1. Project Goals  Support the National Tb Program (NTP)  Developed National Guidelines for prevention and control of Tb  Developed guidelines for treating people co-infected with HIV/AIDS  Implement and expand DOTS (Directly Observed Therapy Short course)  Strengthen Laboratories  Strengthen the Capacity of Educational Institutions Public Health Strengthening in Guyana Implemented by the Canadian Society for International Health (CSIH) in partnership with the Guyanese Ministry of Health Canadian International Development Agency investment 5.5 million CN$ Poster Abstract Public Health Strengthening in Guyana is a capacity development intervention focused on improving and maintaining the health of Guyana’s population. One major component of the Project focuses on improving the National Tuberculosis Program (NTP) by providing technical and administrative support for the NTP Unit, developing and implementing national diagnosis and treatment guidelines and, developing implementation strategies for directly observed therapy short-course (DOTS) using WHO standard treatment. To ensure the success of the project, organization and necessary procurement to introduce AFB laboratory diagnosis have been instituted. TB and bio- safety training sessions and laboratory manual development are completed. Mentorship, training and provision of motorbikes to DOTS workers have further ensured that great strides were made to improve level of patient plus family care. In 2001, there were 787 TB cases nationwide in Guyana. The TB detection rate was 54% for 2000. Moreover, the incidence of TB had increased by 10-20% annually between 1994 and 1999. In many cases, the extent of the problems was impossible to define because of the lack of diagnostic capacities, relevant expertise, and adequate staffing. Furthermore, many of the gains made from public health interventions, such as childhood immunization programs, have been eroded by the consequences of the increasing burden of HIV/AIDS, tuberculosis and co-infections. By supporting an integral approach to disease, prevention, diagnosis, management and care at the National and district/community levels, this project will result in overall improvement in health of the Guyanese. Authors and Affiliations : Dr. Earl Hershfield, Tb expert consultant; Dr. Shamdeo Persaud, National Tuberculosis Officer Guyana; Ms. Roumyana Benedict, Project Director; Ms. Josée Levesque Key Project Components: Expanding and Strengthening the Prevention, Management and Care of STIs/HIV/AIDS Improving National Tuberculosis Prevention and Control Program Strengthening the Health Information System Community Health Development and Care TB in Guyana 590 TB reported cases nationwide (2003) TB detection rate is 54% DOTS (Directly Observed Therapy) coverage is only 12% of the total population Annual rate of infection : 3.2 (estimated) Annual risk of infection : 0.92 TB infection : 14% (105,000 – estimated) Current prevalence : 0.3% (2,400 active cases) Annual incidence : 79/100,000 (reported) Mortality Rate (reported) : 3.25 Minister Ramsammy on a new DOTS bike provided by CSIH Chief technologist and CSIH expert at new PHSG-funded laboratory Consultation at Chest Clinic with NTP Director, Nurse and CSIH expert A CSIH consultant delivers a lecture at UGLaunch of DOTS expansion in region 10 Project Achievements  Key persons trained on a study tour to Canada.  Vehicle and administrative support provided for the NTP  Completed final draft of National TB Manual and TB Laboratory Manual  Eleven new DOTS workers trained, mentored and provided with motorbikes  Central Lab equipped and trained for TB culturing and fluorescent microscopy  Continuing Education sessions for medical technologists  The NGO Guyana Chest Society, re-activated and now member of the IUATLD  First National TB conference held in collaboration with MOH and the Chest Society Region 4 Region 10 Region 6 Guyana Region 4 Region 6 Guyana First National TB conference in Guyana, Oct. 2004 Computer and database training at Chest Clinic with CSIH NetCorps intern TB COMPONENT Notified Cases 1988 - 2003 Cases Age and Gender Distribution 2003 www.csih.org/what/guyana/indexguyana.html CSIH Guyana office: Suzanne Marquis Project Field Manager Tel: (592) 227 3673 csih@guyanapsu.org.gy CSIH Ottawa office: Roumyana Benedict Project Director Tel: (613) 241-5785 Ext.307 rbenedict@csih.org Chest ClinicCuredDefaultedFailureDied Georgetown2121221427 New Amsterdam16806 Linden9407 WDRH7711 Total2441441537 Percent%43.725.22.66.6 Treatment Outcomes -2003 ACTIVITY20032004 Hand WashingNon-existent Finding running water; Using wipes / antiseptic wash Medication Self-administered; Some DOTS in Georgetown only Meds carried in pillboxes Directly Observed; Meds counted and packed in plastic bags Drug Dosages Different dosages ; Varying length of tx ; Missing medications Therapeutic dosages; Most treatments completed in 6 months Information Pertinent information not consistently reported to MD DOTS notes; Lab results posted; Improved documentation Patient Education Done at first visit only; Lack of teaching aids Ongoing; Done with Family members; Teaching aids developed Support Systems Need for Support Systems identified Support Systems continue to be insufficient StatisticsNot done Standardization of format; properly reported Sputum CollectionPatients went to the laboratory Specimens collected at home by DOTS workers DOTS Achievements 2003-2004