What strategies can be implemented to improve tuberculosis surveillance and uptake of preventive treatment among high-risk groups and close contacts at the Lung Center of the Philippines?

Strategies to Improve Tuberculosis Surveillance and Preventive Treatment Uptake at the Lung Center of the Philippines

Implementing a comprehensive, community-based approach with systematic contact investigation and targeted preventive therapy is essential to improve tuberculosis surveillance and treatment uptake among high-risk groups and close contacts at the Lung Center of the Philippines. 1

Priority Interventions

1. Enhanced Contact Investigation System

• Establish a standardized contact investigation protocol that clearly identifies responsible staff for each step and outlines processes to maximize efficiency 1
• Prioritize contacts at highest risk for progression to TB disease:
  • Children under 5 years old
  • HIV-infected persons
  • Immunocompromised individuals 1
• Implement home visits for all close contacts within 72 hours of index case identification 1
• Ensure all contacts receive tuberculin skin testing with results read within 48-72 hours 1
• Provide chest radiographs for all high-risk contacts regardless of skin test results 1

2. Targeted Preventive Treatment Program

• Implement directly observed therapy (DOT) for latent TB infection (LTBI) for all high-risk contacts 1
• Prioritize preventive treatment for:
  • All children under 5 years who are contacts of infectious TB cases
  • HIV-infected contacts (after TB disease has been excluded)
  • Persons on immunosuppressive therapy 1, 2
• Provide free preventive medications and related services to remove financial barriers 1
• Consider "window period" prophylaxis for vulnerable contacts with initial negative skin tests 1

3. Community Engagement and Coalition Building

• Form coalitions with community representatives, local organizations, and healthcare providers to design and implement TB prevention efforts 1
• Conduct a thorough assessment of TB prevalence and sociodemographic characteristics to identify high-risk areas 1
• Engage community leaders and decision-makers in TB elimination planning 1
• Ensure staff composition reflects the sociodemographic makeup of communities being served 1

4. Improved Case Reporting and Surveillance

• Implement electronic reporting systems to facilitate timely TB case reporting from healthcare providers 1
• Offer incentives for early case reporting, such as free laboratory services for providers and free anti-TB drugs for patients 1
• Establish systematic screening programs in high-risk settings:
  • Correctional facilities
  • Homeless shelters
  • Drug treatment centers
  • Long-term care facilities 1

5. Innovative Approaches to Improve Treatment Adherence

• Establish treatment-housing centers for homeless TB patients to provide shelter, food, and continuous treatment 1
• Implement patient-delivered household contact tracing tools to increase TPT uptake among children under 5 years 3
• Provide transportation assistance to ensure patients can access treatment facilities 1
• Use incentives and enablers to improve treatment completion rates 1

Implementation Considerations

Data Management and Evaluation

• Develop systems to track and monitor both TB cases and contacts 1
• Regularly evaluate the effectiveness of contact investigations and develop interventions to improve performance 1
• Create a standardized data collection system to measure key indicators:
  • Proportion of contacts screened
  • Proportion of eligible contacts starting preventive therapy
  • Treatment completion rates 1

Training and Education

• Provide cultural competency training for healthcare staff to improve communication with high-risk communities 1
• Train community health workers in proper contact investigation techniques 1
• Educate healthcare providers about the importance of early TB case reporting 1

Common Pitfalls to Avoid

1. Delayed contact investigation - Contact investigations should begin immediately after identifying infectious TB cases 1
2. Focusing only on household contacts - Consider social networks and congregate settings where transmission may occur 1
3. Poor treatment adherence monitoring - Implement systems to track preventive treatment completion 1
4. Inadequate attention to cultural barriers - Ensure services are culturally appropriate and linguistically accessible 1
5. Long diagnostic delays - The median time to diagnose drug-resistant TB in the Philippines has been reported as 132 days, highlighting the need for rapid diagnostic methods 4

Special Considerations for the Philippines Context

• The Philippines is one of the highest TB burden countries in the world 5
• In urban poor areas of Manila, screening of household contacts has shown effectiveness in identifying children eligible for preventive therapy 6
• The yield of clinically diagnosed TB among children under 15 years was 8-10% in Manila, indicating the importance of contact investigation 6
• Non-governmental organizations achieved higher rates of contact evaluation (95%) compared to local government units (17%), suggesting potential partnerships to improve implementation 6

By implementing these evidence-based strategies, the Lung Center of the Philippines can significantly improve TB surveillance and preventive treatment uptake among high-risk populations, contributing to reduced TB transmission, morbidity, and mortality.