Strengthening the fight against TB – Guyana launches Stop TB Committee
A GINA Feature -- March 24, 2011
Advocates for the fight against TB – Parliamentary Secretary – Health, Joseph Hamilton, PAHO/WHO Country Representative- Guyana, Dr. Beverley Barnett, Minister of Health, Dr. Bheri Ramsaran, Advisor FGH and HIV- PAHO/WHO, Dr. Rosalinda Hernandez, First Lady Mrs. Deolatchmee Ramotar, NTP Programme Manager, Dr. Jeetendra Mohanlall and DOTS Coordinator, Nicola Melville-Nero
Tuberculosis is a recognisable global threat to public health and hinders efforts towards ending poverty however, this illness is preventable, treatable and curable once detected and the stipulated treatment period is completed. This disease is considered as the eighth cause of death worldwide since every year there are millions of new infections and corresponding deaths.
Global estimates for 2010 indicate that there were 8.8 million new or relaxed cases of TB and 1.4 million deaths mostly in developing countries. There will be about 350,000 deaths due to HIV associated tuberculosis with at least 60,000 TB cases not being diagnosed and treated. A high percentage of those cases represent children and youth.
Additionally, 17,000 to 20,000 people with HIV and TB co-infection are not identified and/or diagnosed and 3400 to 5000 multiple drug resistance MDR TB cases are also not identified or diagnosed; evidently globally, regionally and nationally there are still challenges to be faced.
The theme for World TB Day 2012, March 24, “Stop TB in my lifetime” is most timely as people all over the world fights this epidemic which affects millions of families.
Stop TB Committee
To further advance efforts in the fight against TB, the Ministry’s National Tuberculosis Programme (NTP) launched its Stop TB Committee on the eve of World TB Day 2012. This committee comprises representatives from the Ministry, NTP, international partners including PAHO/WHO and other stakeholders.
At the launch, Minister of Health, Dr. Bheri Ramsaran recognised that TB continues to be a public health threat and while there was some amount of complacency, at one time when the World thought it was on top of eradicating the disease that may have led to the current existing complications including the emergence of multi-drug resistant strains.
Minister Ramsaran indicated that since the detection of the germ that causes TB, much has been done yet there is still much to be done as compared to the breakthroughs that have been achieved in combating various diseases. He noted that the available medication and methods to treat TB have aged as such there is a call for more research and newer and more effective drugs.
The committee has some specific tasks to execute in that regard however, while much cannot be contributed to research due to limited capacity but drawing from experiences in Guyana’s fight and the data available an impact can be made nationally, Dr Ramsaran said.
It has been recognised that vulnerable populations, including prisoners, are not adequately addressed and, in this regard Minister Ramsaran disclosed that recently a batch of nurses was attached to the prison service to provide services.
NTP Programme Manager, Dr. Jeetendra Mohanlall presents Guyana’s progress in fighting TB
With regards to the TB programme’s challenges with the hinterland, the Community Health Worker (CHW) will also receive training similar to that of DOTS workers. As more health workers are trained, the Ministry will be in a better position to cater to the needs of the vulnerable groups.
PAHO/WHO Country Representative- Guyana, Dr. Beverley Barnett stated that the commemoration of World TB Day yearly is designed to build public awareness that TB is still prevalent and marks the day in 1882 when Dr. Robert Koch announced his discovery of the cause of tuberculosis -the TB bacillus – a germ. Later on antibiotics were developed that could kill the germ and so with proper treatment this chronic infectious disease that was once thought to be incurable was cured in most cases.
“...between 1990 and 2010 there was a 40 percent decrease in TB deaths globally, people thought that TB had been conquered and before we knew it this chronic but curable disease was once again a public health problem fuelled by the HIV epidemic,” Dr. Barnett pointed out.
She noted that Millennium Development Goal 6 specifically addresses TB as it outlines that by 2015, TB cases would be halted and work would commence to reverse the incidence, prevalence and death rates associated with tuberculosis and the proportion of cases detected and cured under directly observed treatment short course (DOTS).
Dr. Barnett emphasised that Guyana has repeatedly indicated its commitment to make progress to achieve all the MDGs and is committed to the Stop TB Strategy as a major method to achieve MDG 6, and the establishment of the Stop TB Committee is another indication of that commitment.
Six point Strategy
The goal of the stop TB strategy, which builds on the successes of DOTS, is to dramatically reduce the global burden of tuberculosis by 2015 by ensuring all TB patients, including those co-infected with HIV and those with drug-resistant TB, benefit from universal access to high-quality diagnosis and patient-centered treatment. The strategy also supports the development of new and effective tools to prevent, detect and treat TB.
The six components of the Stop TB Strategy are: - Pursue high-quality DOTS expansion and enhancement; address TB-HIV, MDR-TB, and the needs of poor and vulnerable populations; contribute to health system strengthening based on primary health care; engage all care providers; empower people with TB and communities through partnership and enable and promote research.
One of the two new 4x4 vehicles being used in the tracking of TB patients and defaulters
Guyana has signed on to the six-point strategy, as well as the WHO 12 points policy package which includes TB/HIV coordinating bodies, HIV surveillance among TB patient, TB/HIV planning, TB/HIV monitoring and evaluation, intensified TB case finding, ionized preventive therapy, TB infection control in health care and other settings, HIV testing and counselling, HIV preventive methods, cotrimoxazole preventive therapy, HIV/AIDS care and support and antiretroviral therapy to TB patients.
Guyana’s position
NTP Programme Manager, Dr. Jeetendra Mohanlall presented pertinent statistics of Guyana’s progress of addressing TB which is currently being fuelled by the HIV virus and in some cases diabetes. During the period 2005-201, 1107 persons (new TB cases) were co-infected with HIV.
In 2011 there were 683 new cases, 633 were tested for HIV of which147 were HIV positive. Dr. Mohanlall explained that in Region Four, 398 persons were screened and most of the resources are focused on this Region since it has the most TB cases.
A patient in discussion with one of the doctors at the Georgetown Chest Clinic
He indicated that over the years as the programme received more funding for the DOTS programme there was increased TB diagnosis throughout the country.
Dr. Mohanlall explained that while the implementation of the DOTS programme has been a success, a community model is being introduced to target hinterland villages. Village leaders will function in a similar capacity as the DOTS worker so as to ensure TB patients use their medication as required.
He pointed out some of the challenges the NTP is faced with include implementation of Directly Observed Treatment, recording and reporting systems, implementing the 12 TB/HIV collaborative activities, and Limited participation by civil society.
Treatment in Guyana
In the early days, TB was dealt with by isolating patients so as to prevent its spread, a method that proved effective.
Over the years, government has invested in the expansion of the TB programme into the Regions thereby allowing all Guyanese access to care and support at TB sites at the Mabaruma, Port Kaituma and Moruca hospitals, Region 1, Suddie and Charity, Region 2, West Demerara and Leonora hospitals, Region 3, GPHC, and Enmore Poly Clinic, Region 4, Fort Wellington hospital, Region 5, New Amsterdam and Skeldon hospitals, Region 6, Bartica hospital, Region 7, Madhia Regional hospital and Annai health centre, Region 9 and Wismar District hospital, Region 10.
DOTS
Guyana implemented the DOTS initiative recommended by the WHO to reduce and prevent further infections. It entails visits to the homes of patients by a team of trained heath care workers who ensure that patients take their medications in the right doses.
A patient undergoing a respiratory examination
In order for DOTS workers to effectively carry out their duties, they are provided with a motorcycle and fuel by the Health Ministry, nevertheless they are sometimes faced with challenges since some persons, particularly drug addicts may submit incorrect addresses, and this may lead to a relapse since they are not using the provided medication.
These challenges have not deterred the determination of the workers since they are now outfitted with two 4 x 4 vehicles which enable them to track TB patients and, those who have defaulted and reside on the East Coast and East Bank of Demerara.
The NTC also has an Enabler programme whereby persons with TB are provided with a meal and a nutritious drink. There is also a component that caters for persons who frequent the Night Shelter. Visits are made to the shelter early in the morning so as to reach persons needing care, particularly the homeless.