Tuberculosis Patient Centered Treatment Approach For DOT Supporters

The article “Tuberculosis Patient Centered Treatment Approach” is put together by the National Tuberculosis and Leprosy control programme (USAID and TB CARE I). It will enlighten you to know everything about the standard operating procedure for engagement of tuberculosis (TB) treatment supporter for directly observed treatment (DOT).

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What are the standard operating procedures for the engagement of TB treatment supporter for DOT service?

Image source: medlineplus.gov

These include:

1. Educate patients and relatives on the importance of adhering to regular drug intake.

2. Provide information to the patient on the available treatment options:

• Daily direct observation of treatment at a health facility. 
• Daily DOT by a treatment supporter at home. This involves 2 weekly visits to the health facility for drug collection.

3. If the patient chooses to involve a treatment supporter, take steps as outlined below.

4. Provide information to the patient on how to select a treatment supporter using the following criteria:

• Preferably a close relation of the patient (family or nonfamily)
• Living within the same household or walking distance of fewer than 500 meters from patient home
• Physically able to visit the facility 
• The willingness of the individual to provide support to the patient.

5. Place patient on daily DOT treatment while waiting while waiting for treatment supporter.

6. Ask patient to invite treatment supporter to the health facility within a period of 2 days.

7. Provide health education to both patient and treatment supporter on the following:

• Basic information on TB and TB infection control (especially cough etiquette)
• Treatment duration (6 months) and the number of tablets to take daily
• Intervals for sputum follow up examination (2,5&6 months)
• Possible side effects of anti TB drugs and need to report back to a health facility in case of any complaints.

8. Discuss the roles and responsibilities of the treatment supporter.

What are the roles and responsibilities of the tuberculosis treatment supporter?

The major roles and responsibilities of treatment supporter include:

1. Ensuring daily DOT
2. Ticking treatment supporters card
3. Support the patient to come to the health facility for drugs collection every 2 weeks
4. The patients and treatment supporter should return used (empty) blisters and treatment supporters card to the health facility before another supply
5. Support patient to come to a health facility for follow up sputum examination and management of any side effect or complications
6. Inform health care worker in event of opting out or becoming unavailable to provide treatment support.

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9. Reconfirm willingness of the treatment supporter.

10. The treatment supporter and patient should sign an agreement on the remark section of TB treatment card. 

11. Add a name, address and phone number of the treatment supporter to the contact of the patient on the TB treatment card.

12. Ensure that the patient and the treatment supporter agree on the timing of drugs intake and drug storage.

13. Provide treatment supporter with drugs and the treatment supporter's card.

14. The healthcare worker should review the treatment supporter's card and update TB treatment card during the 2 weekly visits.

15. The treatment supporter and patient should discuss any challenges with healthcare workers.

16. Where available community volunteers should be used for supervision and defaulters tracking.

Final Thought on Tuberculosis Patient Centered Treatment Approach For TB DOT Supporters

The patient has the option to reconsider either the use of health care worker or treatment supporter for DOT at any point in time.