Community Based DOT(S)

Kong Kimsan MD, PUHPJICA TB Control Project, Cambodia

11th-July-02

Outline of Presentation

• Summary of workshop on 21st June 2002

• Feed back from NGOs• Experiences from community

survey

Summary of workshop on 21st June 2002(1)

• Who are eligible patients?What criteria for DOT in community?- Handicapped- Child- Very distant- AIDS Home Care client

Summary of workshop on 21st June 2002(2)

• Who can be DOT watcher?1. DOT watcher should be:

- Members of health center committee- Community leaders- Village Health Volunteers- NGO workers/volunteers- Local health professionals - School teachers

2. What kind of training should be provided?

Summary of workshop on 21st June 2002(3)

• Supervision:1. Who can supervise (DOT watcher

& TB patient)?- OD TB supervisor- TB Unit staff- Trained health center staff- Trained NGO health professional

2. How often?- Weekly?, Bi-weekly? ……………

Summary of workshop on 21st June 2002(4)

• Drug management and supply:1. Drug collection: Who?

- DOT watcher- TB patient- Others

2. Who should keep TB drugs of the patient?- DOT watcher- or TB Patient

Summary of workshop on 21st June 2002(5)

• Record?1. TB Register: HC2. Treatment Card: Should be kept in HC or TB Unit3. Who record ()?

DOT watcher?, Patient? or How often?4. Additional: Should have Special Card DOT

watcher

Summary of workshop on 21st June 2002(6)

• How often do TB patient see health worker (HC)?

1. Every week?2. Every 2 weeks?3. Or only 3 times in treatment? Month2,

Month5 and Month8.4. Others?

Summary of workshop on 21st June 2002(7)

1. How to follow up the patient?2. Patient should come to see health worker?

- Weekly? Every 2 weeks? Monthly?2. Home visit by HC/OD? 3. How often?

Summary of workshop on 21st June 2002(8)

• Detection:How to detect patient?

- Symptomatic detection- Sputum collection- Sputum sending - Diagnosis or only screening: Smear+ & Smear-

Summary of workshop on 21st June 2002(9)

• Support DOT in Community1. Who?

- HC staff- DOT watcher- Patient

2. Activities:- Training- Transportation- Incentive ….

Feed back from NGOs (1)

1. RHAC: 2. Eligible patients: + Family Size, Distance3. DOT watcher: + Job description, DOT

watcher should be responsible TB drug collection.

4. Supervision: NGOs worker can be Community DOT(S) Supervisor or DOT watcher.

Feed back from NGOs (2)

• JOCS: 1. Community Participation:

- TB patient detected in community is few- Needed much flexible for guideline- DOT watcher: Ex-TB patient

2. Per diem: If people understand, they will not ask money (DOT watcher)

Feed back from NGOs (3)

1. MSF (Sothnikum): 2. Eligible patients: Many people in village (Very

remote area) cannot come to HC every day, especially women with young children (cost & time).

3. DOT watcher: - Relative of patient, Responsible member of the community, The feedback Committee members. - A small incentive should be paid to DOT watcher by CENAT (Except relative of patient).

Experience from community survey (1)

• Prevalence survey: 1. Clusters:- Chrava Village (Kratie): - Morn Village (Kamport)- Steung Trang (Kampong Cham)2. Who can be DOT watcher?- Family members of the TB patient - Neighbors- Village leaders/feedback committee member- Village Health Volunteers

Experience from community survey (2)

• Note Book Distribution: 1. Where? Primary School in:- Kg Tralach OD (Kg. Chhnang) - Sothnikum OD (Siem Reap)- Thmorkol OD ( Battambang)2. Who can be DOT watcher?- Village leaders/feedback committee member - School teacher- Family members of the TB patient - Village Health Volunteers

Experiences from community survey (3)

• Review of DOTS in HC (Kampong Tralach OD): 1. Svay Chuk2. Svay3. Long Vek4. Kg. Tralach Leu