Tuberculosis (TB) is a widely spread disease globally that causes millions of people’s death worldwide. Treatment for TB is complex and usually involves taking several antibiotics at once for a long time (sometimes up to two years). Considering the severity of the treatment regimen, it becomes hard for the patients to adhere and complete proposed treatment and particularly for those who are infected with drug-resistant strain of TB. Poor adherence to treatment remains significant problem that prevents countries from obtaining high treatment success rates that is essential for health systems to control the epidemic and decrease spread of the disease. A new study from Georgia looks at adherence to treatment factors among drug resistant TB (DR-TB) patients and provides evidence that may help policy-makers develop effective strategies for improving treatment outcomes among DR-TB patients. The study findings might be helpful for other countries in the region where TB burden is also high.
Medication non-adherence is a growing concern, as it is increasingly associated with negative health outcomes and higher cost of care. Tackling the burden of non-adherence requires a collaborative, patient-centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch.
The issue of medical aliteracy has drawn both scholars and medical practitioners’ attention in the recent years. The negative cost of medical aliteracy has continued to constitute major threats to health related issue which has resulted in high mortality rate, high medical expenditure and medical underperformance among others. On this premise the study examined the influence of medical aliteracy among senior medical personnel. The study employed descriptive research design and Chi-Square to test the research hypotheses. A total number of 50 questionnaires were designed to collect information from the sampled population through a random sampling. From the result of the analysis it was revealed that factors such as ineffective supervision of medical personnel, low patient literacy level, lack of personnel-patients engagement could lead to medical aliteracy among senior medical personnel. Senior medical personnel have the knowledge of medical aliteracy and its implications on for medical personnel and the public. Medical aliteracy has an implication on health sector performance which includes increase in mortality rate, increase health expenditure, widening of the gap between patients – medical personnel communication among others. Perception of medical aliteracy has significant influence on medical personnel performance. The study concluded that, medical aliteracy is prevalent among medical personnel and patients and is associated with many poor medical outcomes in the health sector. It was however recommended that medical literacy training, schemes and programmes should be designed according to the needs of the different medical personnel and should therefore be included in medical professional training programs.
Diagnoses and visit length in complementary and mainstream medicinehome
CM physicians differed from mainstream GPs in diagnoses, partly related to general and partly to
specific diagnoses. Between CM practices differences were found on specific domains of complaints. Visit length
was much longer in CM practices compared to mainstream GP visits, and such ample time may be one of the
attractive features of CM for patients
Knowledge, Attitude and Practice of Self-Medication among Medical Studentsiosrjce
Self-medication is a common practice worldwide and the irrational use of the drugs is a major
cause of concern. Self-medication is an issue with serious global implication. The current study aimed to
determine the Knowledge, Attitude and Behavior of self-medication by medical students. A descriptive crosssectional
study was conducted among medical students currently studying first year to assess knowledge,
attitude and practice regarding self-medication in Chitwan Medical College, Bharatpur, Nepal. Seventy five
students studying in first year were selected for the study using stratified random sampling technique and data
was collected using a semi-structured self-administered questionnaire. The study finding revealed, the mean age
of 75 enrolled students was 20 years, 65.3% were in the age group of 17-20 years. Most of them were female
(72%). Seventy three point three percent belong to urban area. Prevalence rate of self-medication of one year
period seems high i.e. 84% and 68.25% in were females. The most common sources of information used by the
respondent were pharmacist (60.31%) and text book (46.03%). More than half of the respondent found to have
a good knowledge about self-medication regarding definition, adverse effect and different types of drug. The
attitude was positive towards self-medication and favored self-medication saying that it was acceptable. The
principal morbidities for seeking self-medication include cold and cough as reported by 85.7% followed by pain
76.2%, fever 73%, diarrhea 47.6% and dysmenorrheal 46%. Drugs / drugs group commonly used for selfmedication
included analgesics 75.8%, and anta-acids 53.2% and antipyretic 46.3%. Among reasons for
seeking self-medication, 79.2% felt that their illness was minor while 61.9% preferred as it is due to previous
experience. This study shows that self-medication is widely practiced among first year students of this medical
institution. There is dire need to make them aware about the pros and cons of self-medication in order to ensure
safe usage of drugs.
An analysis of wrong practices among pharmacies and pharmacists in India-• Disadvantages of Self Medications Adverse Drug Reactions.Lack of knowledge about dose.Chances of using wrong medication.Risk of disease aggravation Drug interactions.
Factors Affecting Non-Compliance among Psychiatric Patients in the Regional I...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Medication non-adherence is a growing concern, as it is increasingly associated with negative health outcomes and higher cost of care. Tackling the burden of non-adherence requires a collaborative, patient-centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch.
The issue of medical aliteracy has drawn both scholars and medical practitioners’ attention in the recent years. The negative cost of medical aliteracy has continued to constitute major threats to health related issue which has resulted in high mortality rate, high medical expenditure and medical underperformance among others. On this premise the study examined the influence of medical aliteracy among senior medical personnel. The study employed descriptive research design and Chi-Square to test the research hypotheses. A total number of 50 questionnaires were designed to collect information from the sampled population through a random sampling. From the result of the analysis it was revealed that factors such as ineffective supervision of medical personnel, low patient literacy level, lack of personnel-patients engagement could lead to medical aliteracy among senior medical personnel. Senior medical personnel have the knowledge of medical aliteracy and its implications on for medical personnel and the public. Medical aliteracy has an implication on health sector performance which includes increase in mortality rate, increase health expenditure, widening of the gap between patients – medical personnel communication among others. Perception of medical aliteracy has significant influence on medical personnel performance. The study concluded that, medical aliteracy is prevalent among medical personnel and patients and is associated with many poor medical outcomes in the health sector. It was however recommended that medical literacy training, schemes and programmes should be designed according to the needs of the different medical personnel and should therefore be included in medical professional training programs.
Diagnoses and visit length in complementary and mainstream medicinehome
CM physicians differed from mainstream GPs in diagnoses, partly related to general and partly to
specific diagnoses. Between CM practices differences were found on specific domains of complaints. Visit length
was much longer in CM practices compared to mainstream GP visits, and such ample time may be one of the
attractive features of CM for patients
Knowledge, Attitude and Practice of Self-Medication among Medical Studentsiosrjce
Self-medication is a common practice worldwide and the irrational use of the drugs is a major
cause of concern. Self-medication is an issue with serious global implication. The current study aimed to
determine the Knowledge, Attitude and Behavior of self-medication by medical students. A descriptive crosssectional
study was conducted among medical students currently studying first year to assess knowledge,
attitude and practice regarding self-medication in Chitwan Medical College, Bharatpur, Nepal. Seventy five
students studying in first year were selected for the study using stratified random sampling technique and data
was collected using a semi-structured self-administered questionnaire. The study finding revealed, the mean age
of 75 enrolled students was 20 years, 65.3% were in the age group of 17-20 years. Most of them were female
(72%). Seventy three point three percent belong to urban area. Prevalence rate of self-medication of one year
period seems high i.e. 84% and 68.25% in were females. The most common sources of information used by the
respondent were pharmacist (60.31%) and text book (46.03%). More than half of the respondent found to have
a good knowledge about self-medication regarding definition, adverse effect and different types of drug. The
attitude was positive towards self-medication and favored self-medication saying that it was acceptable. The
principal morbidities for seeking self-medication include cold and cough as reported by 85.7% followed by pain
76.2%, fever 73%, diarrhea 47.6% and dysmenorrheal 46%. Drugs / drugs group commonly used for selfmedication
included analgesics 75.8%, and anta-acids 53.2% and antipyretic 46.3%. Among reasons for
seeking self-medication, 79.2% felt that their illness was minor while 61.9% preferred as it is due to previous
experience. This study shows that self-medication is widely practiced among first year students of this medical
institution. There is dire need to make them aware about the pros and cons of self-medication in order to ensure
safe usage of drugs.
An analysis of wrong practices among pharmacies and pharmacists in India-• Disadvantages of Self Medications Adverse Drug Reactions.Lack of knowledge about dose.Chances of using wrong medication.Risk of disease aggravation Drug interactions.
Factors Affecting Non-Compliance among Psychiatric Patients in the Regional I...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Background:
Heart failure is a major public health problem, and self-management is the primary approach to control the progression of heart failure. The low research participation rate among rural patients hinders the generation of new evidence for improving self-management in rural heart failure patients.
Purpose:
The purpose of this study is to identify the barriers and strategies in the recruitment and retention of rural heart failure patients in behavioral intervention programs to promote self-management adherence.
Method:
This is a descriptive study using data generated from a randomized controlled trial.
Results:
Eleven common barriers were identified such as the inability to perceive the benefits of the study, the burden of managing multiple comorbidities, and the lack of transportation to appointments. Possible gateways to improve recruitment and retention include using recruiters from the local community and promoting provider engagement with research activities. Multiple challenges inhibited rural heart failure patients from participating in and completing the behavioral intervention study.
Conclusion and implications:
Anticipation of those barriers, and identifying strategies to remove those barriers, could contribute to an improvement in the rural patients’ participation and completion rates, leading to the generation of new evidence and better generalizability of the evidence.
Compliance, concordance and empowerment in patients with type two diabetes me...NiyotiKhilare
This presentation compares the traditional model that focuses on compliance of the patient, with the new model which focuses on empowering the patient. The presentation will also focus elaborately on empowerment as an intervention for improved medical adherence in diabetic patients.
Explore and analyse concordance as a concept and empowerment as a strategic intervention to improve patient outcomes in diabetes.
Impact of health education on tuberculosis drug adherenceSkillet Tony
Adherence is defined as the extent to which patients follow the instructions they are given for prescribed treatments. Until recently, adherence expertise was hard to find, assemble and empower. The study shall solely aim at investigating the influence of patients’ health education on Tuberculosis drug adherence. It will be guided by the following specific objectives; to identify the level of adherence among TB patients at MTRH, to assess the level of patient’s health education on TB drugs, to identify barriers of TB education, to investigate the challenges facing TB patients on treatment and to determine the level of training given to health workers on TB drug adherence. These objectives will enable the researcher to elaborate more on the topic and ensure that those who read through this research shall have a better perspective on the effects of health education on tuberculosis drug adherence. It will take place between the months of July and August. The study will target 17 doctors, 119 nurses and 143 patients of Tuberculosis. The study will employ a case study research design. The case study will enable the researcher be able to collected detailed information as to the influence of patients’ health education on TB drug adherence. The study will employ purposive sampling to sample the doctors and simple random sampling to select both the nurses and the patients who will participate in the study. The researcher will use one research instrument to collect data from the respondents selected to participate in the study which is a questionnaire that will be issued to the respondents on the day of the data collection.
Stop TB Partnership focus group session 10-20-17Bruce Thomas
The Arcady Group founder, Bruce Thomas, led the Stop TB Partnership's Focus Group Workshop On Digital Adherence Technologies. At this meeting, innovators such as Everwell Health (99DOTS), Wisepill Technologies (evriMED medication monitor), Keheala (SMS-based behavioral counseling) and SureAdhere Mobile Technology (V-DOT) were connected with representatives of key NGO implementers and country programs (including Zimbabwe, Philippines, Moldova, and South Africa) to discuss opportunities for experimentation and uptake of digital adherence technologies through TB REACH Wave 6 grants. Bruce and Ram Subbaraman shared new evidence and insights about the importance of treatment adherence to avoid TB relapse.
Medication non-adherence is a growing concern, as it is increasingly associated with negative health outcomes and higher cost of care. Tackling the burden of non-adherence requires a collaborative, patient-centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch.
Perspectives on Transitional Care for Vulnerable Older Patients A Qualitative...Austin Publishing Group
Transitional care for vulnerable older patients is optimal if, on top of the organization of transitional care, these patients and their informal caregivers have trust in the professionals involved. Regarding the challenge of organizing increasingly complex transitional care for vulnerable older patients, the focus should shift towards optimizing trust.
From Medical perspective, patients who don’t comply with doctors orders are usually seen as deviant and deviance needs correction
But many chronically view their behavior differently, as matter of self regulation
American Sociologist Peter Conrad
A good working atmosphere and healthy moral climate makes therapeutic efforts more easy in all Institutions
Background:
Heart failure is a major public health problem, and self-management is the primary approach to control the progression of heart failure. The low research participation rate among rural patients hinders the generation of new evidence for improving self-management in rural heart failure patients.
Purpose:
The purpose of this study is to identify the barriers and strategies in the recruitment and retention of rural heart failure patients in behavioral intervention programs to promote self-management adherence.
Method:
This is a descriptive study using data generated from a randomized controlled trial.
Results:
Eleven common barriers were identified such as the inability to perceive the benefits of the study, the burden of managing multiple comorbidities, and the lack of transportation to appointments. Possible gateways to improve recruitment and retention include using recruiters from the local community and promoting provider engagement with research activities. Multiple challenges inhibited rural heart failure patients from participating in and completing the behavioral intervention study.
Conclusion and implications:
Anticipation of those barriers, and identifying strategies to remove those barriers, could contribute to an improvement in the rural patients’ participation and completion rates, leading to the generation of new evidence and better generalizability of the evidence.
Compliance, concordance and empowerment in patients with type two diabetes me...NiyotiKhilare
This presentation compares the traditional model that focuses on compliance of the patient, with the new model which focuses on empowering the patient. The presentation will also focus elaborately on empowerment as an intervention for improved medical adherence in diabetic patients.
Explore and analyse concordance as a concept and empowerment as a strategic intervention to improve patient outcomes in diabetes.
Impact of health education on tuberculosis drug adherenceSkillet Tony
Adherence is defined as the extent to which patients follow the instructions they are given for prescribed treatments. Until recently, adherence expertise was hard to find, assemble and empower. The study shall solely aim at investigating the influence of patients’ health education on Tuberculosis drug adherence. It will be guided by the following specific objectives; to identify the level of adherence among TB patients at MTRH, to assess the level of patient’s health education on TB drugs, to identify barriers of TB education, to investigate the challenges facing TB patients on treatment and to determine the level of training given to health workers on TB drug adherence. These objectives will enable the researcher to elaborate more on the topic and ensure that those who read through this research shall have a better perspective on the effects of health education on tuberculosis drug adherence. It will take place between the months of July and August. The study will target 17 doctors, 119 nurses and 143 patients of Tuberculosis. The study will employ a case study research design. The case study will enable the researcher be able to collected detailed information as to the influence of patients’ health education on TB drug adherence. The study will employ purposive sampling to sample the doctors and simple random sampling to select both the nurses and the patients who will participate in the study. The researcher will use one research instrument to collect data from the respondents selected to participate in the study which is a questionnaire that will be issued to the respondents on the day of the data collection.
Stop TB Partnership focus group session 10-20-17Bruce Thomas
The Arcady Group founder, Bruce Thomas, led the Stop TB Partnership's Focus Group Workshop On Digital Adherence Technologies. At this meeting, innovators such as Everwell Health (99DOTS), Wisepill Technologies (evriMED medication monitor), Keheala (SMS-based behavioral counseling) and SureAdhere Mobile Technology (V-DOT) were connected with representatives of key NGO implementers and country programs (including Zimbabwe, Philippines, Moldova, and South Africa) to discuss opportunities for experimentation and uptake of digital adherence technologies through TB REACH Wave 6 grants. Bruce and Ram Subbaraman shared new evidence and insights about the importance of treatment adherence to avoid TB relapse.
Medication non-adherence is a growing concern, as it is increasingly associated with negative health outcomes and higher cost of care. Tackling the burden of non-adherence requires a collaborative, patient-centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch.
Perspectives on Transitional Care for Vulnerable Older Patients A Qualitative...Austin Publishing Group
Transitional care for vulnerable older patients is optimal if, on top of the organization of transitional care, these patients and their informal caregivers have trust in the professionals involved. Regarding the challenge of organizing increasingly complex transitional care for vulnerable older patients, the focus should shift towards optimizing trust.
From Medical perspective, patients who don’t comply with doctors orders are usually seen as deviant and deviance needs correction
But many chronically view their behavior differently, as matter of self regulation
American Sociologist Peter Conrad
A good working atmosphere and healthy moral climate makes therapeutic efforts more easy in all Institutions
Levels of Utilization and Socio - Economic Factors Influencing Adherence to U...inventionjournals
The paper intends to assess the level of utilization and socio-economic factors influencing adherence to utilization of Anti Retroviral Therapy (ART) for People Living with HIV/AIDS in Dodoma Municipality and Kongwa District in Tanzania. Documentary review, interview and Focus Group Discussion were used in collecting data. A total of 140 respondents (99 PLWHIV/AIDS and 41 key informants) from four hospitals, two health centers and one dispensary were selected and interviewed as representatives for the purpose of this study. Quantitative data were collected and analyzed by using SPSS version 16 software. The study revealed 100% of PLWHIV/AIDS used ART drugs in Dodoma General Hospital, Kongwa Hospital, Mkoka Health Center and Makole Health Center while 40% in St. Gemma Hospital. Also the study indicated there were high dropout from utilization of ART drugs among PLWHIV/AIDS, 60% in Mirembe hospital, (50%) in Mkoka health center and (44%) in St. Gemma hospital as compared to the rest health centers and hospitals. The drop out caused by ART drugs side effects such as vomiting (25.1%), frequently sickness (19.9%) and decrease in CD 4 (11.2%). Lastly the study revealed four main socio-economic factors influencing adherence to utilization of ART services among PLHIV/AIDS including lack of employment support (66.7 %,) lack of confidentiality (50 %,) patient’s preference to traditional medicines (30%) and cultural belief (29.3%). The study recommends all PLWHIV/AIDS with side effects should report their cases to health centers and hospitals because not all side effects require a change of drugs or discontinuation, PLWHIV/AIDS should be assisted by Government and Non-Government Organizations and family members to secure soft loans that will enable them to establish income generation activities, education on patients confidentiality should be provided to services providers in hospitals and health centers
Factors associated adherence to TB treatment in Georgia report (eng)Ina Charkviani
Tuberculosis (TB) is a widely spread disease globally that causes millions of people’s death worldwide. Treatment for TB is complex and usually involves taking several antibiotics at once for a long time (sometimes up to two years). Considering the severity of the treatment regimen, it becomes hard for the patients to adhere and complete proposed treatment and particularly for those who are infected with drug-resistant strain of TB.
1 Evaluating the Evidence for Directly Obse.docxaryan532920
1
Evaluating the Evidence for Directly Observed Therapy in the Treatment of Tuberculosis
Walden Student
Walden University
NURS 6052, Section 2, Essentials of Evidence-Based Practice
Dr. Trudy Tappan
May 7, 2016
2
Evaluating the Evidence for Directly Observed Therapy in the Treatment of Tuberculosis
Tuberculosis continues to be an issue of concern in the United States and around the
world. In 2014, there were 9.6 million people diagnosed with tuberculosis and 1.5 deaths
worldwide (Centers for Disease Control and Prevention [CDC], n.d.a). In the United States,
there were 9,421 new cases of tuberculosis that same year (CDC, n.d.a). This paper will explore
the case management of tuberculosis in the United States, focusing on the value of directly
observed therapy for tuberculosis clients. The purpose of this paper is to explore the evidence
around the use of directly observed therapy in tuberculosis clients. This will be accomplished by
formulating a researchable question, exploring the existing research, and formulating a plan to
distribute the evidence to local public health nurses.
Part I - Identifying a Researchable Problem
Tuberculosis Treatment and Directly Observed Therapy
For clients who have been diagnosed with active tuberculosis disease, appropriate
treatment is crucial. With proper medication, the majority of tuberculosis cases can be
successfully treated (World Health Organization [WHO], 2016). Without treatment, tuberculosis
is fatal in approximately two-thirds of all cases (WHO, 2016). Recommended treatment for
tuberculosis involves treatment with antibiotics for 6 to 9 months (Centers for Disease Control
and Prevention [CDC], n.d.b). When clients with tuberculosis do not take the medication as
prescribed either by skipping doses or by ending treatment earlier than recommended, drug-
resistant tuberculosis can develop (CDC, n.d.b).
To increase successful tuberculosis treatment and decrease the development of drug-
resistant tuberculosis, the Centers for Disease Control and Prevention (n.d.c) recommends case
management of all tuberculosis cases. One component of case management that the CDC
Comment [T1]: APA
Numbers:
Please make sure you are using numbers correctly. Review
pages 111-115 in APA to make sure you are apply the proper
rules governing the use of numbers in scholarly writing.
3
recommends is directly observed therapy (DOT). DOT involves an individual, often a healthcare
worker, observing the client as the client takes his or her medications (CDC, n.d.c). Including
DOT with all tuberculosis clients is standard care in many local health departments in the United
States (CDC, n.d.c). At the local health department at which I’m where I am employed, DOT is
most often performed in the client’s home.
The cost of performing DOT for tuberculosis clients includes staff salary and travel
expenses. There are also cost ...
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv...CrimsonpublishersCJMI
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv-1 DNA Quantification by Tuofu Zhu in Cohesive Journal of Microbiology & Infectious Disease
Running head: TUBERCULOSIS 1
TUBERCULOSIS 2
Tuberculosis
NRS-427VN | Epidemiology and Communicable Disease
8/26/18
Tuberculosis
About 33% in our existence's people is considered to have been tainted with tuberculosis (TB), new attacks are symbolized in no under 1% of the people every year". In 2016, a standard 1.5 million fatalities associated with TB have took place, the lion's talk about which are from younger looking countries over the world. As this quantity has been reducing, unnecessarily various have been sullied. The best center is situated in the Asian and African countries, at 80%. Within the USA, 5-10% of the individuals studies constructive. With tuberculosis taking after second behind HIV/Helps in most common deaths from powerful ailment, they have transformed into an over-all exchange. Understanding the annals, seeing the signals and appearances, evolved treatment alternatives, and neutralizing activity, will spread this disease to an even of control.
Since the start, tuberculosis has been accessible. Most quick unambiguous affirmation of the malady has been dated around 17,000 years before, in stays of a bison in Wyoming. Effective treatment of tuberculosis has finished up being bothersome and long. Chemical manifestations of the mycobacterium cell dividers and bizarre form, restricts most against microbial alternatives. Most typically used is Isoniazid and Rifampicin. Advised estimations of treatment, for new starting point, are half a year of blend hostile to infections operators. 8 weeks of rifampicin, isoniazid, pyrazinamide, and ethambutol drugs. Together with the latest four a few months of just rifampicin and isoniazid"(Wikipedia, 2015, p. 12).For the individuals who have idle TB receive only a sole against microbial.
This estimation ruins the inert TB to wrap up aspect. As this move out estimations of hostile to infections specialists can be difficult, direct observed treatment is preferred by WHO (World Health Corporation, 2015). Facts have exhibited that folks, who are depended after to adopt their medicine, will miss organized estimations. Immediate discernment treatment contains having an interpersonal protection employee watch the individual taking their remedies. As this is dreary, using diverse contraptions of acknowledgment is necessary. Such overhauls can sign up for booked calls or digital notices. By not doing medication regimens, put others at peril to finding this sickness.
Those in close closeness to specific with tuberculosis are in an especially high danger to finding the opportunity to be debased. Besides, with HIV/Supports hold the most hoisted risk element of all. Early on area and treatment, with fitted hindrances of these polluted is an integral.
Friendly determinants ...
Evaluations of and Interventions for Non Adherence to Oral Medications as a P...NiyotiKhilare
The focus of this presentation will be medical non-adherence as a psychosocial issue in diabetes. The presentation will also focus elaborately on empowerment as an intervention amongst other interventions.
People in the world’s most populated continent are living longer, but not necessarily healthier, lives with overburdened, provider-led healthcare systems. As life expectancy across Asia-Pacific continues to rise, the region now carries a huge global burden of non-communicable diseases such as cancer and mental illnesses. As a result, governments in the Asia-Pacific region will need to consider policies and initiatives that prioritise improvements in care for people with a wide range of chronic conditions—but they must maintain vigilance against infectious diseases such as tuberculosis, HIV/AIDS and hepatitis.
These are among the findings of a new study by The Economist Intelligence Unit (EIU): The shifting landscape of healthcare in Asia-Pacific: A look at Australia, China, India, Japan and South Korea, sponsored by Janssen. Through in-depth desk research and interviews with healthcare experts, the study examines the disease-burden challenges facing healthcare systems in these countries.
For more information, please visit: http://www.economistinsights.com/healthcare/analysis/shifting-landscape-healthcare-asia-pacific
Similar to Factors associated to adherence to DR-TB treatment in Georgia, Policy Brief (Eng) (20)
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
2. 1
EXECUTIVE SUMMARY
Tuberculosis (TB) is a widely spread disease globally that causes millions of people’s death
worldwide. Treatment for TB is complex and usually involves taking several antibiotics at once
for a long time (sometimes up to two years). Considering the severity of the treatment regimen,
it becomes hard for the patients to adhere and complete proposed treatment and particularly for
those who are infected with drug-resistant strain of TB. Poor adherence to treatment remains
significant problem that prevents countries from obtaining high treatment success rates that is
essential for health systems to control the epidemic and decrease spread of the disease. A new
study from Georgia looks at adherence to treatment factors among drug resistant TB (DR-TB)
patients and provides evidence that may help policy-makers develop effective strategies for
improving treatment outcomes among DR-TB patients. The study findings might be helpful for
other countries in the region where TB burden is also high.
PROBLEM STATEMENT
• Tuberculosis remains a global health challenge for the public health throughout the world.
According to the World Health Organization (WHO) statistics, in 2015, 10.4 million people fell
ill with TB of which 1.8 million died from the disease. TB has been a leading cause of death
among infectious diseases
1
.
• In Georgia, the incidence rate of all forms of TB reached 74.7 per 100,000 population in 2015.
Even though Georgia has seen a decreasing trend of TB incidence for the past several years,
Drug Resistant TB (DR-TB) prevalence rate is still high. In 2015, 11.6% of the new cases of
pulmonary TB and 38.8% of previously treated cases accounted to be drug resistant
2
.
• The rate of treatment interruption (patients who stopped taking treatment) among DR-TB
patients is high, which creates a risk of drug resistant TB spread.
1
Global Tuberculosis Report 2016, WHO
2
Statistical Yearbook “Health Care in Georgia” 2015, NCDC
2
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EPIDEMIOLOGICAL REVIEW
The number of TB cases has been decreased in Georgia for the past decade.
Figure 1: TB cases per 100,000 population, 2005-2015 yy.
Source: Statistical Yearbook “Health Care in Georgia” 2015, NCDC
Georgia no longer belongs to the group of the countries with a high burden of DR-TB since
2016, however, DR-TB prevalence rate is still high among new and previously treated TB cases.
Figure 2: DR-TB prevalence in Georgia, 2005-2015 yy.
All Cases New Cases
New Cases Previously treated cases
Source: Statistical Yearbook “Health Care in Georgia” 2015, NCDC
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As for the treatment outcomes, it should be noted that treatment success rate among DR-TB
patients is not satisfactory enough in the country.
Figure 4: Treatment Success rate (%) among DR-TB patients, 2015
Source: Global Tuberculosis Report, 2016, WHO
DR-TB prevalence is higher in Georgia, compared to the countries in Central and Eastern Europe.
Figure 3: DR-TB prevalence among new and previously treated cases (%), 2015
Source: Global Tuberculosis Report, 2016, WHO
Statistical Yearbook “Health Care in Georgia” 2015, NCDC
New cases Previously treated cases
6. 1
The trend for the past several years shows that every third of DR-TB patients stopped treatment.
Figure 5: M/XDR-TB treatment outcome (%) 2011-2013yy cohorts
Source: National Center for Tuberculosis and Lung Diseases, 2015
ABOUT THE STUDY
In 2016 Curatio International Foundation conducted a qualitative study to investigate factors that
enhance or hinder treatment adherence among DR-TB patients.
The study was conducted in Tbilisi, Adjara and Samegrelo-Zemo Svaneti regions using in-depth
interviews with a randomly selected sample of TB patients and focus group discussions (FGD)
with health care providers. The target audience for the study was comprised with the following
types of patients and health personnel:
• DR-TB patients, lost to follow-up from treatment
• DR-TB patients who were currently receiving treatment but had difficulties to adhere to the
treatment regimen, so-called “recalcitrant patients”
• DR-TB patients, who finished treatment successfully
• Phtisiatrists, DOT
1
-nurses, primary health care nurses providing DOT services in rural areas,
epi demiologists.
Set of in-depth interviews were provided also with the key informants. Data generated from the
interviews and FGDs were analysed using a conceptual framework that outlines a range of structural,
personal, social and health system factors affecting adherence to TB treatment
2
.
The document summarizes main findings of the study and proposes recommendations for further
improvement of the system.
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Treatment success Lost to follow-up Died Treatment failed Not evaluated
1
DOT - Directly Observed Therapy
2
Munro, S. A. et al (2007). Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative
Re search. PLoS Medicine, 4(7), e238. http://doi.org/10.1371/journal.pmed.0040238
7. 1
Study conceptual framework
STUDY FINDINGS
The study revealed different types of factors affecting treatment adherence among DR-TB
patients in Georgia. The findings are grouped into structural, social, personal and health system
factors according to the study conceptual framework.
Structural Factors
Some social and economic factors prevent patients from completing the treatment. Despite the
fact that the treatment is free, some patients cannot find time for it because of their work. If a
patient has to choose between employment and treatment, preference is given to employment.
“...I stopped the treatment because I am the only man in the family. I have two
sisters who are single and I cannot leave my family members hungry. I had to
work but it is very difficult to combine work and treatment at the same period...”
A lost to follow-up patient
There exist some conflict between the Labor Code and TB treatment regimen. Working hours of
employed patients and difficulty in obtaining sick leave for treatment do not allow them to
comply with the treatment regimen. In addition to this, some patients do not disclose their
disease to the employers because of stigma or fear to lose their jobs. Therefore, it is difficult
for such patients to combine the work and treatment regimens and they are forced to abandon
treatment.
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8. 1
On the other hand, communication with colleagues helps patients to overcome treatment
related adverse events. As successfully treated TB patients reported they paid less attention to the
unpleasant feelings caused by the TB drugs during work, which helped them to cope with such
factors.
Due to financial problems low economic status patients face difficulties in terms of performing
additional tests and purchasing medications required for side effects management.
The monetary incentive system works well among the patients, especially for those who are
under economic constraints.
“…Of course side effects mean additional expenses because you have to buy
additional medications. Although this voucher creates additional motivation
because some people have no money at all and this helps…”
A patient who has successfully completed TB treatment
Besides the monetary voucher drug resistant tuberculosis patients also receive a voucher that
covers their transport costs. The amount covered by the transport voucher equals the public
transportation cost to visit a DOT center. The voucher was also found to be positively
influencing adherence to treatment.
Social factors
Support from family and society is crucial during the treatment as patients report. Conversations
with family members and friends help patients not to feel alone, not to loose hope, be less
irritated and do not miss visits at DOT centers.
“...Support from family members is very important. You feel that you are not
alone. Sometimes I was too lazy to go to the DOT center but my wife insisted and
forced me…”
A patient who successfully completed the treatment
Lack of attention from family and friends negatively affects adherence to treatment. When a
family member is actively involved in the treatment process and supervises the patient’s visits,
the patient has more responsibility towards himself and his family and tries to fulfil visits.
Patients who have family support are usually those who successfully accomplish treatment.
Decisions made by the majority of patients are greatly influenced by peer experiences. The
majority of patients reported that their decision to continue receiving medicines was a result of
negative consequences of abandoning treatment, which they had seen among other patients.
Successful treatment stories and peers experience on different coping strategies with side
effects had positive influence on treatment adherence.
“… For example, I was looking for patients who had finished treatment wonder-
ing how they felt and how much time had passed since their treatment…”
A patient who successfully completed the treatment
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Peers’ influence turned out to be negative when patients shared information on how to avoid
receiving some medicines and different methods of deceiving health personnel.
Although stigma has never been named as the main reason for treatment interruption among
respondents, some patients reported that they concealed information about their illness and
tried to avoid communication with other people.
Personal factors
Service providers inform patients about the disease, special characteristics of the treatment
regimen and possible occurrence of side effects on a regular basis. Almost all patients
confirmed that they received detailed information about TB from health personnel. Although,
information deficit was revealed with lost to follow-up and recalcitrant patients: one fourth of
these patients reported that they missed visits to the DOT center or stopped treatment because
TB symptoms disappeared or they felt much better. There were also some cases when patients
interrupted the treatment and then resumed it after deterioration of the heath condition.
“...I stopped the treatment a year ago and have not visited the TB hospital to
receive medicine ever since. Physically I was feeling well so I decided that
medicine was no longer needed...”
A lost to follow-up patient
Patients who had successfully finished TB treatment reported that one of the main motivators
for them to complete treatment was their family. These patients had correct understanding of
risks associated with untreated Tuberculosis, so they tried to complete the treatment in order to
protect their family members and friends.
Health system factors
Free treatment and TB program management
The opportunity of receiving treatment free of charge was viewed as a huge benefit provided to
the patients by the National TB Program. Many people emphasized that they received
expensive treatment free of charge within this program.
Besides free health services and pharmaceuticals, all respondents reported that they received
medicines continuously at DOT centers without interruptions. Specialists and service providers
working in this area indicate that TB program is well managed throughout the country. They
positively assess existence of properly running laboratory system, uninterrupted supply of
pharmaceuticals and good program monitoring system.
Service providers expressed dissatisfaction with their limited involvement in the decision making
process. As for the patients’ involvement in the decision making process, it must be noted that
patients did not even expect they should participate in the process.
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Personnel’s Financial Motivation
Service providers complain about low salaries which is below the average salary level in
Georgia. According to the service providers, their only stimulus is professional motivation. In the
frame of National TB Program, a doctor’s minimum monthly remuneration equals to 360 GEL
and 280 GEL for DOT-nurses. A doctor’s salary is considerably lower than a primary healthcare
nurse’s salary. This definitely reduces doctors’ motivation.
“…Salaries are rather low. It is rather bad that primary healthcare nurses have
a salary of GEL 450, while doctors receive only GEL 360. This is a demotivating
factor for us…”
Phthisiatrists’ FGD
The same problem was identified in case of epidemiologists. They talked about an overloaded
work volume and complained about inadequate financing of their efforts.
The research also demonstrated that service providers do not have full financial support
necessary for the performance of their obligations within the program. Doctors and nurses have
to cover communication expenses with patients out of their own pockets, which is not a small
share of their monthly salary. At the same time, frequent communication positively influences
the patients’ adherence to treatment behavior.
“…When a patient does not come to take a medicine, we have to find out where
he is and why he has not come. We spend our salary to top up the mobile phone
account because we have to communicate with patients over the phone all the
time … “
Doctors and nurses FGD
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Health Personnel
The majority of patients reported the positive role of the health personnel during treatment
period. Great attention from doctors and nurses and support at TB treatment facilities were
emphasized by the patients when describing interaction with health personnel. Attentive and
compassionate health personnel significantly influence the patients’ behavior and stimulates
them to complete treatment.
“…Physicians and nurses were positively disposed towards patients. They were
equally attentive to everyone and they motivated us to take drugs. They often
talked to us and supported us in everything. Nurses play a rather big role in the
treatment process; they provide moral support and additional consultations…”
A patient who has successfully completed TB treatment
FGDs with specialists revealed lack of young specialists working in this field. As a result, the
level of accepting and introducing innovations is low. Low salaries and health risks accompanied
with TB service delivery decrease the interest of young health personnel to work in this field.
11. Epidemiologists are responsible to work with lost to follow-up patients in the frame of the
National TB Program. The research demonstrated that this part of the program does not work
effectively. In order to reach lost to follow-up patients, epidemiologists mostly use phone call
communication because transportation costs are not reimbursed for them.
“... It would be good if I could make repeated calls to convince them; if there
were incentives; if we were given money for transportation, for example GEL 10.
In this case we would manage to return lost to follow-up patients in treatment...”
Epidemiologists FGD
Besides low remunerations, the Program currently does not have any incentive mechanisms
(financial or other) for service providers to stimulate their work.
“…There is not even a small gift for us for a cured patient. World TB Day in the
past, where Phtisiatrists from Georgia used to meet each other, exchange
information during the dinner in the evening. This was some kind of expression
of gratitude, there is nothing like that nowadays…”
Regional Phtisiatrists’ FGD
Geographic Distribution and Infrastructural Conditions of TB treatment Facilities
Integration of the services into the primary healthcare system increased geographic access to
services for rural population. But in Tbilisi, both patients and specialists reported about existence
of a geographic barrier to access services. Transportation of patients to DOT centers is a problem
because there are only four DOT centers in Tbilisi, that are not evenly distributed in the city.
“... Even though we reimburse them for their travel expenses under the Global
Fund project, spending 3-4 hours every day to reach the TB treatment
facility and return back is a problem for patients; moreover, only MDR
patients get compensation... “
A field specialist
The patients living in regions face geographic barrier of access to services in terms of
management of side effects. They often have to go to Tbilisi to receive these services. In
addition to this, existing infrastructural problems and poor sanitary conditions at inpatient
hospitals in regions result in geographic access barrier for patients as they seek to get inpatient
service in Tbilisi, where conditions are satisfactory.
Noteworthy that DOT centers also have infrastructural problems. E.g.: regional facilities do not
have enough space for provision of high quality ambulatory services. Despite the fact that the
condition of integrated facilities was improved, they often do not meet international standards for
service delivery, such as constant natural or artificial ventilation and ultraviolet lights in doctor’s
rooms.
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12. 1
Due to the inadequate space or poor sanitary conditions of ambulatory facilities, patients do not
have an opportunity to talk to each other and share experiences that would help them to
overcome difficulties. As it has already been mentioned above, sharing of personal experiences
has a positive impact on the treatment process.
“…Conditions should be improved to encourage a patient to enter the TB
facilities. I used to go home right after taking the medicine. I did not want to stay
there and talk to other patients … “
A lost to follow-up patient
The challenges of DOT
Patients point out difficulties associated with DOT regimen. Pill burden is emphasized as one of
the main challenges of concomitant treatment by the patients. They find it difficult to take a high
number of pills at the health care facility for a long time on a daily basis.
Although DR-TB patients under treatment receive transportation voucher to visit treatment
facilities, patients involved in a new scheme of treatment also complain about visiting TB
treatment facilities 2 times a day. Under the new scheme of treatment patients receive TB drug
infusions, which should take place in hospital settings.
“… It is not difficult to take medicines in the morning but when I come here in
the evening then I feel sick. I have to come here twice a day and I drive here. My
father and my friends accompany me sometimes …”
A recalcitrant patient
The impact of Side-effects and system-level gaps in side effects management
Occurrence of side effects, frequency and their management play an important role on treatment
adherence. Almost all patients involved in the study reported having treatment related physical
and/or mental side effects. A big proportion of lost to follow-up patients attributed non-adherence
to experiencing side effects.
“…Initially, after taking drugs I used to recover more easily. Doctors gave me
everything included in the program – against vomiting, liver-protectors - but
eventually I felt very bad and nothing helped me to recover …”
A lost to follow-up patient
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13. 1
According to experts’ explanations, effective management of side effects caused by TB drugs
requires specific knowledge of different systems by health personnel. Several drugs are
financed by the National TB Program for side-effects management for DR-TB patients, but
besides this there are some investigations and specialists’ consultations patients with
side-effects seek to attend. Patients living in Tbilisi have better access to such services due to
their proximity to the National Center for Tuberculosis and Lung Diseases (NCTLD), where such
services are available. The Center has different specialists such as cardiologist, neurologist,
psychiatrist, gastroenterologist, endocrinologist, etc. who are involved in the management of
side effects. Moreover, patients living in Tbilisi are better informed and use the universal health
coverage program services rather than patients living in rural places. In regions, patients either
visit such kind of specialists directly or get services in Tbilisi, that are associated with additional
expenses.
Most of patients reported having problems like anxiety, insomnia, depression etc., the
management of which requires involvement of a psychologist/psychiatrist. Service providers
and field exerts also emphasize the need of psychological support strengthening countrywide.
Such services similarly to other specialists services are provided in Tbilisi National Center
however are not readily available for majority of patients who need such care.
“...Patients need psychological support. Sometimes he is so exhausted that does
not want to take a medicine any more…”
A spouse of a recalcitrant patient
“… Some of patients become rather reserved and find it harder to deal with this
psychologically, such people need to be supported by a psychologist …”
A patient who has successfully completed the treatment
Risks Associated with TB Service provision
In 2011 the vertical management of TB services underwent changes. As part of the reform
integrated model of TB Services was introduced meaning that private primary care providers in
regions were imposed to carry out TB services. As field specialists report, regulations does not
guarantee that private providers would maintain service uninterrupted provision as the
obligations are valid until 2018.The situation is exacerbated by lack of motivation of service
providers at the institutional and personal levels to maintain TB services. In particular, it has
become evident that managers/owners of health facilities are not interested in implementing
unprofitable TB services and service providers have low motivation to improve performance
since there are no mechanisms that link performance to the payment.
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RECOMMENDATIONS
The study made it clear that the structural, social, individual factors as well as health
system factors are closely interlinked and mutually influence each other. Therefore, a
successful strategy to deal with the factors negatively affecting adherence to TB
treatment must be based on multi-sectoral approach to tackle with existing difficulties.
The recommendations given below are based on the study outcomes.
• Legal/regulatory changes:
• The Labor Code provision on temporary disability term must be
reviewed taking into account the needs for TB treatment
• Regulations need to be developed/refined in order to ensure continuity
of services rendered by private service providers
• Involvement of peer educators in the treatment process is important
to enable sharing of their personal experience with other patients using
different strategies (peer-to-peer groups, social media etc.)
• Improvement of the communication messages through emphasizing
treatment adherence barriers
• Ensuring increased participation of patients and service providers in
the decision making processes
• Ensuring increased motivation of service providers by introducing
results-based financing mechanisms:
• Providing incentives for health personnel
• Providing institutional incentives for health facilities
• Increasing the efficiency of tracing lost to follow-up patients
through operational costs reimbursement and epidemiologists financial motivation
15. 1
• Opening additional DOT centers in Tbilisi and integration in the primary
healthcare services in order to improve geographic access
• Timely introduction of global innovations in the country with the aim to
simplify DOT regimen
• Improvement of access to side effect management:
• Use of Telemedicine to reduce geographical and financial barriers,
save patients’ time and improve quality of services
• Integrate mental health services into the primary healthcare
• Reimburse expenses on medications for socially vulnerable patients
• Motivating young professionals to enter the TB field by reducing financial
barriers on postgraduate studies.
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