REPUBLIC OF Zambia

Management of Tuberculosis
Training for Health Facility Staff
 
 
NATIONAL TB PROGRAM, ZAMBIA
 
 
MODULE A
 
 Learning objectives
 
At the end of the training, participants will be
able to:
• know and understand what HIV tuberculosis
is
• understand TB HIV as a public health problem
• Know and understand the Stop TB Strategy
 What is tuberculosis?

• Tuberculosis (TB) is a disease caused by an

organism called Mycobacterium tuberculosis
(M. tuberculosis).
• These organisms are also known as tubercle
bacilli. Usually they affect the lungs, in which
case the disease is called pulmonary TB (PTB).
Pulmonary TB is the most common type of TB
worldwide. This is the most common type of
opportunistic infection in PLHIV
 Symptoms of pulmonary TB

• Cough of 2 weeks or more

• Hemoptysis (coughing up blood)
• Chest pain
• General symptoms such as weight loss, sweating
(at night), and tiredness
• Fever
 How TB is spread

• When a person with pulmonary TB coughs or

sneezes, tubercle bacilli are spread into the air in
tiny droplets.
• Other people can breathe in these droplets and
become infected.
• If TB affects organs other than the lungs (such as
the lymph nodes, bones and joints, genitourinary
tract, meninges, pleura, or intestines), it is called
extra pulmonary TB (EPTB).
• Patients with extra pulmonary TB are usually not
infectious.
 TB and HIV as a public health problem

•The World Health Organization (WHO) declared TB a

global emergency in recognition of the growing
importance of TB as a public health problem. About
one-third of the world’s population is infected with M.
tuberculosis.
•Worldwide in 2007 there were about 9.27 million new
cases of TB disease with 1.32 million deaths.
•Tuberculosis kills more people than any other single
infectious disease agent. Deaths from TB account for
25% of all avoidable deaths in developing countries.
 Cont’d
• Some 95% of TB cases and 98% of TB deaths occur
in developing countries. Of cases in developing
countries, 75% are in the economically productive
age group (15–50 years old).

• In 2007, Zambia notified 50,415 all forms of TB

cases, of which 22,956 were smear positive.
During the same period the country attained a
77% cure rate, 85% treatment success and 7%
mortality rate.
 Cont’d
• Once infected with M. tuberculosis, a person stays
infected for life and may develop symptoms of TB
disease at any time. However, among infected
persons who are HIV negative, only 1 in 10 (10%)
will develop TB disease in their lifetime; most
(90%) will remain healthy. The most important
trigger for TB disease is weakening of the immune
system.
 
 Cont’d
• Patients with weakened immune systems, such as
those with HIV infection, are at greater risk of
developing TB.
• In the year, 2005 one-third of HIV-infected people
worldwide (about 13 million people) were also
infected with M. tuberculosis.
 Cont’d
• Of people infected with both HIV and M.
tuberculosis, 50% will become sick with TB during
their lifetime; 10% will become sick per year.
• Thus, the prevalence of HIV in a community has
an important effect on the incidence of TB.
• Without treatment, the majority of TB patients
will die. In this course, the terms “TB patients”
and “TB cases” refer to patients in whom TB
disease has been diagnosed.
 THE STOP TB STRATEGY

• The Stop TB Strategy is the recommended strategy

to control TB.
• It builds on the Directly Observed Treatment Short
- Course (DOTS) strategy and expands its scope to
address remaining constraints and challenges to
TB control.
The Stop TB Strategy has six components:-

1. Pursuing quality DOTS expansion and enhancement

through 5 components of DOTS strategy
This component involves the following:
• Political Commitment with increased and sustained
financing . Under this, the following are taken into
consideration; Legislation, planning, human resources,
management, training
• Case detection through quality-assured bacteriology.
Under this, the following are taken into consideration;
Strengthening TB laboratories, drug resistance surveillance
 Cont’d
• Standardized treatment with
supervision and patient support. Under
this, the following are taken into
consideration; TB treatment and
program management guidelines,
international standards of TB care (ISTC),
PPM, PRACTICAL Approach to Lung
Health (PAL), community-patient
involvement
 Cont’d
• An effective drug supply and
management system. Under this the
following are taken into consideration;
Availability of TB drugs, TB drug
management, global Drug Facility (GDF),
Green Light Committee
 Monitoring and evaluation system and impact measurement.

Under this, the following are taken into

consideration;
• TB recording and reporting systems, Global TB
Control Report, data and country profiles, TB
planning and budgeting tool, WHO epidemiology
and surveillance on line training
 Cont’d

2. Addressing TB/HIV, MDR-TB and other special

challenges
3. Contributing to Health Systems strengthening
4. Engaging all care providers
5. Engaging people with TB and affected
communities
6. Enabling and promoting research
IMPORTANT COMPONENTS OF DOTS

A health care provider/ service provider must

watch a patient take each dose (Direct observation
is important) in order:
• To ensure that patients take the correct treatment
regularly and record;
• To notice rapidly when a patient misses a dose,
find out why, and solve the problem; and
• To monitor any problems that the patient may
have with the disease, treatment, or other
symptoms.
 Take home points:
• Tuberculosis (TB) is a disease caused by an
organism called Mycobacterium tuberculosis (M.
tuberculosis).
• When a person with pulmonary TB coughs or
sneezes, tubercle bacilli are spread into the air in
tiny droplets.
• Patients with extra pulmonary TB are usually not
infectious.
• Patients with weakened immune systems, such as
those with HIV infection, are at greater risk of
developing TB.