Posted: March 30th, 2022
Strategies to encourage TB patients to follow their treatment plan.
Poor medical adherence causes problems with TB control. Strategies have been developed to increase compliance, thus increasing the cure rates.
Patients with active TB should be allocated a case manager as soon as possible (within a week of diagnosis). A case manager is to collect the patient’s contact details, follow up patient care, involve other medical practitioners to assist in management by encouraging TB patients to follow the treatment plan. They may employ reminder letters, telephone calls, counselling during face-to-face patient-centred interviews, home visits, and advice and support the patient’s support system.
They can also aid in a random collection of sputum samples, urine tests for monitoring,
The TB case manager should also work with the patient(TB )to develop a health and social care plan to complete patient therapy successfully. Teach the patient about TB how it is spread, pathophysiology ad how its managed, involve the members in the treatment decisions from the start, this leads to full cooperation from the patient, teach the importance of following the treatment plan, gain the patients informed consent to draft up the care plan and agree on follow updates, ensure patients health needs are met before moving to the next,
Offer directly observed therapy for people who have poor medical adherence, have a prior history of TB, have an account of substance/alcohol dependence, have a mental disorder, have a multidrug résistance, or too ill to self administer. Reevaluate the need for direct observational therapy whenever the patient’s circumstance changes.
Alternative to the solid oral dosage forms.
Alternatives improve patient compliance and minimise the side effects of consuming a large number of tablets (up to 8 at one time) which can cause toxicity, other carrier-based drug delivery systems such as liposomes and microspheres have been developed .they use their biodegradable polymers such as DL-lactide co glycolide)(PLG)which release a drug in a controlled manner or require removal after use.
INH and RIF have been trapped in PLG polymers then injected subcutaneously as a single dose; they release drugs in an extended period of 6-7 weeks. However, have the disadvantage of causing pain and discomfort associated with the route.
Oral administration of nanoparticles composed of rifampicin, Isoniazid, and pyrazinamide can reduce dosing frequency for better TB management.
In pulmonary TB, delivery of the drug directly to the site of infection through inhalation of an aerosolised delivery system. It has the advantage of bypassing the first-pass metabolism and maintaining local therapeutic effects with minimal therapeutic effects.
The implant of INH (Isoniazid) poly lactic co glycolic acid (PLGA) advantage ensures levels sustained levels of INH for a period of up to 8 weeks. Disadvantage: immobilisation at the implantation site.
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