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DOTS reception in communitites

By Elizabeth Byrne | 30 Nov, 2010 Last edited by Sophie Beauvais on 03 Feb 2011

Dear All,

I am a student interested in how DOTS is administered on the ground. I am aware that TB drugs often have bad side effects; are there ever situations in which a patient does not want to take his or her medication? If so, what is the role of the provider? Do you follow the patient's wishes or urge them to take the medication, in the interest of public health and preventing the development of drug resistance?

More generally, in your experience with TB care, where do providers draw the line between individual rights and public health concerns?

Thanks for all your help.

Elizabeth Byrne



Junior Bazile Replied at 2:06 PM, 2 Dec 2010

Dear Elisabeth,
In my experience, I have had some difficult patients reluctant to keep taking their medicines. However let me stay that the DOTs is administered by community leaders that we call accompagnateurs who are trained and go to deliver the medicines to the patients on a daily basis. Those accompagnateurs are bridges between the clinic and their respectives communities. They report to us any problem in their communities. They come to the clinic once a month to get medicines for their patients and go deliver them every day. They have forms to fill for their monthly reports. They are extremely important for the success of the patients'treatment.
Regarding adherence, to make sure that we can be successful, before starting the treatment we always have a therapeutic observance session with the patient to make sure that they understand the whole process and what is expected from them. Up to now I have not found any case where we had to urge patients to take their medication in the interest of public health because usually after having psychologist talk to them they would keep taking their meds but I think that for the benefit of the whole population it can be possible that some providers urge patients to take their medicines. Having a patients with MDR-TB for example is a burden, and knowing that this patient can pass on the resistant bacilli to other people in the community is scary. The "Police Power" can be used in those cases I guess.
Hope this help.


Shelly Batra, MD Replied at 12:46 PM, 3 Dec 2010

Thank you for the information. I agree that one has to have a system of counselling in order to prevent default. In Operation ASHA. we have employed fulltime staff who are responsible for counselling and default tracking.

Our first session is carried out *prior to starting treatment*, so that the patient is fully aware of the risks of default and MDR TB. Counselling is repeated when the patient starts feeling better, and also at the time when the patient becomes sputum-negative, becuase these are the times when there is a false sense of having recovered from the disease. Also, the counsellers talk of benefits to immediate family members, which has a great impact.
> For more info, visit www.opasha.org
> or you may write to Hitika Paul, Director Communications, Operation ASHA
> Shelly Batra, MD

Jude C. Munaonye Replied at 1:29 PM, 3 Dec 2010

Dear All,
I have this to say after reading some useful comments here.
Of a truth, the need and important of counselling as to MDR-TB treatment with DOTS can never be over emphasize as it plays a great role to play. To us here at Living Hope Organization, under the NICaB project we use a COE approach by so doing we go into the communities first with a health then teach them all as to TB treat there and then give an advance information on the steady never stop DOTS treatment after which we do a constant fellow up on Home Base Care HBC.
The tracking of defaulteds is easy when you follow up patients on a regular bases through referral cases and HBC, where the fund is available.
The clinic, communities and care giver must be in a cordial relation to achieve the good result, so your PR must be okay in your daily work and passion on this work is a great gain.

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