in collaboration with NTP & PTP Saira Khowaja Indus Hospital ldr TB Control lprogram

Transcription

1 Social Support Program at Indus Hospital PMDT in collaboration with NTP & PTP Saira Khowaja Indus Hospital ldr TB Control lprogram

2 Social Support Providing support to create an environment that is conducive to the completion of treatment and cure of the patient Why is Social Support Necessary? Long, intensive treatment Serious adverse effects Poor socioeconomic factors affect adherence

3 Strengths of Social Support Improve commitment to treatment Improve cure rates Decrease sideeffects effects by nutritional improvement Decrease rates of default, treatment failure and death

4 Components of Social Support Indus Hospital PMDT Counseling Food Assistance Program Nutritional Supplementation for special cases DOT provision through Treatment Supporters Transportation ti and housing costs for special ilcases

5 Long, painful treatment Disconcerting adverse effects Poverty Social stigma and alienation Why is Counseling Necessary? Hopelessness after previous failed treatments Death of a family member Guilt and worthlessness Special case patients

6 Emotional Support in Lima, Peru Treating MDR TB patients since % cure rate Nurses manage provided emotional support Common areas of concern Guilt Stigma Side effects Adherence difficulties Socioeconomic difficulties Death and concurrent illness CHALCO K., WU D.Y., MESTANZA L., MUNOZ M,. el al

7 Food Assistance Program Indus Hospital PMDT Article Flour Rice Lentils Sugar Oil Milk Quantity 20Kg 5Kg 4Kg 4Kg 5Ltr 1Kg

8 Food Assistance Program Advantages Provide nutritional benefits Incentive to comply with treatment Increases worth of patient Allows subsistence in the absence of income Compliancefor follow up sputum submission and clinical Compliance for follow up sputum submission and clinical visits

9 Monthly trend in cost per food basket March 2010 December 2011 PKR USD 3,300 US$ 39 3,200 US$ 38 US$ 37 3,100 US$ 36 PKR 3,000 2,900 US$ 35 US$ 34 USD 2,800 US$ 33 US$ 32 2,700 US$ 31 2,600 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Q2 Q3 Q4 Q1 Q2 Q3 Q US$ 30

10 Monthly Cost of Food Basket Program Projected cost (PKR) Number of patients Number of Treatment Supporters 1,000, , , PKR 700, , , , , t Supporters Number of Patien nts or Treatment 200, ,000 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Q1 Q2 Q3 Q

11 Nutritional Support for DR TB Patients Baseline Height & Weight recorded BMI calculated l Normal BMI Low BMI Very Low BMI (18 25) (16 18) (<16) 2 month follow up Monthly Nutritional consult Monthly Nutritional Consult & Nutritional Supplements

12 Patients on Power pack by Age and Gender (N= 60) Males Females r of Patients Numbe Age Groups (years)

13 Monthly nutritional supplement cost Energid Glucerna Ensure Nido Number of Patients PKR Patients Number of Sept Oct Ot Nov Dec Q Q4 0

14 Why are Treatment Supporter Necessary? Increase compliance Identify and report side effects Identify potential contacts Provide support and some counseling Delivery of medication Assess transmission risk factors in the household Encourage patients to attend their clinical appointments

15 DOT Treatment Treatment Supporters Directly Observed dtherapy for Completion of Pulmonary Tuberculosis Chaulk CP & Kazandjiam VA, JAMA Mar. DOT with incentives andenablers : 86% 96% DOT w/o incentives and enablers : 85% 87% DOT only in part of the therapy: 78% 82% No DOT: 41% 82% Conclusion: Treatment completion rates for pulmonary tuberculosis are most likely to exceed 90%, when treatment is based on a patient centered approach using directly observed therapy with multiple enablers and enhancers.

16 Additional Support Hygiene kits Transportation costs Clothing and shoes Schooling for children Improving housing conditions

17 Challenges Indus Hospital PMDT Treatment supporters Identification for female patients Family vs. community supporters Monitoring Counseling Emotionally draining Angry and aggressive patients Separating physiological symptoms from social/psychological ones Food Assistance Logistics Supply, procurement & storage of large number of food baskets Intake by patients? Deception by workers

18 Thank you!