Delivering DOTS-Plus in the community
Improving and expanding DOTS-Plus: Throughout 2006, SES worked with the Peruvian Ministry of Health and with local health officials to expand treatment for MDR-TB patients both within and beyond Lima. In Arequipa, a major city in the south, the Regional Health Directorate committed to working with SES to expand and improve MDR-TB care. Patients are already enrolling in the DOTS-Plus program there. In Lima, almost 500 of our patients were declared completely cured; another 500 are still receiving medical treatment as well as nutritional, social, and economic support. SES sponsored weekly group therapy sessions over the course of the year, as well as thoracic surgeries for 77 patients. Finally, the committee responsible for decisions regarding treatment protocols has been expanded to include additional health and social service professionals; they will provide a more balanced and comprehensive view of TB treatment and decision making.
Advancing information systems: In May 2006, the National TB Program declared they would utilize the PIH Electronic Medical Records System to track treatment of MDR-TB patients. This collaboration with the Ministry of Health will further the transfer of responsibility for TB care to the public sector, and will continue to improve quality of care among MDR-TB patients. In addition, a laboratory system that will allow patients to receive better treatment more quickly was implemented in 12 health centers throughout Lima. SES also upgraded its own online abilities this year, implementing intranet and pharmacy systems, through which staff can report and track program progress.
HIV/AIDS care: 79 HIV-positive patients are now receiving comprehensive care through the SES HIV program; at the end of 2006, 94 percent of patients were clinically stable and had an undetectable viral load. The HIV team works with 17 volunteer health workers who administer life-saving antiretroviral drugs to patients and give them critical emotional, economic, and nutritional support. The team also works in tandem with the Ministry of Health’s National HIV program to improve patient enrollment and adherence to treatment.
Building on our success: In 2006, SES took on not only direct patient care but also strengthening the Peruvian health care infrastructure. SES supported the construction and maintenance of two operating rooms dedicated to surgeries for MDR TB patients, two in-patient hospital wings for TB and MDR-TB patients, a national reference laboratory for diagnosis of MDR-TB, and an ambulatory care wing for a regional hospital. In addition, we improved five healthcare facilities located in high-risk areas for TB transmission; we refurbished hospital rooms, exam rooms, and waiting rooms in two hospitals and three local health centers.
Telling our story: SES published 3 books (The PIH-EMR Manual, the Nurses’ Guide to MDR-TB and DOTS Plus, and Conquering MDR-TB: Stories of 20 Former Multi-Drug Resistant Tuberculosis Patients) and six articles in scholarly publications ranging from the International Journal of Tuberculosis and Lung Disease to The Journal of the International Association of Physicians in AIDS Care.
Education and training: Not only did SES continue to train fellow Peruvian healthcare professionals in the management of MDR-TB, we also collaborated with our colleagues in Haiti to provide a two-day training program to the Haitian Ministry of Health. SES doctors and nurses (along with one intrepid translator) traveled to the Zanmi Lasante training center in December 2006, and shared their 10 years of experience with their Haitian counterparts. We also adapted the curriculum developed by our Boston-based PACT colleagues for our HIV community health workers, and conducted our first trainings in community-based HIV/AIDS care.
[posted January 2007]