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D.O.T.S. PROGRAMME IN THE BAHAMAS

D.O.T.S. PROGRAMME IN THE BAHAMAS. DOTS PROGRAMME IN THE BAHAMAS. ALICE NEYMOUR Senior Nursing Officer, TB Prevention & Control Programme Stephanie Dean, Nursing Coordinator, Surveillance Unit Kateca Graham, Nursing Officer II, Training Unit February 2005. THE BAHAMA ISLANDS.

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D.O.T.S. PROGRAMME IN THE BAHAMAS

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  1. D.O.T.S. PROGRAMME IN THE BAHAMAS

  2. DOTS PROGRAMME IN THE BAHAMAS ALICE NEYMOUR Senior Nursing Officer, TB Prevention & Control Programme Stephanie Dean, Nursing Coordinator, Surveillance Unit Kateca Graham, Nursing Officer II, Training Unit February 2005

  3. THE BAHAMA ISLANDS • Archipelago of over 700 islands & cays, land mass of 5,382 sq. miles • Scattered over 80,000 sq. miles of Atlantic Ocean, from the tip of Florida to the edge of Caribbean • Population of over 300,000 concentrated mainly in two islands – New Providence and Grand Bahama • 29 populated islands • Other islands are called “Family Islands”

  4. DIRECTLY OBSERVED THERAPY SHORTCOURSE (DOTS) • Officially initiated by WHO (1995) • Patients taking medication under supervision. • Healthcare giver, community-based worker or relative gives patient his/her medication and watch him/her swallow

  5. The DOTS Programme Bahamas • Commenced November 1998 • 76 new cases of TB confirmed in 1998 • Over a three year period, there was over fifty percent reduction in new cases.

  6. Successes • Reduction in new cases • Improved Clinical presentation on DOTS • Better medication compliance • Personalized, individual patient schedule • Improved follow-up care • Improved management of clients

  7. Successes contd. • Enhanced team approach • Reduced financial impact on Public Health budget • Improved continuity of medication refills, monitoring and accounting of medications • More effective monitoring of drug toxicities

  8. Challenges To DOTS • No weekend coverage • Insufficient manpower • Transportation constraints • Language barrier (Creole) • Homeless/unstable housing • Stigma & fear of discrimination • Lack of male case workers

  9. Challenges contd. • Inconvenient appointments (client back to work/school) • Length of time for treatment • Heavy pill/liquid burden • Side effects/toxicities • Taste of medicine • Understanding of dosage requirements

  10. Opportunities • Ongoing patient and public education • Partnership with community stakeholders • Improved client/health caregiver relationship • Legal action if clients are not compliant

  11. Opportunities contd. • Available housing for mandatory lock-down when clients are non-compliant • Mandatory mantoux testing of all primary school children • Mantoux testing of clients before admission to institutions e.g. Old Folks home

  12. Threats • Risk of staff contracting TB • Physical risk to staff in isolated areas • Increased client dependence on health worker • “Black listing” of the country if TB cases increase (effect on tourism)

  13. THANK YOU

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