COMMUNITY HEALTH NURSING 1 SEM 01 | CYC 01

LECTURE AUF-CON

MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE

NCM 0104
DISEASES
● For example, an influenza epidemic, when a
OUTLINE large number of elderly people in a city get
I Definition of Terms the flu
II Tuberculosis ● Pandemic
A TB situation in the Philippines
i Recent Findings about TB ○ When an epidemic outbreak occurs worldwide
ii National Tuberculosis Program
· RA 10767
MODULE PROPER
· Comprehensive Philippine Plan of Action to
Eliminate Tuberculosis
B Discussion of the Disease
TUBERCULOSIS
i Systematic Screening
ii Diagnosis VULNERABLE POPULATIONS
iii Treatment
III Sexually-Transmitted Disease ● A person with TB can infect 5–15 people if left
A Prevention and Control Program
i Bacterial and Viral STDs untreated
IV COVID-19 ○ Without proper treatment, 45% of infected
V Lifestyle-Based Diseases people will die
○ Without proper treatment, 100% of PLHIV could
die from being infected by TB
DEFINITION OF TERMS
● Children
● Communicable Disease ● Persons in congregate living such as prisons,
○ A disease or illness in a susceptible host, shelters, long-term care facilities, and dormitories
caused by a potentially harmful infectious ● Immigrants from countries where TB is endemic
organism or its toxic byproducts ● People with HIV infection and compromised
○ Spreads due to contact between an infectious immune systems
agent and a susceptible host. ● Anyone with poor access to health care for
● Infectious Disease follow-up
○ A disease or illness caused by an infectious
agent entering the body of a susceptible host PRIMARY PREVENTIONS STRATEGIES
and then developing or growing
● Health promotion and education
● Host
● Education on behaviors to reduce risk of
○ A person or other living being that can be
transmission from infected persons
infected by an organism
● Education about environmental factors (sunlight,
● Infectious Agent
ventilation) that can reduce transmission
○ An organism that causes infectious disease
● Educating the public about the need to complete
● Can be bacteria, fungi, viruses, metazoa, or
the entire course of drug treatment
protozoa
● Agent
SECONDARY PREVENTIONS STRATEGIES
○ Something that must be present in the
environment for a disease to occur in a Screening high-risk populations
●
susceptible host. Early diagnosis and treatment
●
● Endemic Minimizing the disease’s ability to spread
●
○ When an infectious agent or disease has a throughout the community
constant presence within a defined geographic Preventing treatment failures from individuals with
●
area poor compliance with the lengthy, potentially
● Epidemic complicated therapy program
○ Occurrences of an infectious agent or disease
that clearly exceed the usual expected TERTIARY PREVENTIONS STRATEGIES
frequency of the disease in a particular
population ● Monitoring long-term health status

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 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES

● Direct observation of therapy to ensure compliance

with treatment

TREATMENT

● Multidrug regimen with direct observation therapy

to ensure compliance
● 📌 REMEMBER: Community health nurses have a key
role in tuberculosis prevention and treatment. They
can identify people at risk, initiate testing programs,
do follow-up for compliance and provide
education.

TB SITUATION IN THE PHILIPPINES

● The incidence of TB is considered very high

● An increase in the prevalence of
multidrug-resistant TB (MDR-TB) and Human
Immunodeficiency Virus (HIV) makes the disease
difficult to control
● The country ranks 4th in the burden of TB worldwide RECENT FINDINGS ABOUT TB
○ With an estimated 22,000 deaths in 2017 and
particularly drug-resistant (DR) has cost a SCIENTIFIC REPORTS
projected loss of 0.31 billion USD in the country’s Mycobacterium tuberculosis whole genome
Gross Domestic Product (GDP). sequencing provides insights into Manila strain and
drug-resistance mutations in the Philippines

Phelan, J.E. et al. (2019)

POINTS TO KNOW FROM THE STUDY

● The country has a high incidence of tuberculosis

disease
● The increasing prevalence of multidrug-resistant
Mycobacterium tuberculosis (MDR-TB) strains
makes it difficult to control
● M. tuberculosis “Manila” ancient lineage 1
strain-type
● Majority of the isolates (80.3%, 143/178) belonged to
the lineage 1 Manila clade
● Minority belonged to lineages 4
(European-American, 18.5%) and 2 (East Asian, 1.1%)
● A high proportion of the isolates (19.1%) were found
to be MDR

THE NATIONAL TUBERCULOSIS CONTROL

PROGRAM

WHAT IS TUBERCULOSIS?

● Highly infectious chronic disease but can be cured

caused by Mycobacterium tuberculosis (tubercle
bacilli)
● Highest number of cases in Southeast Asian
countries (43%); African countries (25%)

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 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES

● In 2020, the new cases of TB came largest from MISSION

South East Asia
● Ranks 4th in the leading cause of mortality and ● Ensure that TB DOTS services are available,
morbidity (2019) accessible, and affordable to the communities in
○ 5.6 million in men; 3.3 million among women; 1.1 collaboration with the LGU’s and other partners
million among children
○ Present in all age groups OBJECTIVES
● Difficult to diagnose in children
○ 1 in 3 people have access to treatment ● A. Improve access to and quality of services
○ Decreased incidence of 2% in 2015-2020 provided to TB patients, TB symptomatic, and
● TOP 6: Tuberculosis, all form (DOH, 2010) Mortality communities by health care institutions and
● TOP 8: TB Respiratory (DOH, 2010) Morbidity providers.
● EXTRAPULMONARY TUBERCULOSIS: TB infection that ● B. Enhance the health-seeking behavior on TB by
occurs outside the lungs affecting other organ communities, especially the TB symptomatic.
systems like bones, kidneys, and liver (e.g.: ● C. Increases and sustain support and financing for
Genitourinary TB, TB Meningitis, Bone TB [Pott’s TB control activities
Disease]) ● D. Strengthen management of TB control services
● COMMON S/SX: prolonged cough (for more than 2 at all levels.
weeks), hemoptysis (sputum with blood),
significant weight loss, chest/back pain, fever, RA 10767
cough, night sweats
● An Act Establishing a Comprehensive Philippine
● INFECTIOUS AGENTS: Mycobacterium tuberculosis
Plan of Action to Eliminate Tuberculosis as a Public
● MOT: Airborne droplet method (e.g.: coughing,
Health Problem and Appropriating Fund Therefor
sneezing, shouting, spitting)
● Falls under SDG 3 (Good Health and Well-Being)
○ Not transmitted through contact with clothes of
infected persons
POINTS TO KNOW ABOUT ITS LEGAL BASIS
○ Extrapulmonary TB cannot be transmitted from
person to person Comprehensive Philippine Plan of Action to
●
● RISK FACTORS Eliminate Tuberculosis
○ The Secretary of the Department of Health
People with weak Severe kidney disease; (DOH) shall establish a Comprehensive
immune systems ESRD Philippine Plan of Action to Eliminate
Low body Tuberculosis in consultation with appropriate
Babies and young
weight/Malnutrition (3x public and private entities
children; elderly >60
risk) ○ The Philippine Plan of Action shall consist of the
following:
People infected with HIV Certain medical
● (a) The country’s targets and strategies in
(18x risk) treatments (surgery; addressing the disease;
transplantation)
● (b) The prevention, diagnosis, treatment,
Diabetes Mellitus Tobacco use (1.6x risk) care and support, and other components of
Silicosis Alcohol use (3.3x risk) the country’s response;
Cancer of the head or Those ever treated for TB ● (c) The development and application of
neck, leukemia or (i.e. with history of previous appropriate technologies to diagnose and
Hodgkin’s Disease TB treatment) treat the disease;
● (d) The strengthening of linkages with local
Healthcare workers
and international organizations for possible
partnership in education, advocacy,
VISION research and funding assistance;
● (e) The establishment of a review and
● A country where TB is no longer a public health
monitoring system to gather data and
problem
monitor the progress made in the
elimination of tuberculosis; and
● (f) The immediate mobilization of anti-TB
services during and after natural and

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 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES
man-made disasters through collaborative
efforts of national and local governments
and other entities.
● Strengthening of the Regional Centers for Health
Development in the Provision of Health Services to
Eliminate TB
○ The Secretary of Health shall strengthen the
Regional Centers for Health Development in the
provision of health services to eliminate TB by
undertaking the following activities:
● (a) Provide free laboratory services through
the DOH retained hospitals;
● (b) Provide reliable supply of drugs to
patients for free by ensuring that local
health centers, through coordination with
local government units (LGUs) concerned,
have sufficient supply of medicines for the
communities they serve;
● (c) Undertake public information and
education programs to train the public on
basic ways and means to prevent the
spread of tuberculosis;
● (d) Train and enhance the capability of
health providers in both public and private
hospitals;
● (e) Ensure the proper monitoring of
tuberculosis cases in the country; and
● (f) Ensure that monitoring services are
extended as far as practicable, at the
lowest local level health unit.
● Education Programs
○ The Secretary of Health, in coordination with the
Commission on Higher Education (CHED), shall
encourage the faculty of schools of medicine,
nursing or medical technology, and allied
health institutions, to intensify information and
education programs, including the
development of curricula, to significantly
increase the opportunities for students and for
practicing providers to learn the principles and
practices of preventing, detecting, managing,
and controlling tuberculosis.
● Inclusion in Basic Education
○ The Secretary of Health, in coordination with the
Secretary of the Department of Education
(DepED), shall work for the inclusion of modules
on the principles and practices of preventing,
detecting, managing and controlling
tuberculosis in the health curriculum of every
public and private elementary and high school.
● Media Campaign
○ The Secretary of Health, in coordination with the
Philippine Information Agency (PIA), shall
encourage local media outlets to launch a
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media campaign on tuberculosis control,
treatment and management, using all forms of
multimedia and other electronic means of
communication.
○ The media campaign shall include materials
that would discourage the general public from
spitting in public places and exhibiting
unhygienic behavior that tend to undermine
the overall effort of preventing the spread of the
disease.
● Regulation on Sale and Use of TB Drugs
○ The Food and Drug Administration (FDA) shall
strengthen its implementation of the “No
prescription, No anti-TB drugs to regulate the
sale and use of anti-TB drugs in the market. It
shall also ensure the quality of TB drugs
distributed in the market.
● Notification on TB Cases
○ All public and private health centers, hospitals
and facilities shall observe the national protocol
on TB management and shall notify the DOH of
all TB cases as prescribed under the Manual of
Procedures of the National TB Program and the
Philippine Plan of Action on Tuberculosis
Control.
● PhilHealth TB Package
○ The Philippine Health Insurance Corporation,
otherwise known as PhilHealth, shall, as far as
practicable, expand its benefits package for TB
patients to include new, relapse and
return-after-default cases, and extension of
treatment.
○ PhilHealth shall enhance its present outpatient
Directly Observed Treatment Short Course
(DOTS) package to make it more responsive to
patients’ needs. It shall likewise increase the
number of accredited DOTS facilities to widen
the target beneficiaries who may avail of
reimbursements.
COMPREHENSIVE PHILIPPINE PLAN OF ACTION TO
ELIMINATE TUBERCULOSIS
I. VISION
● TB-free Philippines
II. MISSION
● To reduce TB burden (by reducing TB incidence and
TB mortality)
● To achieve catastrophic cost of TB-affected
households
● To responsively deliver TB service
 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES

III. GOALS ● Collaborate with other government agencies to

reduce out-of-pocket expenses and expand social
● LONG-TERM [2035] protection programs
○ Reduce TB burden by decreasing TB mortality ● Harmonize local and national efforts mobilize
by 95% and TB incidence by 90% adequate and competent human resources
● MEDIUM-TERM GOALS [2022] ● Innovate TB information generation and utilization
○ Reduce TB burden by: for decision making
● Decreasing the number of TB deaths by ● Enforce standards on TB care and prevention and
50%, from 22,000 to 11,000 use of quality products
● Decreasing TB incidence rate by 15% from ● Value clients and patients through integrated
554/100,000 to 470/100,000 patient-centered TB services
○ Reduce catastrophic costs incurred by ● Engage national, regional and local government
TB-affected households from 35% to 0% units/ agencies on multi-sectoral implementation
○ At least 90% of patients are satisfied with the of TB elimination plan
services of the DOTS facilities
DISCUSSION OF THE DISEASE
IV. PROGRAM COMPONENTS
DEFINITION OF TERMS
● Health Promotion
● Financing and Policy ● Active TB Disease
● Human Resource ○ A presumptive TB case that is either
● Information System bacteriologically confirmed or clinically
● Regulation diagnosed by the attending physician
● Service Delivery ● Pulmonary TB (PTB)
● Governance ○ A case of tuberculosis involving the lung
parenchyma
V. TARGET POPULATION ○ A patient with both pulmonary and
extrapulmonary tuberculosis should be
● Presumptive TB and TB-affected households classified as a case of pulmonary TB
● Extrapulmonary TB (EPTB)
VI. AREA OF COVERAGE ○ A case of tuberculosis involving organs other
than the lungs
● Nationwide
● e.g. larynx, pleura, lymph nodes, abdomen,
genito-urinary tract, skin, joints and bones,
VII. PARTNER INSTITUTIONS
meninges
● Department of Health: Food and Drug ● Bacteriologically-Confirmed TB (BCTB)
Administration, Bureau of Quarantine ○ A patient from whom a biological specimen,
● Other Government: DepEd, DSWD, DILG (BJMP), DOJ either sputum or non-sputum sample, is
(BuCor) positive for TB by smear microscopy, culture or
● Non-Government Organizations: PhilCAT, PBSP rapid diagnostic tests
● International Organizations: WHO, USAID, GFATM, ● Such as Xpert MTB/RIF, line probe assay for
ICRC, HIVOS-KNCV TB, TB LAMP
● Clinically-Diagnosed TB (CDTB)
VIII. POLICIES AND LAWS ○ A patient for which the criterion for
bacteriological confirmation is not fulfilled but
● RA 10767: Comprehensive TB Elimination Plan Act of diagnosis is made by the attending physicians
2016 on the basis of clinical findings, X-ray
abnormalities, suggestive histology and/or
IX. STRATEGIES, ACTION POINTS, AND TIMELINE other biochemistry or imaging tests
● New
● Activate communities and patient groups to ○ A patient who has never had treatment for TB or
promptly access quality TB services who has taken anti-TB drugs for less than one
month. Preventive treatment is not considered
as previous TB treatment

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 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES
● Previously treated for TB
○ A patient who had received one month or more
of anti-TB drugs in the past
○ Also referred to as Retreatment
● Rifampicin-resistant TB (RR-TB)
○ Resistance to rifampicin detected using
phenotypic or genotypic methods, with or
without resistance to other anti-TB drugs
○ Includes any resistance to rifampicin, whether
monoresistance, multidrug resistance, polydrug
resistance or extensive drug resistance.
● Turnaround Time (TAT)
○ The time from collection of the first sputum
sample to initiation of treatment for TB. The
desired turnaround time is five working days
(also referred to as Program TAT)
● Multidrug-Resistant Tuberculosis (MDR-TB)
○ Previously treated for TB, new TB cases that are
contacts of confirmed DR-TB (drug-resistant
TB) cases or non-converter among patients on
DS-TB (drug-sensitive TB) regiments
○ Can refer to resistance to rifampicin and/or
isoniazid
SYSTEMATIC SCREENING IN HEALTH FACILITIES
(Intensified Case FInding)
● Systematic screening in facilities shall be done for
all clients visiting the facility regardless of reason
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● Most potent drugs against tuberculosis
○ Treatable and curable by using second-line
drugs
● Bedaquiline: by the end of 2020, this was
used in an effort to improve the
effectiveness of MDR-TB treatment
○ CAUSES
● Inappropriate use of medications
● Incorrect prescription
● Poor quality drugs
● Prematurely stopping treatment
● TB and HIV
○ People living with HIV are 18x more likely to
develop active TB disease than people without
HIV
● People with TB should undergo HIV testing
and vice versa
○ HIV and TB form a lethal combination, each
speeding the other’s progress
○ In 2020, about 215,000 people died of
HIV-associated TB
for consultation. If the patient consults due to any of
the four cardinal signs/symptoms
○ (i.e. at least two weeks of cough, unexplained
fever, unexplained weight loss and night
sweats)
 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES
The following steps are involved in screening for
pulmonary TB (PTB) in adults ≥ 15 years old:
1.1 Record the patient’s demographic and contact
information in a register of consults.
1.2 Ask all patients consulting the health facility, if they
have the following cardinal signs and symptoms that
are lasting for ≥2 weeks:
a. cough
b. unexplained fever
c. unexplained weight loss
d. night sweats.
1.3 If any of the above signs/symptoms are present for
at least two weeks, identify as a presumptive TB.
1.4 For those who do not have any of the cardinal
signs/symptoms above or experienced it for less than
two weeks, offer chest X-ray screening if one has not
been conducted in the past year.
CHEST X-RAY POSTEROANTERIOR UPRIGHT VIEW
● A chest X-ray posteroanterior (PA) upright view
should be requested and previous chest X-rays
should be brought for comparison.
○ For pregnant women, written consent shall be
taken and an abdominal protective shield shall
be used by the X-ray facility
● The National TB Prevalence Survey in 2016 showed
that “screening for TB cases using symptoms alone
would have missed one-third to two-thirds of
bacteriologically-confirmed pulmonary TB cases.”
○ If resources are limited, you have the option to
prioritize those with TB risk factors as primary
clients for chest X-ray screening.
● Contacts of TB patients
● Those ever treated for TB (i.e. with a history
of previous TB treatment)
● People living with HIV (PLHIV)
● Elderly (> 60 years old)
● Diabetics
● Smokers
● Health-care workers
● Urban and rural poor (indigents)
● Those with other immune-suppressive
medical conditions (silicosis, solid organ
transplant, connective tissue or
autoimmune disorder, end-stage renal
disease, chronic corticosteroid use, alcohol
or substance abuse, chemotherapy or
other forms of medical treatment for
cancer)
● If a chest X-ray is not available and these high-risk
patients have signs and symptoms lasting less
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than two weeks, the physician may decide whether
to consider the patient a presumptive TB case
The following steps are involved in screening for
pulmonary TB (PTB) in children <15 years old:
2.1 Ask if the child has TB signs and symptoms. Identify
as presumptive TB if the child has at least one of the
three main signs and symptoms suggestive of TB:
a. coughing/wheezing of two weeks or more,
especially if unexplained (e.g. not responding to
antibiotic or bronchodilator treatment)
b. unexplained fever of two weeks or more after
common causes such as malaria or pneumonia have
been excluded
c. unexplained weight loss or failure to thrive not
responding to nutrition therapy
2.2 Ask if the child is a close contact of a known TB
case. If the child is a contact, the presence of fatigue,
reduced playfulness, decreased activity, not eating
well or anorexia that lasted for two weeks or more
should also be considered and identify them as a
presumptive TB.
2.3 If the child already has a chest X-ray, review the
results. If chest X-ray findings are suggestive of PTB,
identify as presumptive TB.
NOTE: Screening by chest X-ray is not routinely
recommended for children, except for TB household
contacts who are 5 years old and above.
2.4 For all PTB identified, ask about previous history of
treatment and exposure to TB case to determine risk
for DR-TB.
2.5 Record the patient. Presumptive TB Master List and
follow the diagnostic algorithm as outlined in the
diagnostic section below.
DIAGNOSIS OF TUBERCULOSIS
A. GENEXPERT
● New test that is revolutionizing tuberculosis (TB)
control by contributing to the rapid diagnosis of TB
disease and drug resistance
● In two hours, the test results will be released
● All processing is fully automated
● Recommended as the initial diagnostic test
○ Can quickly identify MTB
● GeneXpert MTB/RIF Ultra
○ Has been developed to overcome the
limitations of the old Xpert MTB/RIF G4 assay
with improved sensitivity in the detection of TB
and RIF resistance
● The result will come out after 18 minutes
○ Rapid assay that uses an improved assay
chemistry and cartridge design
 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES
XPERT MTB/RIF RESULTS AND INTERPRETATION
NOTATION INTERPRETATION
Mycobacterium tuberculosis detected;
rifampicin resistance** not detected
T available.
**indicator of MDR-TB as
isoniazid-resistance co-exists with it
MTB detected; rifampicin resistance
RR
detected
MTB detected, rifampicin resistance
TI
indeterminate
N MTB not detected
I Invalid/no result/error
B. DIRECT SPUTUM SMEAR MICROSCOPY (DSSM)
● Sputum smear microscopy allows a rapid and
reliable identification of patients with pulmonary
tuberculosis (PTB) where there are more than 5000
bacilli/mL of sputum.
● If the sputum has less than 5000 bacilli/mL, smear
microscopy is highly unlikely to diagnose PTB.
● COLLECTION OF SPUTUM
○ Prepare a sputum cup or 50 mL conical tube
and accomplish Form 2a (laboratory request
and result form)
○ Instruct patient to expectorate one sputum
sample on the spot for diagnostic testing with
Xpert (if not available, SM or TB LAMP).
● Collect 1ml for Xpert MTB/RIF and TB LAMP
and 3–5 ml for SM.
○ Collect specimen in a well-ventilated
designated sputum collection area, or outside
the health facility.
● Usually done in the morning
● If possible, ask the client to stay for an hour
for the collection of second sputum sample
○ Confirmatory
○ Instruct the patient on how to expectorate:
● Clean mouth by thoroughly rinsing with
water (do not brush teeth)
● Breathe deeply, hold breath for a second or
two, and then exhale slowly. Repeat the
entire sequence two more times;
● Cough strongly after inhaling deeply for the
third time and try to bring up sputum from
deep within the lungs; and
● Expectorate the sputum in the sputum cup
or conical tube.
○ Sputum induction for individuals unable to
expectorate should be done only in facilities
where the staff is trained, supplies and
equipment are available, and infection control
measures are in place.
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○ If the child cannot expectorate (especially <5
years old), nasopharyngeal aspirate or gastric
lavage may be performed in facilities where
trained staff, supplies and equipment are
○ Label the body of the sputum cup/conical tube,
indicating the patient's complete name and
indicating the specimen for Xpert (or SM/TB
LAMP).
○ Check the quality of the sputum.
○ For Xpert, testing should be performed on any
collected spot sputum sample (i.e. a
coughed-out sample) regardless whether it is
sputum or saliva.
○ For SM, examine the specimen to see that it is
not just saliva.
● Mucus from the nose and throat, and saliva
from the mouth are not good specimens.
● Repeat the process if necessary.
○ For SM, instruct to collect a second sample one
hour later or an early-morning sputum sample
the following day.
● Follow-up within three days if the patient
fails to submit a second specimen unless
the first specimen already tests positive for
acid-fast bacillus (AFB) in which case the
second specimen will not be necessary.
○ Seal the sputum cum or conical tube and
transport it to an Xpert site, TB microscopy
laboratory, or TB LAMP site together with the
completed form 2A.
○ If the laboratory is in another facility, use the
triple packaging system.
● Place the primary container and individual
plastic bags.
○ Place each in a durable, leak-proof, watertight,
and properly-sealed container (i.e. biological
bottles or plastic jars as secondary containers).
○ Enclosed in a sputum transport box (tertiary
container).
○ Transport at cold temperature by placing cold
packs inside the tertiary container.
○ Accomplish a dispatch list.
● Submit the specimen within 1 hour (window
time)
○ Specimens for SM can also be smeared
immediately by trained volunteers and then
stored appropriately before transport to the TB
microscopy laboratory.
○ For diagnosis of EPTB, facilities with the
necessary capability can collect body fluid
samples or tissue biopsy samples from the
suspicious site. Refer it necessary
 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES

INTERPRETATION FOR RESULTS FOR BOTH BRIGHTFIELD AND FLUORESCENCE MICROSCOPY

IUATLD/WHO FLUORESCENCE MICROSCOPY
BRIGHTFIELD MICROSCOPY
SCALE 200X MAGNIFICATION 400X MAGNIFICATION

No AFB seen in 300 oil

0 No AFB observed/1 length No AFB observed/1 length
immersion field (OIF)

Confirmation 1-4 AFB in one length (150

1-2 AFB/1 length +n 1-9
Required OIF)

+n n AFB seen in 1 length 5-49 AFB/1 length 3-24 AFB/1 length

1+ 10-99 AFB in 1 length 3-24 AFB/1 length 1-6 AFB/1 length

1-10 AFB/OIF, at least 50
2+ 25-250/1 field 7-60/1 field
fields
3+ >10 AFB/OIF, at least 20 OIF >250/1 field >60/1 field

TREATMENT OF TUBERCULOSIS
C. TB LAMP
PROCEDURES
● Manual assay that requires less than one hour to
perform and can be read with the naked eye under ● Initiation of treatment Inform the patient that they
ultraviolet light. have TB disease
● Following review of the latest evidence, WHO ● Provide key messages for TB patients and families:
recommends that TB-LAMP can be used as a ○ Basic information about TB disease covering:
replacement for microscopy for the diagnosis of cause, transmission, clinical signs and
pulmonary TB in adults with signs and symptoms of symptoms
TB ○ How TB is diagnosed
● It can also be considered as a follow-on test to ○ How to prevent TB
microscopy in adults with signs and symptoms of ● Duration of treatment: six months for DS-TB, 12
pulmonary TB, especially when further testing of months for severe drug susceptible EPTB, and 9–20
sputum smear-negative specimens is necessary months for DR-TB cases
● The schedule of regular clinical and laboratory
D. CHEST X-RAY follow-up for treatment monitoring
● Potential adverse events during treatment and how
● Posteroanterior upright view should be requested
to address them
● Previous chest x-rays should be brought for
● The relevance of contact investigation and TB
comparison
preventive treatment (TPT)
● Pregnant clients must provide written consent and
● Tracing mechanism in case of treatment
should be given abdominal protective shield shall
interruption (missed dose)
be used by the X-ray facility
● Availability of free-of-charge services for TB
diagnosis and treatment and TPT
TB CATEGORIES — CATEGORY 1
● Discuss with patients their social and financial
TYPE OF TB TESTS needs and offer possible sources of social support
to enable adherence to treatment (e.g. Department
Bacteriologically
(+) Gene Xpert of Social Welfare and Development, Social Security
Confirmed
System, Government Service Insurance System,
Clinically (-) Gene Xpert Employees Compensation Commission, local
Diagnosed (+) X-ray
government units (LGUs), etc.)

Extrapulmonary TB Extra pulmonary TB

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 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES

TREATMENT REGIMENS FOR ALL KINDS OF Regimen 1 Regimen 2 Regimen 3 Regimen 4

TUBERCULOSIS 2RIPES 4RI 2HRZE 4HR
HRZE: Isoniazid, Rifampicin, Pyrazinamide, and
Ethambutol
RIPES: Rifampicin, Isoniazid, Pyrazinamide,
Ethambutol, and Streptomycin

STANDARD REGIMENS

ACCORDING TO PATIENT / INTENSIVE AND REGIMEN

INTENSIVE MAINTENANCE
CATEGORY TYPES OF PATIENT
PHASE PHASE

● New pulmonary TB (larynx, lymph nodes, abdomen,

I genitourinary tract, and skin) 2RIPE 4RI
● New extrapulmonary TB except CNS, bones, and joints

IA ● New extrapulmonary, includes CNS, bones, and joints 2RIPE 4RI

● Pulmonary or Extrapulmonary (previously-treated

drug-susceptible TB)
○ Relapse
II ○ Treatment after failure 2RIPES OR 1RIPE 5RIE
○ Treatment after lost to follow-up
○ Previous treatment outcome unknown
○ Other
● Extrapulmonary (previously-treated drug-susceptible TB,
IIA 2RIPES OR 1RIPE 5RIE
includes CNS, bones, and joints)

STANDARD REGIMENS FOR DS-TB: DOSING FOR ADULTS

NO. OF TABLETS PER DAY
WEIGHT (KG) INTENSIVE PHASE, 2 RHZE (150/75.400/275 mg) AND
CONTINUATION PHASE, 4 RH (150/75 mg)
25–37 2
38–54 3
55–70 4
70 5
STANDARD REGIMENS FOR DS-TB: DOSING FOR CHILDREN USING FIXED-DOSE COMBINATION
NO. OF TABLETS PER DAY
WEIGHT BAND INTENSIVE PHASE, RHZ (75/50/150 mg) OR ETHAM (100 mg/tab) AND
CONTINUATION PHASE RH (75/50 mg)
4–7 kg 1
8–11 kg 2
12–15 kg 3
16–24 kg 4
25+ kg Adult dosing recommended

MATRIX FOR NUMBER OF TABLETS

MATRIX FOR NUMBER OF TABLES REQUIRED (ADULTS)

DSTB REGIMEN 1 DSTB REGIMEN 2
WEIGHT (KG)

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 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES

4 FIXED-DOSE
COMBINATION (No. of 2 FDC 4 FDC 2 FDC
tablets)
25–37 112 224 112 224
38–54 168 336 168 336
55–70 224 448 224 448
More than 70 280 560 280 560

MATRIX FOR NUMBER OF TABLES REQUIRED (CHILDREN)

WEIGHT DSTB REGIMEN 1 DSTB REGIMEN 2

(KG) HRZ ETHAM 100mg HR HRZ ETHAM 100mg HR
4–7 kg 56 56 112 56 56 280
8–11 kg 112 112 224 112 112 560
12–15 kg 168 168 336 168 168 840
16–24 kg 224 224 448 224 224 1120
Follow computations for standard regimens for DS-TB (dosing for children using fixed-dose
25+ kg
combination)

TREATMENT REGIMEN FOR DRUG-SENSITIVE TB

TREATMENT REGIMENS FOR DS-TB

REGIMEN ELIGIBLE TB PATIENTS
● PTB or EPTB (except CNS, bones, and joints) whether new or retreatment with final Xpert
result
○ MTB RIF sensitive
Regimen 1 ○ MTB RIF indeterminate
2HRZE/4HR ● New PTB or new EPTB (except CNS, bones, and joints) with positive SM/TB LAMP or clinically
diagnosed, and
○ Xpert not done
○ Xpert result is MTB not detected
● EPTB of CNS, bones, joints whether new or retreatment, with final Xpert result:
○ MTB RIF sensitive
Regimen 2 ○ MTB RIF indeterminate
2HRZE/10HR
● New EPTB of CNS, bones, joints, with positive SM/TB LAMP of clinically diagnosed, and:
○ Xpert not done*
○ Xpert result is MTB not detected

TYPE OR MDR-TB AND RR-TB TREATMENT REGIMENS

REGIMEN NAME TYPE OF DR-TB REGIMEN REMARKS

4–6 months:
Lfx–Bdq(6)-Cfz-Pto-E-Z-Hdh
Regimen 3:
NOTE: Bdq shall always be given
Standard Short All Oral MDR-TB and RR-TB
for 6 months
Regimen eligible to SSOR
(SSOR)
5 months:
Lfx-Cfz-Z-E

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 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES

Regimen 4: 6 months:
Standard Long All Oral MDR-TB and RR-TB Lfx-Bdq-Lzd-Cfz Request for off-label use at TB
Regimen for FQ eligible to SLOR (no FQ MAC if extending use of Bdq
Susceptible resistance) 12–14 months: beyond 6 months
(SLOR FQ-SI) Lfx-Lzd-Cfz
6 months:
Regimen 5:
MDR-TB and RR-TB Lzd-Bdq-Dlm-Cfz-Cs Request for off-label use of Bdq
Standard Long Oral
eligible to SLOR (with and Dlm combination at TB
Regimen for FQ
FQ resistance) 12–14 months: MAC
Resistance
Lzd-Cfz-Cs
Retreatment MDR-TB
Present the case at TB MAC and
Individualized and RR-TB cases (not Construct to have at least 4–5
follow their advice for the
treatment regimen eligible to SSOR nor likely effective drugs
regimen design
SLOR)
LEGEND
Z: Pyrazinamide | E: Ethambutol | Bdq: Bedaquiline | Dlm: Delamanid | Lfx: Levofloxacin | Cfz: Clofazamine
Lzd: Linezolid | Cs: Cycloserine | Pto: Prothionamide | HdH: High-dose Isoniazid

LOST TO FOLLOW-UP (LTFU)

TREATMENT OUTCOMES FOR DS-TB
CURED
A patient with bacteriologically confirmed TB at the
beginning of treatment and who was smear- or
culture-negative in the last month of treatment and
on at least one previous occasion in the continuation
phase.
TREATMENT COMPLETED
● A patient who completes treatment without
evidence of failure but with no sputum smear
negative results in the last month of treatment
and on at least one previous occasion, either
because tests were not done or because results
are unavailable.
● This group includes clinically diagnosed patients
who completed treatment.
TREATMENT FAILED
● A patient whose sputum smear or culture is
positive at five months or later during treatment.
● Treatment terminated because of evidence of
additional acquired resistance (e.g. RIF resistance
on Xpert at 2nd month)
● A patient for whom follow-up sputum
examination was not done (e.g. child or EPTB) and
who does not show clinical improvement anytime
during the treatment.
● Severe uncontrolled adverse drug reaction.
DIED
A patient who dies for any reason during the course
of treatment.
● A patient whose treatment was interrupted for at
least two consecutive months.
● A patient diagnosed with active TB but was not
started on treatment (i.e., initial LTFU).
NOT COMPLETED
● A patient for whom no treatment outcome is
assigned.
● This includes patients transferred to another
facility for continuation of treatment but the final
outcome was not determined.
DIRECT OBSERVED TREATMENT SHORT COURSE
(DOTS)
● Also known as Tutok Gamutan
○ Supervision of patients undergoing treatment
○ A concept where health care workers
(treatment partners) watch as each patient
takes the correct medication daily, especially
during the intensive phase, and conduct weekly
supervision during the maintenance phase.
TWO ANTI-TB DRUG FORMULATIONS
FIXED-DOSE COMBINATION
● 2 or more first line anti-TB drugs combined in one
tablet
○ Rifampicin 450 mg: red orange-colored
urine/semen
● Advice the patient that this is normal
● May also experience flu-like symptoms
(fever and muscle pains)
● Thrombocytopenia, anemia, and shock
○ Isoniazid (INH) 100 mg: burning sensation in the
feet d/t peripheral neuritis

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 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES
● Advice Vitamin B6 (50–100 mg) treatment;
10 mg daily for prevention
● Psychosis and convulsions
○ Ask client to discontinue the drugs and
refer back to physician
○ Pyrazinamide 500 mg: arthralgia d/t
hyperuricemia
● If symptoms persist, consult for uric acid
○ Ethambutol 400 mg: impairment of visual
acuity and color vision d/t optic neuritis
○ Streptomycin 1 gm: ototoxic
● Pain in injection site (deltoid area)
○ NI: apply hot/warm compress or
administer injection site on right/left
(liwasan)
● Severe skin rash
● Hearing impairment, ringing of the ear and
dizziness due to CN 8 damage
○ RIP: gastro-intestinal intolerance
● Nursing Responsibilities: Ask the client to
take the medicine at bed time, take light
meals
● Advantages
○ Reduces the number of pills patients must take
○ Minimizes errors in dosing
○ Simplifies distribution of pill to patients
○ Simplifies monitoring adherence
SINGLE DRUG FORMULATION
● Each drug prepared individually
● Myrin P-Forte (RIPE), Myrin P (RIE)
○ Quality of FDCs must be ensured.
○ PTB symptomatics asked to undergo other tests
only after 3 consecutive sputum specimens
yielding negative results.
○ No TB diagnosis shall be made on the X-ray
results alone. PPD skin test is not a basis for TB
diagnosis in adults.
○ Implementation of passive case finding.
○ Only trained medical technologists
microscopists (and trained Brgy. Health
Workers) shall perform DSSM
○ Patients recommended for Hospitalization
includes those with the following conditions:
● Massive hemoptysis
● Pleural effusion
● Miliary TB
● TB meningitis
● TB pneumonia
● Requiring surgical interventions or with
complications.
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○ Management of DS-TB in special situations:
● For pregnancy
○ Most anti-TB drugs are safe for
pregnant women except Streptomycin
(ototoxic for fetus)
● For lactating mothers
○ Advise them to breastfed baby before
taking TB drugs
● For contraceptive users
○ Rifampicin interacts with oral
contraceptive medications with a risk of
decreased protective efficacy against
pregnancy
SEXUALLY TRANSMITTED DISEASES (STDS)
● Although there are many types of communicable
diseases, a major focus of a community health
nurses’s prevention efforts are sexually transmitted
diseases (STDs), which are spread through sexual
contact
PREVENTION AND CONTROL PROGRAM ON
SEXUALLY TRANSMITTED INFECTIONS
● STIs include Gonorrhea, Syphilis, Chlamydia,
Trichomoniasis, Gardianella Vaginitis, Hepatitis B
and HIV/AIDS
○ Among these STIs, the following are treatable:
Chlamydia, Gonorrhea, Trichomoniasis and
Syphilis (with antibiotics)
BACTERIAL SEXUALLY-TRANSMITTED DISEASE
● Diseases/STDs in this category are caused by a
bacterial infectious agent
● Many bacterial sexually transmitted diseases are
treated with antibiotics, although strains of
drug-resistant bacterial STDs are becoming more
common
● Includes the following:
or ○ Gardianella Vaginitis
● Slightly graying/yellow odorous vaginal
discharge
○ Hepatitis B
● Most serious
● Massive liver damage and
hepatocarcinoma of the liver
GONORRHEA
(Neisseria gonorrhoeae)
● This STD is a frequently occurring infection that
affects over a million Americans each year
○ It often occurs in tandem with chlamydia
 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES

● SIGNS AND SYMPTOMS CHLAMYDIA

○ Burning urination and pus discharges (Chlamydia trachomatis)
○ Symptoms include discharge and pain on
urination for men ● Most frequently reported STD in the United States
○ Many women do not have symptoms, or ● SIGNS AND SYMPTOMS
infection presents only as mild discomfort ○ Often has no symptoms, and those with the
during urination infection may pass it on to others without
● VULNERABLE POPULATIONS knowing it
○ Sexually active people (gonorrhea can infect ○ Female Clients
the genitals, throat, or anus) ● Vaginal discharge
○ Newborns during birth ● Burning on urination
● Pregnant patients diagnosed with ● Pain during intercourse
gonorrhea undergo CS delivery to avoid ○ Male Clients
transmitting the bacteria to the neonate ● Itching
○ Children who are sexually abused ● Burning around the penis
○ Anyone who has sex with a carrier, a person ● VULNERABLE POPULATIONS
who harbors the infectious agent without ever ○ Sexually active people
showing symptoms of the disease ○ Newborns may also be infected during delivery
● TREATMENT ● TREATMENT
○ A course of antibiotics ○ Regimen of antibiotics
○ Some gonorrhea strains have developed ○ Treatment for gonorrhea is generally given at
resistance to antibiotics the same time, since infection with both
diseases often occurs
SYPHILIS
(Treponema pallidum)
PROTOZOAL SEXUALLY-TRANSMITTED DISEASE
● Can lead to serious debilitating disease if left TRICHOMONIASIS
untreated (Trichomonas vaginalis)
● SIGNS AND SYMPTOMS
○ Painless chancre (sore) at site of entry of germs ● Commonly called “trich,” this STD affects 2 to 3
○ Swollen gums million Americans each year
● THREE STAGES ● SIGNS AND SYMPTOMS
○ Primary ○ Female Clients
● Painless lesion at site of entry of bacterium ● White or greenish-yellow vaginal discharge
○ Secondary with a foul odor
● Infectious lesions and flu-like symptoms ● Burning
○ Tertiary ● Painful urination
● Mental deterioration and other ○ Male Clients
complications ● Clear discharge
● Neurosyphilis: affects the brain and spinal ● Mild irritation
cord ● Tingling sensation in the penis
● Cardiovascular Syphilis: affects the heart ● VULNERABLE POPULATIONS
and associated organs ○ Sexually active people especially females
● Late Benign Syphilis: skin (formation of ● TREATMENT
gummas) ○ Dose of metronidazole
● VULNERABLE POPULATIONS ○ Screening and treatment for other STDs is
○ Sexually-active people recommended on finding trichomoniasis
○ Newborns infected during birth
○ Women who may be asymptomatic VIRAL SEXUALLY-TRANSMITTED DISEASE
● DIAGNOSIS
● STDs in this category are caused by a viral
○ Rapid tests are available
TREATMENT infectious agent
●
● There is no cure for virally sexually transmitted
○ Penicillin
diseases, although in some cases the virus can be
controlled

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 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES
HUMAN PAPILLOMAVIRUS
● Most frequently reported STD in the United States
● Affects the anal and genital area
○ Flesh-colored or gray growths found in the
genital area and anal region in both men and
women
● Start as tiny, soft, moist, pink or red
swellings, which grow rapidly and may
develop stalks
● Rough surfaces give them the appearance
of small cauliflowers
● Often asymptomatic
● People who develop genital warts are at higher risk
of developing cancer of the cervix, anus, penis, and
vulva
● PREVENTION
○ DOH launched a school-based prevention
program (HPV vaccine)
● Given to girls aged 9–12
○ Mayro’n na kaagad target population,
making it beneficial
● Before, HPV vaccines are only given to
sexually-active individuals
● TREATMENT
○ Removing warts through chemical applications,
cryotherapy, laser, or electrosurgery
HERPES SIMPLEX VIRUS 2
● Most frequently reported STD in the United States
● Contagious, chronic infection that causes sores
○ FEMALES
● The principal sites of primary anogenital
herpes virus infection are the cervix and
vulva, with recurrent disease affecting the
vulva, perineal skin, legs, and buttocks
○ MALES
● Lesions appear on the penis, and in the
anus and rectum of those engaging in anal
sex
● VULNERABLE POPULATIONS
○ Sexually-active people
○ Newborns infected during birth
● SIGNS AND SYMPTOMS
○ Burning sensation in the genitals
○ Low back pain
○ Pain upon urination
○ Flu-like symptoms may accompany the initial
outbreak
● TREATMENT
○ Currently, there is no cure
○ Antiviral medications help reduce duration and
control S/Sx
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HIV/AIDS
(Retrovirus: Human T-cell Lymphotropic Virus 3)
● Human Immunodeficiency Virus (HIV)
○ Causes Acquired Immunodeficiency Syndrome
(AIDS)
○ Harms your immune system by destroying the
white blood cells that fight infection
○ This puts the patient at risk for serious infections
and certain cancers
● Acquired Immunodeficiency Syndrome (AIDS)
○ Final stage of infection with HIV
● Not everyone with HIV develops AIDS
● MODE OF TRANSMISSION
○ Unprotected sex with an infected person
○ Sharing drug needles
○ Contact with the blood of an infected person
○ Patients can give it to their babies during
pregnancy or childbirth
○ NOTE: HIV is not transmitted through air/water,
saliva, sweat, tears, closed-mouth kissing,
insects/pets, and sharing toilets, foods, or drinks
● SIGNS AND SYMPTOMS
○ The first signs of HIV infection may be swollen
glands and flu-like symptoms (fever, muscle
aches, and sore throat)
● These may come and go within two to four
weeks
○ Also includes night sweats, fatigue, chills, and
mouth ulcers
○ Severe symptoms may not appear until months
or years later
● VULNERABLE POPULATIONS
○ Anyone having unprotected sex or sharing
needles with infected persons
○ Babies born to HIV-positive mothers
● Hindi sila 100% infection
○ People exposed to blood products or tissues of
infected persons
● DIAGNOSIS
○ Enzyme Linked Immuno-Sorbent Assay (ELISA):
presumptive test
○ Western Blot: confirmatory test
○ Blood Test: can tell HIV infection
● The health care provider can do the test, or
by using a home testing kit
● May also be through free testing sites
● PREVENTIVE MEASURES
○ Primary
● Avoid sexual intercourse or maintain
mutually monogamous sexual relationship
with uninfected person
● Avoid sharing needles
 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES

○ Secondary HIV/STI PREVENTION PROGRAM

● Low-cost testing, especially for pregnant
women VISION
● Drug treatment facilities
● Zero New Infections, Zero Discrimination, Zero
● Protecting health care workers from
AIDS-related Deaths
exposure
○ Discrimination impacts patients; ayaw na
○ Tertiary
magpa-test and magpa-counsel
● Connecting clients with appropriate
○ HIV/AIDS has no cure, but it can be controlled
support agencies
○ Tuberculosis is mainly associated with
● Informing clients of new treatments that
AIDS-related deaths in the Philippines
improve outcomes
○ FIVE PREVENTION PILLARS
● Combination prevention for adolescent MISSION
girls, young women and their male partners
● To improve access and utilization of preventive
in high-prevalence locations
primary healthcare services for HIV and STI
● Combination prevention programmes for
○ Hospitals, clinics, and support groups
all key populations
● Strengthened national condom and related
OBJECTIVE
behavioral change programmes
● Voluntary medical male circumcision
● Reduce the transmission of HIV and STI among the
(VMMC)
Most At Risk Population and General Population and
● Offering pre-exposure prophylaxis (PrEP) to
mitigate its impact at the individual, family, and
population groups at substantive risk and
community level
experiencing high levels of HIV incidence
○ ABCDE OF HIV PREVENTION
PROGRAM ACTIVITIES
● Abstain from sex (Ayoko)
● Be faithful (Basta ikaw at ako lamang) ● With regards to the prevention and fight against
● Consistently use condoms (Condoms, stigma and discrimination, the following are the
gamitin nang tama) strategies and interventions:
● Do not share used needles (Dapat ○ Availability of free voluntary HIV Counseling
pang-ineksyon, laging bago) and Testing Service
● Educate yourself ○ 100% Condom Use Program (CUP) especially
for entertainment establishments
● TREATMENT
● Prevention is better than cure
○ There is no cure, but there are many medicines ○ Peer education and outreach
that fight/control HIV infection and lower the
● Support groups and counseling
risk of infecting others
○ Multi-sectoral coordination through Philippine
● Monitoring viral load National AIDS Council (PNAC)
● Minimizing risk for opportunistic viral ○ Empowerment of communities
infections
○ Community assemblies to reduce stigma
○ People who get early treatment can live with ○ Augmentation of resources of social hygiene
the disease for a long time and protect their clinics
partners
○ Procured male condoms to be distributed as
○ Treatment of AIDS includes protease inhibitors education materials during outreach
and reverse transcriptase inhibitors, designed
to keep the virus from reproducing and
STI-HIV/AIDS
destroying disease-fighting cells
OVERVIEW AND OBJECTIVES OF THE PROGRAM
RA 11166
● World Health Organization (WHO)
● Philippine HIV/AIDS Policy Act of 2018 ○ Nearly a million people currently acquire STIs
● Expanding access to evidence-based HIV which includes the Human Immunodeficiency
prevention strategies Virus (HIV) globally

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 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES
○ The presence in a person of other STIs greatly
increases the risk of acquiring or transmitting
HIV
○ It is initially seen among what we call key
populations which include Males who have Sex
with Males (MSM), Transgender (TG), People
Who Inject Drugs (PWID) and Freelance Sex
Workers (FSW)
● Philippines
○ One of the countries with rapidly increasing
HIV/AIDS cases
○ In Central Luzon, a total of 385 cases have been
diagnosed from 1984 to October 2017
○ Our prevalence rate is 2.06% which is above the
National Health Target of maintaining a 1% and
below prevalence rate
○ Seventy percent (70%) of the diagnosed cases
are from Baguio City affecting mostly Men
having Sex with Men (MSM)
○ Looking further, the city has an 8% HIV/ AIDS
prevalence rate from 1984 to present
○ For the other provinces and cities, the
prevalence rate is below 1% in 2017
NEW PROGRAM THRUSTS
● If healthcare workers are supported and protected,
they can deliver safe and effective HIV services,
especially to marginalized groups
○ Ending discrimination can eventually end AIDs
● VISION
○ Zero New Infections, Zero Discrimination, Zero
AIDS-related Deaths
● GOAL
○ By 2020, the country will have maintained a
prevalence of less than 66 HIV cases per
100,000 population by preventing the further
spread of HIV infection and providing treatment
care and support to reduce the impact of the
disease on individuals, families, sectors and
communities
● PURPOSE (OUTCOME)
○ To contain and prevent the further spread of
HIV among key populations with four (4)
strategies that enabled strengthened delivery
of essential services (prevention, treatment and
care interventions)
OBJECTIVES (NATIONAL TARGETS TO ACHIEVE FROM
2015–2020)
● Maintain a prevalence rate of less than 1% HIV
prevalence
● Reduction of HIV incidence among MSM to <50%.
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● Reduction to <1.5% of syphilis among the key
population
PROGRAM STRATEGIES
● Continuum of HIV/STI prevention, diagnosis,
treatment and care services to key populations
● Health promotion and Communication on HIV and
STI Prevention and Care Services
● Enhanced strategic information systems
● Strengthened health system platform for broader
health outcomes
ROLE OF THE DEPARTMENT OF HEALTH
● Policy dissemination
● Capacitate health facilities to promote the
continuum of HIV/STI prevention, diagnostic,
treatment and care services to key populations
● Provide information on HIV and STI services
promotion
● Logistics augmentation to health facilities providing
STI and HIV/AIDS services
● Enhance strategic information campaign
regionwide
● Conduct monitoring and evaluation activities to
identify gaps and propose tangible plans.
ROLE OF LOCAL GOVERNMENT UNITS
● Implement policies/issuances on STI HIV/AIDS
● Conduct mapping of affected key populations
● Support establishment of Local AIDS Council
● Ensure adequate supply of logistics needed in
providing quality STI and HIV services
● Strengthen advocacy strategies for STI and HIV
awareness across key populations
● Advocate for STI and HIV testing especially among
key populations
● Network with various agencies and NGOs for wider
coverage of STI services and advocacy
● Capacitate frontline health workers in providing STI
HIV/AIDS awareness, skills in counseling and testing
etc.
● Support HIV awareness and counseling activities by
strategically employing trained peer educators
FUTURE PLANS/STRATEGIES (2018–2022)
Continuum of HIV/STI prevention, diagnostic,
●
treatment and care services to key populations
○ Includes trainings such as HIV counseling and
testing, Reagents and Medicines
● Expand the platform for publicizing STI services
 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES
○ The health services in our trained facilities has
to be promoted to increase consultations,
enrollment to support and care services,
thereby decreasing the further spread of STIs
and HIV
● Enhance strategic information for the LGU to
continuously conduct the following:
○ Monitor and prevent the spread of STI cases in
their areas, and to conduct mapping of key
affected population
○ Organize, analyze and use their own data to
intensify and customize strategies
● Strengthen health system platform for broader
health outcomes
● Expansion of STI HIV/AIDS service delivery spots
through the following:
○ Creation of an STI-HIV/AIDS hotline
○ Support establishment and operations of
HIV/AIDS support groups
○ Support to provincial/city mobile testing
initiatives
○ Increase collaboration with LGUs and NGOs in
the conduct of community HIV screening
(community- or facility-based) with emphasis
on proper counseling and referral to prevent
loss to care
○ Promotion of the creation of sundown clinics
○ Establishment of Rapid HIV Diagnostic (rHIVda
sites) with prioritization per year as per
guideline of the DOH-Central Office
● Ensuring continuous supply of logistics to health
facilities providing STI and HIV services
○ A logistics supply management system or
mechanism will be placed in these facilities to
ensure good flow of supply and demand.
● Expand tri-media advocacy campaigns on STI
HIV/AIDS prevention and management (radio
shows, newsprint, social media, videos, awarding of
best practices)
COVID-19
(Novel Coronavirus)
● An infectious disease caused by a new strain of
coronavirus
○ This new virus and disease were unknown
before the outbreak began in Wuhan, China, in
December 2019
● TIMELINE
○ On 30 January 2020, the Philippine Department
of Health reported the first case of COVID-19 in
the country with a 38-year-old female Chinese
national
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○ On 7 March, the first local transmission of
COVID-19 was confirmed. WHO is working
closely with the Department of Health in
responding to the COVID-19 outbreak
○ As of 2022, the World Health Organization said
that “the end is in sight”
● DIAGNOSIS
○ Viral Tests
● Tells the patient if they have a current
infection
○ Antibody Tests
● Might indicate a past infection
● Might not show if you have a current
infection because it can take 1–3 weeks
after infection for your body to make
antibodies
● Having antibodies to the virus that causes
COVID-19 might provide protection from
getting infected with the virus again
○ If it does, we do not know how much
protection the antibodies might provide
or how long this protection might last
● SIGNS AND SYMPTOMS
○ On average it takes 5–6 days from when
someone is infected with the virus for
symptoms to show, however it can take up to 14
days
○ Most Common
● Fever, dry cough, and tiredness
○ Less Common
● Aches and pains
● Sore throat
● Diarrhea
● Conjunctivitis
● Headache
● Loss of taste and/or smell
● Rash on skin or discoloration of fingers and
toes
○ Serious Symptoms
● Difficulty breathing or shortness of breath
● Chest pain/pressure
● Loss of speech/movement
● TREATMENT
○ Vaccinations against COVID-19 are available
○ If you feel sick you should rest, drink plenty of
fluid, and eat nutritious food
○ Stay in a separate room from other family
members, and use a dedicated bathroom if
possible
○ Clean and disinfect frequently touched
surfaces
○ Everyone should keep a healthy lifestyle at
home
 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES
● Maintain a healthy diet, sleep, stay active,
and make social contact with loved ones
through the phone or internet
● Children need extra love and attention from
adults during difficult times
○ Keep to regular routines and schedules as
much as possible
○ It is normal to feel sad, stressed, or confused
during a crisis
● Talking to people you trust, such as friends
and family, can help
● If you feel overwhelmed, talk to a health
worker or counselor
● PREVENTIVE/PRECAUTIONARY MEASURES
○ Regularly and thoroughly clean your hands with
an alcohol-based hand rub or wash them with
soap and water
○ Maintain at least 1 meter (3 feet) distance
between yourself and others
○ Avoid going to crowded places
○ Avoid touching eyes, nose and mouth
○ Make sure you, and the people around you,
follow good respiratory hygiene
● This means covering your mouth and nose
with your bent elbow or tissue when you
cough or sneeze, then dispose of the used
tissue immediately and wash your hands
○ Stay home and self-isolate even with minor
symptoms such as cough, headache, mild
fever, until you recover
● Have someone bring you supplies. If you
need to leave your house, wear a mask to
avoid infecting others
○ If you have a fever, cough and difficulty
breathing, seek medical attention, but call by
telephone in advance if possible and follow the
directions of your local health authority
○ Keep up to date on the latest information from
trusted sources, such as WHO or your local and
national health authorities
○ Safe Use of Alcohol-based Hand Sanitizers
● To protect yourself and others against
COVID-19, clean your hands frequently and
thoroughly
○ Use alcohol-based hand sanitizer or
wash your hands with soap and water
● If you use an alcohol-based hand sanitizer,
make sure you use and store it carefully
● Keep alcohol-based hand sanitizers out of
children’s reach
○ Teach them how to apply the sanitizer
and monitor its use
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● Apply a coin-sized amount on your hands.
There is no need to use a large amount of
the product
● Avoid touching your eyes, mouth and nose
immediately after using an alcohol-based
hand sanitizer, as it can cause irritation
● Hand sanitizers recommended to protect
against COVID-19 are alcohol-based and
therefore can be flammable
○ Do not use it before handling fire or
cooking
● Under no circumstance, drink or let children
swallow an alcohol-based hand sanitizer
○ It can be poisonous
● Remember that washing your hands with
soap and water is also effective against
COVID-19
LIFESTYLE-RELATED DISEASES
● Non-communicable diseases (NCDs) include
cardiovascular conditions (hypertension, stroke),
diabetes mellitus, lung/chronic respiratory diseases
and a range of cancers which are the top causes of
deaths globally and locally
○ 15 million deaths between the age of 30–69
years old
○ 85% of premature deaths occur in low- to
middle-income countries
● 75% of total deaths in the PH are attributed
to NCDs
● These diseases are considered as lifestyle related
and are mostly the result of unhealthy habits
● Behavioral and modifiable risk factors like smoking,
alcohol abuse, consuming too much fat, salt and
sugar and physical inactivity have sparked an
epidemic of these NCDs which pose a public threat
and economic burden
VISION
● A Philippines free from the avoidable burden of
NCDs (non-communicable diseases)
MISSION
● Ensure sustainable health promoting environments
and accessible, cost-effective, comprehensive,
equitable and quality health care services for the
prevention and control of NCDs, and guided by the
principle of “Health in All, Health by All, Health for All”
whereas Health in All refers to Health in All Policies,
Health by All involves the whole-of-government
and the whole-of-society and the Health for All
 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES

captures the KP (Kalusugan Pangkalahatan) or the Integrated Management of Hypertension and

Universal Health Care (UHC) Diabetes for Primary Health Care Facilities
● AO No. 2013–0005
OBJECTIVE ○ The National Policy on the Unified Registry
Systems of the Department of Health (Chronic
● To raise the priority accorded to the prevention and Non-Communicable Diseases, Injury Related
control of non-communicable diseases in national, Cases, Persons with Disabilities, and Violence
regional and local health and development plans Against Women and Children Registry Systems)
● To strengthen leadership, governance, and ● AO 2015-0052
multisectoral actions for the prevention and ○ National Policy on Palliative & Hospice Care in
control of non-communicable diseases the Philippines
● To reduce modifiable risk factors for ● AO 2016-0001
non-communicable diseases and underlying social ○ Revised Policy on Cancer Prevention and
determinants through creation of health-promoting Control Program
environments ● AO 2016–0014
● To strengthen health systems and increase access ○ Implementing Guidelines on the Organization of
to quality medicines, products and services, Health Clubs for Patients with Hypertension and
especially at the primary health care level, towards Diabetes in Health Facilities
attainment of universal health coverage
● To promote and support research and DETERMINANTS AND RISK FACTORS
development for the prevention and control of
non-communicable diseases ● UNDERLYING DETERMINANTS
● To monitor the trends and determinants of ○ Poverty and poor living conditions
non-communicable diseases and evaluate ○ Social exclusion
progress in their prevention and control ○ Design of cities and towns
○ Availability and marketing of goods
PROGRAM COMPONENTS ● BEHAVIORAL RISK FACTORS
○ Unhealthy diet
● Cardiovascular Disease ○ Physical inactivity
○ HYPERTENSION ○ Tobacco use
● Normal BP: <120/80 mmHg ○ Harmful alcohol use
● Borderline BP: 120–139/80-89 mmHg ● INTERMEDIATE RISK FACTORS
● Hypertension: ≥140/90 mmHg ○ Overweight/obesity
● Properly-validated semi-automated ○ Raised blood sugar
oscillometric (home/office) or aneroid ○ High blood pressure
sphygmomanometer ○ Abnormal blood lipids
● Diabetes Mellitus ● The prevention of these risk factors is the
● Cancer responsibility of all ministries, while the clinical
● Chronic Respiratory Disease management/secondary prevention is the
● MAIN NCDs responsibility of the health ministry
○ Heart disease, diabetes, stroke, cancer, and
chronic respiratory disease BEHAVIORAL RISK FACTORS

UNHEALTHY DIET
POLICIES AND LAWS
● Sodium and salt consumption in the PH is high
● AO No. 2011-0003
○ Estimated to be twice as high as the WHO
○ The National Policy on Strengthening the
recommendation
Prevention and Control of Chronic Lifestyle
● Attributable NCDs include stomach cancer,
Related Non-Communicable Diseases
ischemic heart disease, stroke, and diseases d/t
● AO No. 2012-0029
hypertension
○ The Implementing Guidelines on the
○ Proportion of CV deaths attributable to high
Institutionalization of Philippine Package of
sodium is 28%
Essential NCD Interventions (PhilPEN) on the
● Interventions
○ Food-based dietary guidelines

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 MODULE 02 – DOH PROGRAMS FOR COMMUNICABLE AND NON-COMMUNICABLE DISEASES
○ Malnutrition labeling on pre-packaged food
products
○ Mass media campaign
○ Behavioral change
○ Communication and counseling
○ TRAIN Law: taxation on sugar-sweetened
beverages
● Recommendations
○ Choose sensible portions of foods lower in fat
○ Learn healthier ways to make favorite foods
○ Learn to recognize and control environmental
cues that make you want to eat
○ Have a healthy snack an hour before a social
gathering
○ Engage in moderate-intensity physical activity
for 30 minutes a day
○ Do not eat meals in front of the television
○ Keep records of your food intake and physical
activity
○ Pay attention to why you are eating
PHYSICAL INACTIVITY
● Less than 5x/week of 30 minutes of moderate
activity
● Less than 3x/week of 20 minutes of vigorous activity
● Almost half of adults in the PH are insufficiently
physically active
● Attributable NCDs include coronary heart disease,
type 2 diabetes, and breast/colon cancer
● Women are more frequently physically inactive
compared to men
● Metabolic Equivalents of Activity based on
Intensity
○ Light-Intensity Activity (<3.0 METs)
● Walking slowly, sitting using computer,
using light hand tools, standing, performing
light work, preparing meals, doing arts and
crafts
○ Moderate-Intensity Activity (3.0–6.0 METs)
● Walking briskly, cleaning, doing carpentry,
playing sports, dancing
○ Vigorous-Intensity Activity (>6.0 METs)
● Running, hiking, jogging, carrying heavy
loads, competitive sport
TOBACCO USE
● Major concern
● 40% of men smoke and 12% of school-based
adolescents (13–15 years old) are current smokers
● Attributable NCDs include cancer, ischemic heart
disease, stroke, COPD, pneumoconiosis, etc.
● Smoking prevalence is still greatest among people
with low income
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● Second-hand smoke remains to be an issue in the
Philippines
○ 22% of adults were exposed to tobacco smoke
in enclosed areas
● Policies and Laws
○ RA 10351: Syntax Reform Law
● Increasing tax imposed to tobacco
○ RA 10643: Graphic Health Warnings Law
○ EO 26: Providing for the Establishment of
Smoke-Free Environments in Public and
Enclosed Places
● Quick Reference Guide for Treating Tobacco Use
and Dependence
○ ASK: Systematically identify all tobacco users
at every visit
○ ADVISE: Strongly urge them to quit
○ ASSESS: Determine willingness to make a quit
attempt
○ ASSIST: Aide the client in quitting
○ ARRANGE FOLLOW-UP: Ask clients if they still
smoke. Compliment ex-smokers as soon after
the visit and just before original quit day
HARMFUL ALCOHOL USE
● On average, men drink six times as much as
women
● One in two male drinkers binged in the past month
● Attributable NCDs include cancer, pancreatitis,
epilepsy, diabetes, cirrhosis, road traffic injuries
● Policy Interventions
○ RA 10351: raising taxes on alcohol
○ Restricting availability of retail alcohol
○ Enforced restrictions on alcohol advertising
○ Enforced drunk driving laws
REFERENCES
Synchronous Lecture: 13 Sept 2022 (CI: Ma’am Hydee
Pangilinan)
Asynchronous Lecture: Module 02
Module: NCM 0104 LEC - Module 02