral and deviate their attention on what they are feeling or thinking while on going treatment; feeding program of patients to improve their nutritional status and to improve treatment adherence most especially to interrupters while on going long treatment duration.