TB Treatment Begins

I've just finished doing the TB skin tests for all of our new children and those that somehow slipped through the cracks in previous years. Starting Monday, my public health team will begin distributing INH prophylactic drugs to the 145 children and adults that tested positive on their PPD tests. (The PPD is a special skin test for tuberculosis. There are many different names for the PPD, including TB skin test, tuberculin test and Mantoux test. PPD stands for purified protein derivative). Often times, a person who lives in an area where TB is endemic, will test positive by exposure. Therefore, a positive test does not necessarily mean that you have tuberculosis, however, it does mean that you have an increased risk of developing TB later in life. For this reason, anyone who tests positive (11mm or greater) is being put on a nine month regimen of INH treatment. This treatment is a prophylactic that when taken regularly, can reduce the chances of developing TB by up to 90%.

TB is among the leading killers of contagious diseases worldwide. It is caused by a bacterial infection and mainly affects the lungs, but can also affect other organs. TB is very common, especially in poorer socioeconomic settings and the developing world. It can be found in prisons and homeless shelters and overcrowded homes. You may even know someone who has it. TB is contagious, so if you live with someone who has TB, it is important to be tested as soon as possible.

Under normal circumstances, a positive TB skin test should be followed by a chest x-ray. However, resource poor settings such as ours do not allow for that luxury. Instead, everyone who tests positive receives a physical exam where we listen to their breathing and ask them a series of questions in order to discover the presence of any active TB symptoms (cough, including bloody phlegm, weight loss, fever, night sweats, difficulty breathing etc.)

TB can be treated with medications, but you must take them every day. The best way to ensure adherence is to institute a directly observed therapy program (DOT) which is what my public health guys and I are doing. The INH treatment we are dispersing requires that a person take one pill, twice a week. Each of the public health team members have a list of 30 names of people who they need to give medicine to every Monday and Thursday morning. I supply them with a jug of water, cups, 30 tablets and a checklist to keep track of who has received their meds. After an intense three-day seminar on tuberculosis, my team understands how important treatment is for TB and for that reason, they are dedicated to searching for everyone on their list twice a week and watching them take their medicine.

Last year, the success rate of INH completion was under 48%. This year, we have nearly double the number of kids on INH than last year. With a DOT program in place, I'm hoping to see at least 90% completion. We start everyone on treatment Monday and will finish just before school lets out for the summer. Wish me luck!