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SESSION 2: Essential Elements of DOT – Part 1

SESSION 2: Essential Elements of DOT – Part 1. Risks for Nonadherence. When patients are adherent: 1. Risk for developing drug-resistant TB is decreased 2. Risk of TB spreading to others is decreased 3. Prolonged illness, disability, and possible death are avoided. Risks for Nonadherence (2).

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SESSION 2: Essential Elements of DOT – Part 1

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  1. SESSION 2:Essential Elements of DOT – Part 1

  2. Risks for Nonadherence When patients are adherent: 1. Risk for developing drug-resistant TB is decreased 2. Risk of TB spreading to others is decreased 3. Prolonged illness, disability, and possible death are avoided

  3. Risks for Nonadherence(2) Can we predict who will be nonadherent? No! Anyone can be nonadherent, regardless of social class, educational background, age group, gender, or ethnicity.

  4. Risks for Nonadherence(3) Persons at especially high risk: • Homeless or people who don’t have permanent housing • Persons who use alcohol or other substances

  5. Risks for Nonadherence(4) Persons at especially high risk (continued): • Persons who have mental, emotional, or physical disabilities • Children and teenagers • Persons who previously did not adhere to TB treatment

  6. How Can DOT Staff Build Rapport and Trust? 1. “Start where the patient is.” 2. Protect patient confidentiality 3. Communicate clearly 4. Avoid criticizing patient; suggest behavior changes respectfully

  7. How Can DOT Staff Build Rapport and Trust?(2) 5. Be on time and be consistent 6. Adopt and reflect a non-judgmental atittude 7. Other ways?

  8. Skills That Contribute to Good Communication 1. Listen attentively and respectfully; use open, relaxed body language 2. Assure patient of privacy and confidentiality 3. Avoid being judgmental or accusatory and never show frustration

  9. Skills That Contribute to Good Communication(2) 4. Use simple, nonmedical terms 5. Use appropriate language level for the patient 6. Limit the amount of information given

  10. Skills That Contribute to Good Communication(3) 7. Discuss most important topics first and last 8. Repeat important information 9. Listen to feedback and questions from the patient

  11. Skills That Contribute to Good Communication(4) 10. Use concrete examples 11. Ask open-ended questions

  12. Common Adverse Reactions to TB Drugs Caused by: Any drug Adverse reaction: Allergic reactions Signs/symptoms: Skin rash

  13. Common Adverse Reactions to TB Drugs(2) Caused by: Ethambutol Adverse reaction: Eye damage Signs/symptoms: Blurred or changed vision; changed color vision

  14. Common Adverse Reactions to TB Drugs(3) Caused by: INH, PZA, RIF Adverse reaction: Hepatitis Signs/symptoms: Abdominal pain Abnormal LFTs Dark urine

  15. Common Adverse Reactions to TB Drugs(4) Caused by: INH, PZA, RIF Adverse reaction: Hepatitis Signs/symptoms: Fatigue Fever > 3 days Flu-like symptoms Lack of appetite

  16. Common Adverse Reactions to TB Drugs(5) Caused by: INH, PZA, RIF Adverse reaction: Hepatitis Signs/symptoms: Nausea Vomiting Yellowish skin or eyes

  17. Common Adverse Reactions to TB Drugs(6) Caused by: Isoniazid Adverse reaction: Nervous system damage Signs/symptoms: Dizziness Tingling/numbness around mouth

  18. Common Adverse Reactions to TB Drugs(7) Caused by: Isoniazid Adverse reaction: Peripheral neuropathy Signs/symptoms: Tingling/numbness in hands and feet

  19. Common Adverse Reactions to TB Drugs(8) Caused by: Pyrazinamide Adverse reaction: Stomach upset Signs/symptoms: Stomach upset Vomiting Lack of appetite

  20. Common Adverse Reactions to TB Drugs(9) Caused by: Pyrazinamide Adverse reaction: Increased uric acid Signs/symptoms: Abnormal UA level Joint aches Gout (rare)

  21. Common Adverse Reactions to TB Drugs(10) Caused by: Rifampin Adverse reaction: Bleeding problems Signs/symptoms: Easy bruising Slow blood clotting

  22. Common Adverse Reactions to TB Drugs(11) Caused by: Rifampin Adverse reaction: Discoloration of body fluids Signs/symptoms: Orange urine, sweat, or tears Stained soft contact lenses

  23. Common Adverse Reactions to TB Drugs(12) Caused by: Rifampin Adverse reaction: Drug interactions Signs/symptoms: Interferes with some medications: BC pills, BC implants, methadone

  24. Common Adverse Reactions to TB Drugs(13) Caused by: Rifampin Adverse reaction: Sun sensitivity Signs/symptoms: Frequent sunburn

  25. Common Adverse Reactions to TB Drugs(14) Caused by: Streptomycin Adverse reaction: Ear damage Signs/symptoms: Balance problems Hearing loss Ringing in the ears

  26. Common Adverse Reactions to TB Drugs(15) Caused by: Streptomycin Adverse reaction: Kidney damage Signs/symptoms: Abnormal kidney function test results

  27. Review Questions 1. What are 2 negative consequences that can result if a TB patient does not adhere to the treatment regimen? 2. What are 5 reasons that a patient might be nonadherent? What is a possible way to deal with each reason?

  28. Review Questions(2) 3. Name 5 techniques to build trust and communicate effectively with TB patients. 4. What are 2 ways you can be sure that a dose is actually swallowed by a patient?

  29. Review Questions(3) 5. What are 3 commonly observed adverse reactions to anti-TB medications?

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