What is the Philippine government doing through the Department of Health to eliminate or minimize tuberculosis among the population?

Answer 1

The Philippines government use many of the same strategies all countries do in trying to control one of the most common infectious diseases in the world.

1) Screening - the government is working with international funders and the US to build lab capacity, training and infrastructure to run the most common tests for TB: PPD, X-ray, sputum smear microscopy and culture. Placing the PPD test intradermally and reading the test site 48-72 hours later is sometimes difficult in places like the Philippines, where access to clinics and hospitals is not as easy as in the US. Most diagnosis is done after disease has manifested; few latent disease cases are detected. X-rays are only available in big city hospitals.

2) Medication - treatment of TB and, most importantly, prevention of antibiotic resistant TB, requires multiple drug therapy. The four first line drugs are isoniazid, ethambutol, rifampin and pyrazinamide. These are given at the outset of treatment while testing for resistance is conducted and, if no resistance is detected (the process can take months to grow cultures and test) the treatment is adjusted to two drugs, usually Isoniazid and Rifampin. There are other drugs, combination drugs and different dosages and durations used.

3) Adherence - treatment of TB in the best case can take as long as 6 months. Even in the US, few people will continue taking medication once they feel well and even fewer in developing nations where people have barriers to obtaining treatment and competing needs that outpace adherence to a disease which is no longer making them feel sick. Development of Directly Observed Therapy (DOT) programs, in which trained paramedical workers in conjunction with a case management nurse monitor the patient and observe them taking the medicine for the duration of treatment.

4) Contact Investigation - household and close social contacts of TB patients are at risk of developing TB. These individuals should be examined for TB by placement of a PPD and, if no disease is detected, a course of INH to preventively treat the exposure and destroy the possibility of developing disease.

In the Philippines and other emerging nations, there are major problems with unregulated access to over the counter antibiotics. Sometimes, individuals are able to take just enough medication to make the sputum and culture tests come out negative. Also, the chance of developing a resistant strain of TB is high under these circumstances.

Many people emigrate from the Philippines to the US - in Hawaii, the highest TB rate state in the US, the bulk of newly detected cases are found in foreign-born individuals, usually from the Philippines. Although there are some safeguards in place through the Immigration process, many cases still surface years later.

Through the Department of Health, the Philippine government is implementing the National TB Program. This program is being implemented nationwide. Its aim is to detect active TB cases and cure them.