Project Goals Support the National Tb Program (NTP) Developed National Guidelines for prevention and

control of Tb Developed guidelines for treating people co-infected

with HIV/AIDS Implement and expand DOTS (Directly Observed

Therapy Short course) Strengthen Laboratories Strengthen the Capacity of Educational Institutions

Public Health Strengthening in Guyana

Implemented by the Canadian Society for International Health (CSIH) in partnership with the Guyanese Ministry of Health Canadian International Development Agency investment 5.5 million CN$

Poster AbstractPublic Health Strengthening in Guyana is a capacity development intervention focused on improving and maintaining the health of Guyana’s population. One major component of the Project focuses on improving the National Tuberculosis Program (NTP) by providing technical and administrative support for the NTP Unit, developing and implementing national diagnosis and treatment guidelines and, developing implementation strategies for directly observed therapy short-course (DOTS) using WHO standard treatment. To ensure the success of the project, organization and necessary procurement to introduce AFB laboratory diagnosis have been instituted. TB and bio-safety training sessions and laboratory manual development are completed. Mentorship, training and provision of motorbikes to DOTS workers have further ensured that great strides were made to improve level of patient plus family care. In 2001, there were 787 TB cases nationwide in Guyana. The TB detection rate was 54% for 2000. Moreover, the incidence of TB had increased by 10-20% annually between 1994 and 1999. In many cases, the extent of the problems was impossible to define because of the lack of diagnostic capacities, relevant expertise, and adequate staffing. Furthermore, many of the gains made from public health interventions, such as childhood immunization programs, have been eroded by the consequences of the increasing burden of HIV/AIDS, tuberculosis and co-infections.By supporting an integral approach to disease, prevention, diagnosis, management and care at the National and district/community levels, this project will result in overall improvement in health of the Guyanese.

Authors and Affiliations : Dr. Earl Hershfield, Tb expert consultant; Dr. Shamdeo Persaud, National Tuberculosis Officer Guyana; Ms. Roumyana Benedict, Project Director; Ms. Josée Levesque

Key Project Components:• Expanding and Strengthening the Prevention,

Management and Care of STIs/HIV/AIDS

• Improving National Tuberculosis Prevention and Control Program

• Strengthening the Health Information System

• Community Health Development and Care

TB in Guyana• 590 TB reported cases nationwide

(2003)• TB detection rate is 54%• DOTS (Directly Observed Therapy)

coverage is only 12% of the total population

• Annual rate of infection : 3.2 (estimated)

• Annual risk of infection : 0.92• TB infection : 14% (105,000 –

estimated)• Current prevalence : 0.3% (2,400

active cases)• Annual incidence : 79/100,000

(reported)• Mortality Rate (reported) : 3.25

Minister Ramsammy on a new DOTS bike provided by CSIH

Chief technologist and CSIH expert at new PHSG-funded laboratory

Consultation at Chest Clinic with NTP Director, Nurse and CSIH

expert

A CSIH consultant delivers a lecture at UGLaunch of DOTS expansion in region 10

Project Achievements Key persons trained on a study tour to Canada. Vehicle and administrative support provided for the

NTP Completed final draft of National TB Manual and TB

Laboratory Manual Eleven new DOTS workers trained, mentored and

provided with motorbikes Central Lab equipped and trained for TB culturing and

fluorescent microscopy Continuing Education sessions for medical

technologists The NGO Guyana Chest Society, re-activated and now

member of the IUATLD First National TB conference held in collaboration with

MOH and the Chest Society

Region 4

Region 10

Region 6

Guyana

Region 4

Region 6

Guyana

First National TB conference in Guyana, Oct. 2004 Computer and database training at Chest Clinic with CSIH

NetCorps intern

TB COMPONENT 0

200

400

600

800

Cas

es

0

20

40

60

80

100

Male

Female

Notified Cases 1988 - 2003

Case

s

Age and Gender Distribution 2003

www.csih.org/what/guyana/indexguyana.html

CSIH Guyana office:Suzanne MarquisProject Field ManagerTel: (592) 227 3673csih@guyanapsu.org.gy

CSIH Ottawa office:Roumyana BenedictProject DirectorTel: (613) 241-5785 Ext.307rbenedict@csih.org

Chest Clinic Cured

Defaulted

Failure

Died

Georgetown 212 122 14 27New Amsterdam

16 8 0 6

Linden 9 4 0 7WDRH 7 7 1 1Total 244 144 15 37Percent% 43.7 25.2 2.6 6.6

Treatment Outcomes -2003

ACTIVITY 2003 2004

Hand Washing Non-existentFinding running water;Using wipes / antiseptic wash

Medication

Self-administered; Some DOTS in Georgetown onlyMeds carried in pillboxes

Directly Observed; Meds counted and packed in plastic bags

Drug DosagesDifferent dosages ; Varying length of tx ; Missing medications

Therapeutic dosages; Most treatments completed in 6 months

InformationPertinent information not consistently reported to MD

DOTS notes; Lab results posted; Improved documentation

Patient Education

Done at first visit only; Lack of teaching aids

Ongoing; Done with Family members; Teaching aids developed

Support Systems

Need for Support Systems identified

Support Systems continue to be insufficient

Statistics Not doneStandardization of format; properly reported

Sputum Collection

Patients went to the laboratory

Specimens collected at home by DOTS workers

DOTS Achievements 2003-2004