The TB plan

The TB prevention program strategy will focus in on two areas. The first is diagnosis and treatment of all persons with active pulmonary TB. Prompt diagnosis and appropriate treatment of those persons are essential to limiting the spread of TB. Directly Observed Therapy (DOT) is indicated for all persons being treated for pulmonary TB. The second area includes the public health investigation of close contacts of all cases of pulmonary TB. All household members and close contacts of a patient with active TB will receive appropriate treatment in order to reduce the risk of future TB disease. These investigations are critical to identify likely sources of transmission and to limit the spread of TB. The consistent application of the above strategy will reduce the transmission of TB and decrease the population of infected persons at risk of developing TB disease, ultimately leading to the control of the disease.
The above strategy will be applied through several components aimed at controlling this endemic scourge. The first component is the development of a Tuberculosis case registry. This registry will enable us to track diagnostic information on patients with TB and monitor their clinical management and response to therapy. Second, is the provision of anti-tuberculosis drugs. Thirdly, laboratory services including increased utilization of sputum specimens will be employed for early detection of infectious pulmonary TB. A fourth component will be expert consultation from both local health care providers in Haiti and physicians from the US that will be made available through telephone and online consultation between the Espwa clinic and the Providence TB clinic. The fifth component is disease reporting and surveillance. The sixth component will include intensive training of the Espwa clinic health care workers on TB diagnosis, treatment, follow-up and epidemiology in southern Haiti.
Key activities of the TB prevention program will include direct medical care to patients. The evaluation and treatment of patients with suspected or documented active or latent TB infection will be conducted by health care providers at the Espwa clinic. Chest radiographs will be obtained at the public hospital when a specific medical indication exists (ie, symptoms, relevant history, or candidate for treatment of latent TB infection). With the assistance of health care personnel at the Espwa clinic, the program will monitor and encourage patient compliance with medical treatment and with clinical follow-up. Finally, we intend to present and share our results with the Public Health Ministry in Les Cayes. Preliminary discussions with the Minister of Health in Southern Haiti have occurred. The public health officials are interested in reviewing our data, yet remain unconvinced of the practicality and efficacy of treating latent TB. By presenting a well-designed and carefully executed program, we hope to persuade the local medical community to accept and embrace the concept of TB prevention in Haiti.