User:Christinetranster/Tuberculosis management

DOTS strategy (*need to weave into existing sub-section on DOTS under "Standard regimen")
The first element of DOTS involves creating increased sustainable financial services and a short and long term plan provided by the government, dedicated to eliminating tuberculosis.The World Health Organization helps encourage mobilized funding to reduce poverty standards that will prevent tuberculosis. The second component of the DOTS strategy is case detection, which involves improving the accuracy of laboratory tests for bacteriology and improving communication from labs to doctors and patients. Case detection means that laboratories that detect and test for bacteriology are accurate and communicative to its doctors and patients. The third strategy is to provide standard treatment and patient support. The guidelines to adhere to adequate treatment is to provide pharmaceutical drugs that will help eliminate tuberculosis and follow-up check-ups to ensure that tuberculosis is not a deterring factor in a patient’s life. There are many cultural barriers as many patients might continue to work under unsanitary living conditions or not have enough money to pay for the treatments. Programs that provide stipends and incentives to allow citizens to seek treatment are also necessary. The fourth element to the DOTS approach is to have a management program that supplies a sustainable long term supply of reliable antibiotics. Lastly, the fifth component is to record and monitor treatment plans in order to ensure that the DOTS approach is effective. The DOTS approach not only aims to provide structure for tuberculosis programs, but also to ensure that citizens diagnosed with tuberculosis adhere to protocols which will prevent future bacterial infections.

DOTS-Plus strategy
Community engagement is a new approach that is being initiated alongside the DOTS individualized treatment. This new approach is called the DOTS-plus model which creates a community for health workers to give support to patients and hospital faculty. The DOTS-plus model also incorporates psychological structural support treatments to help accommodate patients to ensure completion of treatment. Treatment with the new strategy is a total duration of 18-24 months.

Management in Asia (new section between existing sections 7. and 8.)
The Asia‐Pacific region carries 58% of the global tuberculosis burden, which includes multi drug-resistant tuberculosis. Southeast Asia suffers from high burdens of tuberculosis as a result of inefficient and inadequate health infrastructures. According to the World Health Organization, many Asian countries have high cases of tuberculosis, but their governments will not invest in new technology to treat its patients.

Philippines
From 2005-2009, the IPHO-Maguindanao, a governmental organization in Maguindanao, Philippines, partnered with the Catholic Relief Services (CRS) to increase tuberculosis awareness. CRS implemented a USAID-assisted project to fund tuberculosis testing. Additionally, they launched an "Advocacy, Communication, and Self-Mobilization" project featuring workshops to encourage testing in communities. Citizens attending religious sermons were able to distribute information about tuberculosis and inform their communities on where to seek treatment and how to adhere to treatment protocols The DOTS-Plus strategy, designed to deliver from within familiar local institutions, was successful at conveying information about tuberculosis prevention and treatment.

India
In 1906, India opened its first air sanatorium for treatment and isolation of TB patients.However, the World Health Organization reviewed the national program in India which lacked funding and treatment regimens that could report accurate tuberculosis case management. By 1945, there were successful immunization screenings due to campaigns that helped spread messages about the prevention of disease. This was also around the same time that the World Health Organization declared tuberculosis to be a global emergency and recommended countries adopt the DOTS strategy.

Bangladesh, Cambodia, Thailand
In Bangladesh, Cambodia, and Indonesia, there is a diagnostic treatment for latent tuberculosis in children below 5 years of age. The IGRA approach (Interferon Gamma Release Assay) is used in these countries. IGRA testing and diagnosis are whole blood cell tests where fresh blood samples are mixed with antigens and controls. A person infected with tuberculosis will have interferon-gammas in the blood stream when mixed with the antigen. It is a highly accurate but expensive test and is technologically complex for immuno-compromised patients. These developing countries were unable to get rid of tuberculosis effectively because the national health policies did not cover screening and testing for tuberculosis. There were also no programs in place to educate citizens and provide training for healthcare workers. Without the mobilization of sufficient resources and the backing of  sustainable government funding, these developing countries failed to adequately provide the treatment and resources necessary to combat tuberculosis.

Vietnam
According to the WHO, Vietnam ranks 13th on the list of 22 countries with the highest tuberculosis burden in the world. Nearly 400 new cases of TB and 55 deaths occur each day in Vietnam. In 1989, the Ministry of Health in Vietnam addressed the tuberculosis burden by establishing the National Institute of Tuberculosis and Lung Diseases and implemented the DOTS strategy as a national priority. Vietnam’s health service system consists of four different levels: the central level headed by the Ministry of Health (MOH), provincial health services, district health services, and commune health centers”. These departments worked with the National Institute of Tuberculosis and Lung Diseases to ensure that there were treatment and prevention plans for long term reduction of tuberculosis. In 2002, Vietnam also implemented a communication plan to provide accurate educational information in order to respond to any barriers or misperceptions about tuberculosis treatment. The government worked with the World Health Organization, Center for Disease and Control Prevention, and local medical non-profits such as Friends for International Tuberculosis Relief to provide information about the causes of TB, sources of infection, how it is transmitted, symptoms, treatment, and prevention. The National Tuberculosis Control Program works closely with the primary health care system at the central, provincial, district, and commune levels which has proven to be an incredibly imperative measure of success.

Tuberculosis non-profits in Asia
Friends for International TB Relief is a small non-governmental organization whose mission is to help prevent tuberculosis and the spreading of TB. FIT not only diagnoses patients, but also provides preventative tuberculosis detection in order to pilot a comprehensive patient-centered TB program that aims to stop TB transmission and reduce suffering. The organization focuses on island screening due to the high level of risk and burden the population faces. Through its method of search, treat, prevent, and integrative sustainability, FIT is working closely with most of the population on the island (roughly 2022 patients), and partnered with the Ho Chi Minh City Public Health Association on a pilot that provides active community outreach, patient-centric care and stakeholder engagement.

Located in Ha Noi, the National Institute of Tuberculosis and Lung Diseases is responsible for the direction and management of TB control activities at the central level. The Institute supports the MOH in developing TB- related strategies, and in handling management and professional guidelines for the system. The provincial level centers diagnose, treat, and manage patients, implement TB policies issued by the NTP, and develop action plans under the guidelines of the Provincial Health Bureau and the provincial TB control committees. The districts are capable of detecting TB and treating patients. All districts have physicians specializing in TB, laboratories, and X-ray equipment and have either a TB department or a TB-communicable diseases department in the district hospital. The district level is also responsible for implementing and monitoring the NTP, and the supervision and management of TB programs in the communes. The commune level provides treatment as prescribed by the district level, administering drugs, and vaccinating children. In TB control, village health workers play critically important roles in identifying suspected TB patients, conducting counseling for examination and tests, paying home visits to patients undergoing treatment, and reporting problems in monthly meetings with the CHC.

TB Alliance is a non-governmental organization that is located in South Africa and was discovered in the early 2000s. The NGO is a leading non-profit for global tuberculosis research and development of new TB vaccines. To advance TB development, TB Alliance creates partnerships with private, public, academic, and philanthropic sectors in order to develop products in underserved communities. In 2019, TB Alliance became the first not-for-profit organization to develop and register an anti-TB drug. TB Alliance also works closely alongside the World Health Organization (WHO), U.S FDA, and the European Medicine Agency (EMA) to endorse regulative policies and treatments that are affordable.

FHI 360 is an international tuberculosis non-profit organization funded by USAID to treat and support patients in Myanmar, China, and Thailand. The organization developed an app called DOTsync in order for healthcare staff to administer antibiotics and monitor the side effects of patients. This is incredibly imperative to eliminating tuberculosis because it allows healthcare workers to have follow-up checkups with patients in order to ensure that tuberculosis treatments are effective.

Operation ASHA is a TB nonprofit organization that was founded in 2006. Located in India and Cambodia, Operation ASHA focuses on the development of "e-Compliance," which is a verification and SMS text messaging system where patients can use their fingerprints to access their medical records and be reminded daily via text when to take their medication. According to Operation ASHA, the e-Compliance treatment successive rate is 85%.

Criticisms of DOTS (new sub-section under "Current research")
Although the DOTS approach has dramatically reduced the amount of people suffering from tuberculosis, the disparity between developing countries and first-world countries is too vast to go unnoticed and unconfronted. Criticism of the DOTS strategy typically notes its failure to address structural issues developing countries face and that exacerbate the spread and treatment of TB. Some scholars also talk of its failure to reach into communities to foster TB prevention.

Structural violence
Dr. Paul Farmer, a physician dedicated to eradicating tuberculosis, argues that  “the global spread of TB and its drug-resistant strains by pointing to the dispositions of individual patients amounts to ‘immodest claims of causality’ that do not address the true roots of disease and suffering” He states that “Structural violence is one way of describing social arrangements that put individuals and populations in harm’s way. The arrangements are structural because they are embedded in the political and economic organization of our social world" . For example, developing countries from unsanitary working conditions which allow for microorganisms to invade the daily lives of people. Scholars note that the structural issues amount to a form of structural violence . Structural violence addresses how tuberculosis, social inequality, healthcare inaccessibility, and poverty are interconnected. Tuberculosis is a "social disease" that burdens countries that do not have the medical infrastructure and resources to safely eradicate the disease despite the fact that there is a vaccine and multiple strategic plans endorsed by the World Health Organization. Patients susceptible to tuberculosis are more likely to work in areas where the working conditions have poor ventilation and sanitation. For example, Vietnam ranks 13th on the list of 22 countries with the highest tuberculosis burden in the world and is also ranked 10th for poorest air polluted country. Without proper resources and solutions that tackle the systemic issues that perpetuate poverty burdens, chronic diseases will continue to exist and further preserve structural violence.

Community approach: Engage-TB
Engage-TB is a World Health Organization approach for communities to work alongside NGOS and healthcare providers to help implement preventative and diagnostic tuberculosis treatments. It is an operational guidance to provide support groups such as women groups and micro-credit lending associations that will help provide stipends for people to be able to seek tuberculosis treatment and vaccination. Community mobilization is a cost effective long-term strategy to create trusting relationships in a clinical environment that are also mindful about the social predispositions that are put in place in a high burden tuberculosis country. The WHO notes that early case finding is an integral part in the community approach because it encourages communities to be proactive about their health and seek treatment support if needed. Engage-TB also implements educational projects in classroom settings to spread messages about preventing the transmission of TB. The core principles of Engage- TB are to have a mutual understanding and respectful environment that recognizes differences in background and culture and to have a national system that works in conjunction with NGOS and health care providers. The success of Engage-TB is monitored by how many new referrals are influenced by community engagement and if patients are able to fully recover and attend follow-up visits.