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1.9 Effective TB Control: WHO Strategy for Controlling Tuberculosis

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The work upon which this publication is based was performed in part under Grant Agreement 118-G-00-99-00112 (WHO) and PASA 118-P-00-98-00165 (DHHS/CDC) funded by the U.S. Agency for International Development. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the U.S. Agency for International Development. Additional funding was provided by the World Health Organization and the Centers for Disease Control and Prevention. 2003 1 Introduction: Managing TB at the Raion Level Module 1 – Table of Contents 1.1 Purpose of the Course .........................................................................................1 1.2 Target Audience..................................................................................................1 1.3 Organization of the Course .................................................................................1 1.3.1 Course Materials To Be Used....................................................................... 1 1.3.2 The Role of a Facilitator............................................................................... 3 1.4 Course Goal and Objectives................................................................................3 1.5 TB Transmission .................................................................................................5 1.6 Global and Regional Burden of TB.....................................................................5 1.7 TB Burden in Russia ...........................................................................................6 1.8 Factors Contributing to The Rise of TB in Russia..............................................7 1.9 Effective TB Control: WHO Strategy for Controlling Tuberculosis ..................9 1.10 Aim of a National Tuberculosis Program .........................................................12 1.11 The Structure of the TB Health Care Delivery Program in Russia...................13 1.11.1 The Central Level ..................................................................................... 15 1.11.2 The Oblast Level ...................................................................................... 16 1.11.3 The Raion Level ....................................................................................... 17 1.11.4 General Medical Services Level............................................................... 18 1.12 Summary ...........................................................................................................19 Annex A.......................................................................................................................21 Annex B .......................................................................................................................41 This page is left intentionally blank for double sided printing. 1 Introduction: Managing TB at the Raion Level 1.1 Purpose of the Course The tuberculosis (TB) training modules entitled Managing Tuberculosis at the Raion Level are a series of educational modules designed to provide the technical knowledge and skills essential for TB control at the Raion (district) level in Russia. The course has been developed by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), in collaboration with the Central Tuberculosis Research Institute (CTRI) in Moscow, and TB specialists from Oblasts implementing the WHO’s strategy for controlling TB. The information presented in this course is based on experiences of the implementation of the WHO’s proven and cost-effective TB treatment strategy known as directly observed treatment short-course. This course provides an overview of the technical knowledge and skills needed to implement the WHO’s strategy for TB control in the context of the health care delivery system in Russia. 1.2 Target Audience The target audience for this course is the TB Specialist or TB Coordinator at the raion level, as well as other raion-level staff who are responsible for planning, organizing, delivering, and supervising TB control activities at the raion level. Although the principal target audience is raion-level staff, the information in this course may also be relevant for oblast level staff who supervise TB activities at the raion-level. 1.3 Organization of the Course 1.3.1 Course Materials To Be Used This course consists of 11 instructional booklets called modules, which serve as the main resource for this course, a workbook to complete the exercises found within the modules, and an answer book. The modules review the technical knowledge and skills essential for TB control at the raion level. Within the modules are exercises that allow the course participant to practice important skills for planning, organizing, delivering, and supervising TB control at the raion level. The course Workbook is essentially consists of copies of the TB Patient Register (TB 03), and is used for all exercises that involve working with a TB Patient Register (TB 03). Each module is based on a major task that makes up a raion TB Coordinator’s job. 1 1 Introduction: Managing TB at the Raion Level These major tasks are: Module 1: Introduction to managing TB at the Raion level Module 2: Identification of tuberculosis suspects Module 3: Administering treatment Module 4: Registering cases Module 5: Monitoring treatment outcomes Module 6: Completing quarterly reports on new cases and relapses of tuberculosis Module 7: Completing quarterly reports on treatment results of pulmonary patients Module 8: Maintaining regular drug supplies and other materials Module 9: Supporting laboratory services Module 10: Conducting supervisory visits Module 11: Patient education Each module contains the following sections: • Introduction: Background information to help the reader understand the purpose of the module. • Objectives: A guide to the information included in the module. • Reading material: The reading material for the module, including forms. • Study exercises: Sets of exercises, spread throughout the reading material, designed to help the reader apply the knowledge learned during the course. These will either be individual or group exercises. • Summary: A description of key points in the module. Before each individual exercise, the following picture will appear: For the group exercises, course participants will be asked to work with other participants to discuss answers to a given situation or to participate in a role-play exercise. A facilitator will lead the small group discussions and observe and comment on each role-play exercise. Before each group exercise, the following picture will appear: 2 1 Introduction: Managing TB at the Raion Level 1.3.2 The Role of a Facilitator Although the course modules can be used on their own, the course is designed to be facilitated in a classroom setting by a course facilitator. The facilitator should be an expert in the WHO’s strategy for controlling TB and could be from the raion, oblast, national, or international level. The facilitator should give an overview of the content in each module. The participants should then read the module and work through the individual exercises at their own pace. The facilitator should also lead group exercises and summarize each module. The facilitator should • introduce each module; • answer questions whenever they arise, or find the appropriate answer; • facilitate group discussions; • summarize each module. 1.4 Course Goal and Objectives The goal of this course is to increase the technical knowledge and skills of staff at the raion level and to improve their ability to implement the proven and cost- effective WHO’s strategy for controlling TB. The course provides the knowledge and needed skills to identify TB suspects, diagnose TB disease, treat patients effectively, monitor the patients during treatment, and evaluate treatment outcomes at the end of chemotherapy. The WHO strategy for controlling TB requires the completion of several cards, forms and registers. This course provides an overview of the procedures for completing these documents. An explanation and example of each card, form, and register can be found in Appendix A of this introduction module. 3 1 Introduction: Managing TB at the Raion Level Table 1.1 Names of Cards, Forms, and Registers used in WHO Strategy for Controlling TB TB Patient Treatment Card (TB 01) TB Patient Register (TB 03) Tuberculosis Laboratory Register (TB 04) Request For Sputum Microscopy Examination (TB 05) Request for Culture/Drug Sensitivity Testing Form (TB 06) Quarterly Report on New Cases and Relapses of Tuberculosis (TB 07) Quarterly Report on the Results of Treatment of Pulmonary Tuberculosis Patients Registered 12-15 Months Earlier (TB 08) Tuberculosis Referral/Transfer Form (TB 09) Quarterly Report on Sputum Conversion (TB 10) Course Objectives By the end of the course, participants should be able to perform the following objectives: • Complete TB Patient Treatment Card (TB 01); • Ensure the proper prescription and administration of drugs during the entire course of treatment, and document patient adherence; • Provide health education to patients and train health workers to do the same; • Register patients in the TB Patient Register (TB 03); • Verify that patients’ sputum specimens have been examined at the correct intervals and record the results in the TB Patient Register (TB 03); • Review the TB Patient Treatment Card (TB 01) to identify treatment outcomes and record the treatment outcomes in the TB Patient Register (TB 03); • Control data entry into
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