The DOTS (Directly Observed Treatment Strategy) Clinic of the Lung Center of the Philippines was established in early 2000. it was a self-installed Public-Private Mix DOTS clinic certified by the Department of Health, and accredited by the Philhealth Insurance Corp.  It became a Satellite DOTS Plus Clinic in 2004 through a tripartite coordination between the Department of Health, Tropical Disease Foundation Inc., and the Lung Center of the Philippines.  

DOTS Short-course Program

Directly observed treatment short-course of DOTS is considered as one of the most effective methods of ensuring patient compliance and has been recommended by the World Health Organization (WHO).  

With DOTS we can achieve a higher cure rate and expand our services to detect more of our TB cases.  The program is open for all suspected TB patients regardless of ones status in life.

OBJECTIVES:

• Political commitment

• Identifying cases as quickly as possible based on smear microscopy

• Providing a secure drug supply

• Effective delivery of the 6th to 8th month course with directly observed treatment and program monitoring

 All patients with tuberculosis enrolled into our program are required to attend health education provided by a trained individual which consist of the following instructions:

1. A brief review of the disease, including how the disease is contracted and spread.

2. Basic principles of treatment.

3. Monitoring of adverse effects/reactions.

4. Signs of favorable response to treatment.

5. Consequences of failure of treatment.

6. Mechanics of the DOTS program including schedule of drug intake, filling up of the daily drug diary and schedule of follow-up visits.

Once instructions are completed, the treatment period can be started.  Patients receive their drugs daily under the direct supervision of a health worker.

The treatment outcome of patients treated for pulmonary tuberculosis at the Lung Center of the Philippines has seen a remarkable success.  Eighty-eight percent (88%) of our cases were cured of their tuberculosis in 2004 and partial result for 2005 (first quarter) revealed a success rate of 100% among our smear positive new cases.  These results has surpassed the expected global outcome of curing at least 85% of TB cases detected.  By implementing the DOTS program, tuberculosis can be treated effectively and it should be made available to everyone with pulmonary tuberculosis.

DOTS-PLUS Program for Multi-Drug Resistant Tuberculosis (MDRTB)

The problem of multi-drug tuberculosis is a global concern.  It is likely to affect tens of millions worldwide due to the infectious nature of the disease.  In the Philippines, an estimated 4.3% among smear positive TB cases are considered multi-drug resistant TB.  MDRTB is a case of tuberculosis excreting bacilli resistant to at least Isoniazid and Rifampicin, the main anti-tuberculosis drugs.  It is harder to cure with a treatment duration of at least 18 months.  Treatment is expensive and often unsuccessful.  A WHO publicity in 1997 considered MDRTB to be more deadly than AIDS.  Once unleashed, we may never be able to stop it.

Some important factors contributing to the development of drug resistance are the following:

1. Directly observed treatment short-course (DOTS) is not being used.

2. Failure to recognize risk factors for development of drug resistance like diabetes.

3. Adding a single new drug to a failing regimen.

4. Wrong dosages and number of drugs.

5. Non-compliance and non-adherence with therapy.

6. Lack of patient education.

Drug resistant tuberculosis is the consequence of human error through poor case management by the doctor, poverty, and poor management of drug supply in programs offering treatment for TB.  Indeed it is an indicator of failure in TB control.

Prescription of inadequate chemotherapy may be due to the physician's lack of knowledge or ignorance.  Common mistakes on the part of the physician is to treat TB cases with only a single drug.  The use of 2-3 drugs during the initial phase of treatment in a new smear positive patient initially resistant to Isoniazid as well as the addition of one drug to a failing regimen can lead to MDRTB.  Inadequate explanation by the doctor before starting treatment can also lead the patient to discontinue treatment when he feels better.

Patients undergoing TB treatment discontinue treatment partially or completely during adverse drug reactions leading to non-adherence with therapy.  Because of poverty, patients buy only 1 or 2 kinds of drugs in the regimen.  Another practice is to buy drugs in installment depending on available budget.  Due to the hard times, patients are seen to prioritize on their basic needs such as food, shelter, etc.

Frequent or prolonged shortages of the anti-TB drugs due to financial constraints in developing countries can lead to poor management of a TB program.  The use of drugs or drug combinations of unproven bioavailability will also lead to the emergence of multi-drug resistant TB>

The MDRTB Program of the Lung Center of the Philippines started in 1995 to systematically address the situation......read more