National Tuberculosis Control Program Manual of Procedures 5th Edition

7/26/2019 National Tuberculosis Control Program Manual of Procedures 5th Edition

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National Tuberculosis Control Program Manual of Procedures, 5 th ed.

145

Part 7. Supervisory ChecklistObserve or Interview the health staff regarding the following:

Procedure to Observe(Question)

Observation/Response Remarks

1. Identifying presumptive TB (How do youidentify presumptive TB?)

2. Collecting sputum specimens (Describehow you instruct patients to collect sputumspecimens for diagnosis)

3. Deciding on treatment based on results ofdiagnostic tests (What do you tell patientsafter a positive/negative DSSM result?)

4. Referring patients for DR-TB screening

(Who are the patients consideredpresumptive MDR-TB cases?)5. Initiating treatment (What are the key

messages when initiating treatment for TB?)6. Explaining DOT (How is DOT done?)7. Monitoring response to treatment (How

do you monitor response of patient totreatment?)

8. Managing Adverse Drug Reactions (Whatare the common ADRs your patients

encounter and how do you address them?)9. Assigning and explaining treatment

outcomes (Dene the different treatmentoutcomes. What will you advise a patientwho has completed treatment?)

B. Evaluation

1. All NTP Quarterly reports will be reviewed and analyzed by the DOTS facilityphysician prior to submission to the PHO/CHO. Together with the DOTS facility staff,the physician will analyze the program indicators to track the progress of programimplementation towards the set goals and objectives (See Section VI, ProgramIndicators below) .

2. Quarterly reports will be collected, consolidated and analyzed by the PHO/

CHO, RO and NTP (See Table 24 on page 61) . At all levels, identied problems andrecommended actions will be given as feedback.

3. Program Implementation Reviews (PIR) will be conducted on a semi-annual orannual basis to evaluate performance. General steps in the conduct of the PIR are:

a. Plan for the PIR by deciding what program elements to evaluate, what data

collection tools and methods to use and by preparing the necessary logistics.

b. Collect the necessary data prior to the actual PIR.


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c. Analyze and interpret the TB data collected. Report and explain the results ofthe analysis.

d. Discuss strategic directions that will address the program implementationgaps.

e. Prepare the PIR report and disseminate.

4. Analyze the core program indicators (CDR, CR, TSR) from the LGU scorecard.

Table No. 36 - Flow of NTP Reporting and Timelines

Level Functions Timeline forSubmissionDOTS Facility Data collection, analysis and

submission to next higher level1st week of the monthfollowing end of quarter

PHO/CHO Data collection, analysis,consolidation, feedback andsubmission

2nd week of the monthfollowing end of quarter

RO Data collection, analysis,consolidation, feedback andsubmission

3 rd week of the monthfollowing end of quarter

DOH-NTP Data collection, analysis,consolidation, feedback and

submission

1st month of the followingquarter

VI. PROGRAM INDICATORS

The program indicators measure the progress of implementation towards the set goals andobjectives. They will be determined at least quarterly at all levels. Some indicators (i.e.,case detection rates) are more applicable at provincial/regional/national levels rather thanBarangay or Municipal levels. The next table summarizes the main program indicators, thedenition and calculation, and the data sources. 40


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Table No. 37 - Program Indicators and Denitions

Indicator Denition/Calculation Data Source1. Case Notication Rate

(all forms)Number of Notied TB, all forms, forevery 100,000 population

all forms

by 100,000

Note: Notied TB, all formsinclude new and relapse, (whetherbacteriologically-conrmed orclinically-diagnosed) who were

detected, registered and reportedto the NTP

Report 3a. Quarterlyreport on CaseFinding of Drug-susceptible TBCases and IPT

2. TB Case Detection Rate(all forms)

Percentage of TB cases (all forms)detected and treated out of theestimated incident cases of TB (allforms)

forms detected

TB,all forms estimated to occureach year based on the global TBreport (i.e., population x incidencerate of TB, all forms)


3. Notication rate ofMDR-TB

Proportion of MDR-TB casesregistered out of the estimatedMDR-TB cases among notied TBcases

bacteriologically-conrmed drug-

resistant TB (RR/MDR-TB) cases

cases among the new andretreatmentTB cases

Report 3b. QuarterlyReport on DR-TBCases


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4. Treatment Success Rate(all forms)

Percentage of TB, all forms that aresuccessfully treated

forms, that are cured and complet-

ed treatment

all forms, registered during aspecied period

Report 5a. Quarterlyreport on TreatmentOutcome of Drug-susceptible TBCases

5. Cure Rate (NewBacteriologically-conrmed)

Percentage of TB, newbacteriologically-conrmed, that arecured

bacteriologically-conrmed TB

cases cured

new bacteriologically-conrmed TBcases registered during a speciedperiod

Report 5a. Quarterlyreport on TreatmentOutcome of Drug-susceptible TBCases

6. Treatment Success Rateof MDR-TB

Percentage of MDR-TB that aresuccessfully treated

bacteriologically-conrmed drug-

resistant TB cases (RR/MDR-TB)cured and completed treatment

registered bacteriologically-conrmed drug-resistant TB cases(RR/MDR-TB) during a speciedperiod

Report 5c. AnnualReport on theTreatment Outcomeof DR-TB Cases

7. Percent of bacteriolog-ically-conrmed MDR-TB cases with negative

culture after 6 months oftreatment (interimoutcome)

Percentage of bacteriologically-conrmed MDR-TB cases withnegative culture after 6 months

Numerator: Number ofbacteriologically-conrmed MDR-TB cases with negative culture after6 months of MDR-TB treatment

Denominator: Total number ofbacteriologically-conrmed MDR-TB cases

Report 5b. QuarterlyReport on TreatmentInterim Outcome of

DR-TB Cases


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8. Total number ofpresumptive TBexamined

Absolute number of presumptiveTB examined during the reportingperiod

Report 1. QuarterlyReport on TBMicroscopy andGX LaboratoryExaminations

9. Percent contributionfrom non-NTP careproviders

Percentage of notied TB casescontributed by non-NTP careproviders

cases, all forms, referred/managedby all non-NTP care providers(e.g., other government, private, orcommunity-based providers, etc.)

notied TB cases, all forms


10. Number of childrenwith TB detected andgiven treatment andthose given IPT

Absolute number of children withTB detected and given treatmentplus those given IPT


11. Percentage of TBcases in Category Aand B areas with HIVcounseling and testingaged 15 years old andabove

Percentage of registered TB casesin Category A and B areas thatunderwent HIV counseling andtesting

TB cases in category A and B areasprovided with HIV counseling andtesting 15 years old and above

registered TB cases in categoryA and B areas 15 years old andabove

Report 3a. QuarterlyReport on CaseFinding of Drug-susceptible TBCases and IPT

12.Percentage of DR-TBcases provided with HIVcounseling and testingaged 15 years old andabove

Percentage of registered DR-TB cases that underwent HIVcounseling and testing

DR-TB cases provided with HIVcounseling and testing 15 years oldand above

registered DR-TB cases 15 yearsold and above

Report 3b. QuarterlyReport on DR-TBCases


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13. Percent of TMLs withinEQA standards

Percentage of TMLs with less than5% major errors

have less than 5% major errors(adequate performance)

TB laboratory services within theNTP laboratory network

Report 2. QuarterlyReport on EQA forTB Microscopy

14. Percent of DOTS/Laboratory facilitieswith no stock-outsof anti-TB drugs andlaboratory supplies inthe last 6 months

Percentage of DOTS facilities withno stock-outs of anti-TB drugs andlaboratory supplies in the past 6months

laboratory facilities with no stock-outs of 1 st line and 2 nd line anti-TBdrugs and lab supplies in the past 2quarters

DOTS and Lab facilities

Report 4. QuarterlyReport on drug andsupply inventory andrequirement


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1. Department of Health. 2010 Philippine Health Statistics (Draft), Manila, Philippines: DOH, 2010.

2. Department of Health. 1982-83 National Prevalence Survey. Manila, Philippines: DOH, 1983.

3. Department of Health and Tropical Disease Foundation. 1997 National TB PrevalenceSurvey. Manila, Philippines: DOH, 1997.

4. Department of Health and Tropical Disease Foundation. 2007 Nationwide TB Prevalence Survey.Manila, Philippines: DOH, 2007.

5. Philippine Nationwide Drug Surveillance Team. Nationwide Drug Resistance Surveyin the Philippines. Journal of IUATLD. April 2009, pp 500-507.

6. World Bank. Gross National Income per Capita. http://data.worldbank.org/org. July 10, 2013.

7. Department of Health and Philippine Coalition Against Tuberculosis. Comprehensive and UniedPolicy for TB Control in the Philippines. Manila, Philippines: 2003.

8. Department of Health. Administrative Order 2008-2011. Revised guidelines for ImplementingTuberculosis control Program in Children. Manila, Philippines: DOH,

9. Department of Health. Administrative Order 2008-0018. Guidelines for the Implementation of theProgrammatic Management of Drug Resistant Tuberculosis, Manila, Philippines: DOH, 2008.

10. Department of Health. Administrative Order 140 s. 2004. Revised Guidelines for Hospital BasedTB Control Program Under the Hospitals for Wellness Program. Manila, Philippines: DOH, 2004.

11. World Health Organization. Global Tuberculosis Control 2012. Geneva, Switzerland: WHO, 2012.12. Department of Health. National TB Control Program Performance Report. Manila, Philippines:

DOH, 2012.

13. Department of Health. 2010 16 Philippine Plan of Action to Control TB. Manila, Philippines: DOH,2010.

14. World Health Organization. Recommendations for Investigating Contacts of Persons with InfectiousTuberculosis in Low- and Middle-Income Countries. Geneva, Switzerland: WHO, 2012.

15. World Health Organization. Systematic Screening for Active Tuberculosis: Principles andRecommendations. Geneva, Switzerland: WHO, 2013.

16. World Health Organization. Denitions and Reporting Framework for Tuberculosis- 2013 Update.Geneva, Switzerland: WHO, 2013.

17. Department of Health. Department Memorandum 2013-0021: Revision of NTP Policy on SpecimenCollection and Diagnosis by DSSM. Manila: DOH, 2013.

18. World Health Organization. Automated real-time nucleic acid amplication technology for rapidand simultaneous detection of tuberculosis and Rifampicin resistance: Xpert MTB/RIF system forthe diagnosis of pulmonary and extra-pulmonary TB in adults and children. Geneva, Switzerland:WHO, 2013.

19. Harrisons Principles of Internal Medicine, 18th ed. McGraw-Hill Medical Publishing Division. NewYork, USA. 2011

20. Philippine Pediatric Society (PPS). Tuberculosis in Infancy and Childhood. Manila, Philippines:PPS, 2010.

4$($#$9*$-


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21. World Health Organization. Guidance for National Tuberculosis Programmes on the Managementof Tuberculosis in Children. Geneva, Switzerland: WHO, 2006.

22.Department of Health. Administrative Order 2009-0003: Technical Guidelines for Implementing

DOTS Strategy in Jails and Prisons. Manila: DOH, 2009.23. Department of Health. Administrative Order 2008-0022: Policies and Guidelines in the Collaborative

Approach of TB and HIV Prevention and Control. Manila: DOH, 2008.

24. World Health Organization. Rapid Advice: Treatment of Tuberculosis in Children. Geneva,Switzerland: WHO, 2010.

25. World Health Organization. Treatment of Tuberculosis Guidelines, 4 th edition. Geneva, Switzerland:WHO, 2010.

26. Department of Health and Philippine Pediatric Society, Inc. Joint Statement on Treatment ofTuberculosis in Children. Quezon City: DOH-PPS, 2011.

27. Bailoy, B., Koren G. The Pediatric Clinics of North America: New Frontiers in Pediatric Drug Therapy,February, 1997: 44 (1):67

28.Task Force on Tuberculosis, Philippine Practice Guidelines 4Group in Infectious Diseases.Pulmonary Tuberculosis: Clinical Practice Guidelines. PPGG-ID Philippine Society for Microbiologyand Infectious Diseases and Philippine College of Chest Physicians, p. 45.

29. World Health Organization. Tuberculosis Care and Control in Refugee and Displaced Population.Geneva, Switzerland: WHO, 2007.

30. Swart A, Harris V. Drug interactions with Tuberculosis therapy. Continuing Medical EducationJournal (Formerly South African Medical Journal). Vol. 23, Number 2: February 2005.

31. Department of Health. Guidelines on Infection Control for TB and other Airborne Infectious Diseases.Manila: DOH, 2011.

32. Borade AB, Bansod SV. Domain of Supply Chain Management A state of Art. Journal of TechnologyManagement and Innovation: Volume 2, Issue 4, 2007.

33. Rational Pharmaceutical Management Plus Program. Managing TB Medicines at the Primary Level.Submitted to the U.S. Agency for International Development by the Rational Pharmaceutical PlusProgram, Management Sciences for Health, Arlington, VA; 2007.

34. Management Sciences for Health. MDS-3: Managing Access to Medicines and Health Technologies.www.mds-online.org. MSH: Arlington, VA, 2012.

35. Global Laboratory Initiative, World Health Organization. Guidance for Countries on the Specicationsfor Managing TB Laboratories and Supplies. WHO, Geneva; 2011.

36. Department of Health. NTP Manual of Procedures. Philippines: 2005.

37. Department of Health. The Health Promotion Handbook: A Guide to Doing Advocacy, Communicationand Social Activities in the TB Control Program in Communities. Manila: DOH, 2009.

38. United States Agency for International Development. Improving Interpersonal CommunicationBetween Health Care Providers and Clients. USAID: Washington, USA, 1995.

39. Linking Initiatives and Networking to Control Tuberculosis (TBLINC Project). Improving Monitoring,Supervision and Evaluation: Skills Enhancement Training in MSE (unpublished). PBSP: Manila,2009.

40. Department of Health. Updated 2010 16 Philippine Plan of Action to Control TB. Manila,Philippines: DOH, 2014.


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ANNEX A. Diagnostic Algorithm for PLHIV

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ANNEX C. Philippine Priority Areas for HIV Intervention

Source Department of Health. Memorandum from National Epidemiology Center: Philippines Priority Area for HIVIntervention (PAHI). March 5, 2012

Category A+ Category B+ ROTC

Paraaque City

Muntinlupa CityTaguig CityPasay CityMakati CityMandaluyong CityMarikina CityQuezon CityCaloocan CityNavotas CityLas Pias CityManila cityPasig CitySan Juan CityMalabon CityValenzuela CityPaterosAngeles CityDavao CityCebu CityMandaue CityBacoor, CavitePuerto Princesa CityZamboanga CityCagayan de Oro CityBaguio City

Olongapo City

Antipolo City, RizalDasmarias City, CaviteBatangas City, BatangasCainta, RizalImus, CaviteLipa City, BatangasIloilo CityBacolod City, Negros OccidentalLapu-Lapu City, CebuTalisay, CebuGeneral Santos CityButuan CityDanao CitySan Fernando,PampgangaMabalacat,PampangaSan Jose del Monte, BulacanMeycauayan, BulacanSta. Rosa, Laguna

All other citiesandmunicipalities

Table 2. Number of Most At-Risk Population in each Priority Category and theRest of the Country

Area Category MSM IDU FSW Male Clients of FSM

A (22 areas) 119,733 4,989 36,290 199,558NCR 95,908 1,126 20,117 159,850Cities of Cebu,Mandaue, & Danao 10,144 3,528 3,213 16,906

Davao City 11,105 148 1,763 18,508Angeles City 2,576 34 11,197 4,294

B (18 areas) 56,383 2,497 11,625 87,976C (30 area) 49,048 654 9,161 81,813

Rest of the Country 454,365 8,467 32,099 779,868

Combined A & B (40 areas) 176,116 7,446 47,915 287,534Combined A, B & C (70areas) 225,164 8,111 57,076 360,347


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Natural and/or mechanical Provide sketch. Check airow (withsmoke, vaneometer), Calculate ACH

Fans Maintenance, placement?

UVGI Provide Sketh. LAst maintenancecheck? UVGI design and installationadequate for the space?

Personal protective equipment

Pesperators Type? Average usage? Stocks?Storage? Signage?

Fit testing How is it organized? Frequency of ttest

1) Function, use and utilization of room assessed for ACH

2) Sketch room. Include main room, anteroom, hallway, UV lights fans, windows, furnitureand airow direction:


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ANNEX E. Revised Guidelines for the PhilHealth Outpatient Anti-TB DOTS BenetPackage


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National Tuberculosis Control Program Manual of Procedures 5th Edition

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