Transcript Tuberculosis Epidemiology

SESSION 2:
Essential Elements of DOT –
Part 1
Risks for Nonadherence
When patients are adherent:
1. Risk for developing drug-resistant
TB is decreased
2. Risk of TB spreading to others is
decreased
3. Prolonged illness, disability, and
possible death are avoided
DOT Curriculum Session 2
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Risks for Nonadherence (2)
Can we predict who will be
nonadherent?
No! Anyone can be nonadherent,
regardless of social class, educational
background, age group, gender, or
ethnicity.
DOT Curriculum Session 2
3
Risks for Nonadherence (3)
Persons at especially high risk:
•
Homeless or people who don’t
have permanent housing
•
Persons who use alcohol or
other substances
DOT Curriculum Session 2
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Risks for Nonadherence (4)
Persons at especially high risk
(continued):
•
Persons who have mental,
emotional, or physical disabilities
•
Children and teenagers
•
Persons who previously did not
adhere to TB treatment
DOT Curriculum Session 2
5
How Can DOT Staff Build Rapport
and Trust?
1.
2.
3.
4.
“Start where the patient is.”
Protect patient confidentiality
Communicate clearly
Avoid criticizing patient; suggest
behavior changes respectfully
DOT Curriculum Session 2
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How Can DOT Staff Build Rapport
and Trust? (2)
5. Be on time and be consistent
6. Adopt and reflect a non-judgmental
atittude
7. Other ways?
DOT Curriculum Session 2
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Skills That Contribute to Good
Communication
1. Listen attentively and respectfully; use
open, relaxed body language
2. Assure patient of privacy and
confidentiality
3. Avoid being judgmental or accusatory
and never show frustration
DOT Curriculum Session 2
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Skills That Contribute to Good
Communication (2)
4. Use simple, nonmedical terms
5. Use appropriate language level for
the patient
6. Limit the amount of information given
DOT Curriculum Session 2
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Skills That Contribute to Good
Communication (3)
7. Discuss most important topics first
and last
8. Repeat important information
9. Listen to feedback and questions
from the patient
DOT Curriculum Session 2
10
Skills That Contribute to Good
Communication (4)
10. Use concrete examples
11. Ask open-ended questions
DOT Curriculum Session 2
11
Common Adverse Reactions to
TB Drugs
Caused by:
Any drug
Adverse reaction:
Allergic reactions
Signs/symptoms:
Skin rash
DOT Curriculum Session 2
12
Common Adverse Reactions to
TB Drugs (2)
Caused by:
Ethambutol
Adverse reaction:
Eye damage
Signs/symptoms:
Blurred or changed
vision; changed color
vision
DOT Curriculum Session 2
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Common Adverse Reactions to
TB Drugs (3)
Caused by:
INH, PZA, RIF
Adverse reaction:
Hepatitis
Signs/symptoms:
Abdominal pain
Abnormal LFTs
Dark urine
DOT Curriculum Session 2
14
Common Adverse Reactions to
TB Drugs (4)
Caused by:
INH, PZA, RIF
Adverse reaction:
Hepatitis
Signs/symptoms:
Fatigue
Fever > 3 days
Flu-like symptoms
Lack of appetite
DOT Curriculum Session 2
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Common Adverse Reactions to
TB Drugs (5)
Caused by:
INH, PZA, RIF
Adverse reaction:
Hepatitis
Signs/symptoms:
Nausea
Vomiting
Yellowish skin or
eyes
DOT Curriculum Session 2
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Common Adverse Reactions to
TB Drugs (6)
Caused by:
Isoniazid
Adverse reaction:
Nervous system
damage
Signs/symptoms:
Dizziness
Tingling/numbness
around mouth
DOT Curriculum Session 2
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Common Adverse Reactions to
TB Drugs (7)
Caused by:
Isoniazid
Adverse reaction:
Peripheral neuropathy
Signs/symptoms:
Tingling/numbness
in hands and feet
DOT Curriculum Session 2
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Common Adverse Reactions to
TB Drugs (8)
Caused by:
Pyrazinamide
Adverse reaction:
Stomach upset
Signs/symptoms:
Stomach upset
Vomiting
Lack of appetite
DOT Curriculum Session 2
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Common Adverse Reactions to
TB Drugs (9)
Caused by:
Pyrazinamide
Adverse reaction:
Increased uric acid
Signs/symptoms:
Abnormal UA level
Joint aches
Gout (rare)
DOT Curriculum Session 2
20
Common Adverse Reactions to
TB Drugs (10)
Caused by:
Rifampin
Adverse reaction:
Bleeding problems
Signs/symptoms:
Easy bruising
Slow blood clotting
DOT Curriculum Session 2
21
Common Adverse Reactions to
TB Drugs (11)
Caused by:
Rifampin
Adverse reaction:
Discoloration of
body fluids
Signs/symptoms:
Orange urine,
sweat, or tears
Stained soft
contact lenses
DOT Curriculum Session 2
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Common Adverse Reactions to
TB Drugs (12)
Caused by:
Rifampin
Adverse reaction:
Drug interactions
Signs/symptoms:
Interferes with some
medications: BC pills,
BC implants,
methadone
DOT Curriculum Session 2
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Common Adverse Reactions to
TB Drugs (13)
Caused by:
Rifampin
Adverse reaction:
Sun sensitivity
Signs/symptoms:
Frequent sunburn
DOT Curriculum Session 2
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Common Adverse Reactions to
TB Drugs (14)
Caused by:
Streptomycin
Adverse reaction:
Ear damage
Signs/symptoms:
Balance problems
Hearing loss
Ringing in the ears
DOT Curriculum Session 2
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Common Adverse Reactions to
TB Drugs (15)
Caused by:
Streptomycin
Adverse reaction:
Kidney damage
Signs/symptoms:
Abnormal kidney
function test results
DOT Curriculum Session 2
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Review Questions
1. What are 2 negative consequences
that can result if a TB patient does
not adhere to the treatment
regimen?
2. What are 5 reasons that a patient
might be nonadherent? What is a
possible way to deal with each
reason?
DOT Curriculum Session 2
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Review Questions (2)
3. Name 5 techniques to build trust
and communicate effectively with TB
patients.
4. What are 2 ways you can be sure
that a dose is actually swallowed by
a patient?
DOT Curriculum Session 2
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Review Questions (3)
5. What are 3 commonly observed
adverse reactions to anti-TB
medications?
DOT Curriculum Session 2
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