Tuberculosis case finding and case holding practices in selected Drug Abuse Treatment and Rehabilitation Centers (DATRCS) in Luzon, Philippines

@#<p style="text-align: justify;"><strong>Background and Objectives:</strong> Tuberculosis (TB) remains a public health problem in the Philippines despite trends indicating a decline in the burden of disease. Persons who use drugs who are confined in government-retained drug abuse treatment and rehabilitation centers (DATRCs) face an increased risk for TB because of the congestion in the facility coupled with the absence of guidelines on TB management specific to DATRCs. Thus, this study was conducted to document the current case finding and case holding practices as well as TB treatment pathway in six (6) Luzon-based, government-retained DATRCs.</p><p style="text-align: justify;"><strong>Methods:</strong> Key informant interviews were conducted with DATRC personnel involved in TB diagnosis and management in six selected DATRCs in Luzon, Philippines. Interviews were transcribed and coded for thematic analysis. We compared the DATRC practices with the provisions of the 2014 National TB Control Program (NTP) Manual of Procedures. Results were validated through a workshop with (a) a group of physicians and rehabilitation practitioners assigned in other DATRCs; and (b) a group of experts who have experience in managing or overseeing DATRCs in the country.</p><p style="text-align: justify;"><strong>Results:</strong> Two physicians and four nurses participated in the interviews. Variations in case finding and case holding practices in six DATRCs have been found. National guidelines exist for congregate settings but are more specific to jails/prisons, which are administratively and operationally different from DATRCs.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Development of special guidelines for TB case finding and case holding in DATRCs as well as staff training on the latest NTP Manual of Procedures are recommended. However, gaps and inequities posed by the current set-up underscore the need to address health system-wide factors affecting the practice and performance of these facilities.</p><p style="text-align: justify;"><strong>Key Words:</strong> tuberculosis, case finding, case holding, drug abuse treatment and rehabilitation centers, Philippines</p>

The design and outputs of the pilot implementation of the “Enhancing skills in screening and assessment for physicians and rehabilitation practitioners level 2 course”, Philippines, 2014

@#<p style="text-align: justify;"><strong>Background and Objectives:</strong> The Philippine Department of Health (DOH) is mandated by law to, among others, develop capacities and accredit physicians and rehabilitation practitioners across the country on the assessment and management of drug dependence. This paper describes the design and presents the outputs of an advanced course on screening and assessment of drug dependence developed by DOH in partnership with the College of Public Health of the University of the Philippines Manila, Philippine College of Addiction Medicine, and the Group for Addiction Psychiatry of the Philippines.</p><p style="text-align: justify;"><strong>Methodology:</strong> Review, abstraction and synthesis of data from training-related documents and records for the training activities implemented in 2014.</p><p style="text-align: justify;"><strong>Results:</strong> The Level 2a course is a five-day program that focuses on enhancing the skills of physicians and rehabilitation practitioners on the screening and assessment of drug dependence using team-based and practical learning approaches, and builds on learnings from the basic accreditation course. A total of 36 participants from ten Drug Abuse Treatment and Rehabilitation Centers (DATRCs) in nine regions completed the pilot implementation of the course in 2014. In general, the overall participant feedback on the training was mainly favorable based on data from 47% of participants who agreed or strongly agreed to statements on the relevance and attainment of the course aims (mean rating of 1.10±0.31, 1 = Strongly agree, 5 = Strongly disagree), and the appropriateness of its content (1.24±0.43) and design (1.18±0.39). A paired-samples t-test comparing scores for 44% of participants showed that there was a highly statistically significant difference in the pre-test (54%±13%) and post-test scores (69%±10%); t(16)=6.4240, p <0.0001.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Development and design of capability-building initiatives in the field of drug rehabilitation will necessitate alignment with practice standards, grounding in the real-world setting in which professionals work, and orientation towards practical learning.</p>

Tuberculosis in Selected Drug Abuse Treatment and Rehabilitation Centers (DATRCs) in Luzon, Philippines

Background and Objectives@#Tuberculosis (TB) continues to be a public health concern in the Philippines. Vulnerable populations in congregate settings such as drug abuse treatment and rehabilitation centers (DATRCs) have higher risks of TB transmission and infection. With the Duterte administration’s intensified campaign against illegal drugs, government-retained DATRCs are filled to capacity. There is an identified need to profile drug users and dependents living in DATRCs. Furthermore, national guidelines for TB management specific to this population is absent. A study was conducted to determine the profile of admitted clients diagnosed with TB, TB prevalence, treatment outcomes and choice of TB diagnostic modalities in six (6) Luzon-based DATRCs from 2013-2015.@*Methods@#All medical records of drug users admitted in this period were reviewed. Information on the total patient census was sought from DATRC heads and used to compute for prevalence.@*Results@#A total of 347 records were obtained. Overall TB prevalence in the study sites was 7,216 per 100,000 population. The typical individual diagnosed with TB in a DATRC was male, with a mean age of 35 years, with at least high school education, and unemployed. Weight loss and fatigue were the most common symptoms reported. The majority (79.83%) completed TB treatment in the DATRCs. Sputum microscopy and chest x-ray were both used for TB diagnosis in 92.80% (322) of the cases.@*Conclusion@#The high burden of TB in Luzon-based, government-retained DATRCs is alarming and underscore the critical need for standards and guidelines in the National Tuberculosis Control Program addressing the unique context of these facilities.

Antibacterial activity of guyabano, ulasimang bato, sambong, and tsaang gubat leaf extracts against common drug-resistant bacteria

Background@#Using plants as antimicrobials has long been a practice of traditional healers and validating these customs may lead to the discovery and development of useful herbal medicines.@*Objective@#This study aimed to determine the antibacterial activity of guyabano, tsaang gubat, sambong, and ulasimang bato against common pathogens.@*Methods@#Aqueous or alcoholic leaf extracts of the different medicinal plants were prepared. The solid agar dilution method was used to determine the MIC of guyabano, tsaang gubat, sambong, and ulasimang bato against common pathogens including Staphylococcus aureus, Echerichia coli, Streptococcus pneumoniae, Hemophilus influenzae, Pseudomonas aeruginosa, Salmonella typhi, and Shigella flexneri.@*Results@#The alcoholic leaf extract of guyabano showed moderate activity against oxacillin-sensitive S. aureus with an MIC of 5-6.3 mg/mL. However, tsaang gubat did not exhibit any antibacterial activity for drug-resistant enteric organisms (S. typhi, S. flexneri, and E. coli) and S. aureus at a concentration of 25 mg/mL. Even at a concentration of 100mg/mL, ulasimang bato failed to show any antibacterial activity against drug-resistant S. aureus, S. pneumonia, H. influenzae, E. coli, and P. aeruginosa. Sambong alcoholic extract had some antibacterial activity against penicillin-resistant S. pneumoniae with an MIC of 12.5 mg/mL. @*Conclusions@#Guyabano alcoholic leaf extract showed moderate antibacterial activity against oxacillin-sensitive S. aureus. Sambong alcoholic extract likewise exhibited inhibitory activity against S. pneumoniae. However, tsaang gubat and ulasimang bato aqueous extracts failed to show significant antibacterial activity for the pathogens tested.

Lessons learned from government-academe-civil society partnership to improve the assessment and management of drug dependence in the Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVE: </strong>This paper presents the experiences of, and lessons learnt from, a seven-year government-academe-civil society collaboration in the development, implementation, and evaluation of a training program for Filipino physicians and rehabilitation practitioners on the management of drug dependence.</p><p style="text-align: justify;"><strong>METHODS:</strong> Review of memoranda, records, and reports relevant to the initiation and implementation of the training activity. Where relevant, we also perused internal notes and minutes of meetings written by the authors, who are also members of the training team.</p><p style="text-align: justify;"><strong>RESULTS:</strong> A tripartite collaboration between government, academe, and professional organizations developed a training program on the management of drug dependence for physicians and rehabilitation practitioners. Learner-centered approaches to education were adopted in the delivery of training content. Participation in the training is a prerequisite for government accreditation as rehabilitation professionals. A ladderized approach to the training was adapted, with participants first obtaining a broad introduction to the program, followed by in-depth focus on the assessment and management of drug dependency. This was done as a response to the perception that a single, two-week training program is insufficient to fully capacitate physicians and rehabilitation practitioners with the requisite knowledge and skills necessary to manage persons with drug dependence. Future plans include an executive course for established practitioners, and a course on community-based management of drug dependency.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The current perspective on drug use and dependence is transitioning from a politico-legal issue to a public health concern. Attaining the sustainable development goals in 2030 will necessitate the development of a cadre of professionals who are, among others, capable of assessing and treating persons who suffer from drug dependence. The Philippine experience may serve as a model for other countries struggling with the drug menace.</p>

Seroprevalence of leptospirosis among water buffaloes, pigs, and dogs in selected areas in the Philippines, 2007 to 2008

@#<p><strong>BACKGROUND:</strong> Domestic animals are known to be either maintenance or accidental hosts of Leptospira. Determination of seroprevalence of leptospirosis among these animals is of great importance due to their close association with humans, economic loss as well as the public and veterinary health problems caused by the said zoonosis.</p><p><strong>OBJECTIVE:</strong> This study aimed to determine the seroprevalence of leptospirosis among water buffaloes, pigs, and dogs in selected areas in the Philippines.</p><p><b>METHODS:</b> Microscopic agglutination test (MAT) was used to test for leptospirosis. Testing was done from January 2007 to August 2008.</p><p><strong>RESULTS:</strong> With the cut-off titer set at 1:80, the MAT-positivity rates were 82%, 67%, and 79% for 190 water buffaloes, 45 pigs, and 106 dogs, respectively. The most common prevailing serovars detected were Hardjo, Tarassovi, and Hebdomadis for water buffaloes; Semaranga, Grippotyphosa, and Patoc for pigs; and, Manilae, Patoc, and Autumnalis for dogs. MAT-positivity rates among these animals in terms of age (except for water buffaloes), sex and sample collection sites were not statistically significant. No Leptospira was isolated from the blood, urine, and kidney samples of these animals.</p><p><strong>CONCLUSION:</strong> Results indicate a high seroprevalence of leptospirosis among the animals studied and that several pathogenic leptospires are causing infection in these animals.</p>