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Pharmacists work towards stopping the spread of Tuberculosis

World TB Day, 24 March 2009, is about celebrating the lives and stories of people affected by TB: women, men and children who have taken TB treatment; pharmacists; nurses; doctors; researchers; community workers--anyone who has contributed towards the global fight against TB. (Read more about World TB Day 2009 and about the Stop TB Partnership here )

Throught affected areas pharmacists have played an integral role in educating patients on the disease and more importantly how to curb its spread. FIP is pleased to bring you an article contributed by Manjiri Gharat and Tim Rennie on pharmacists' work in treating and stopping tuberculosis.
Tuberculosis and the Role of Pharmacists

Tuberculosis and the Role of Pharmacists

Tuberculosis (TB) today remains an epidemic in much of the world, causing the deaths of several million people each year, mostly in the developing countries. Twenty-two countries, mostly in South East Asia and Africa, account for 80% of the TB cases in the world. Moreover, TB cases are on the rise in many developed countries too, largely owing to migration and social deprivation - a known predisposer to TB.

If TB disease is detected early and fully treated, people with the disease quickly become non-infectious and usually cured. Resistance to antituberculous drugs - including multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) - HIV-associated TB, and weak health systems are major challenges in healthcare.

Pharmacies seem to be globally ubiquitous. It would be pertinent to seize this valuable resource worldwide in terms of what the pharmacy profession can offer to the patient. For example, a service to provide Directly Observed Treatment (DOT) of TB in community pharmacies is currently being implemented across North East London (UK) and in Mumbai (India). This initiative aims to provide health expert led TB care that is more convenient for patients where adherence is a challenge. It is also an excellent example of public-private mix activity strengthening national TB control programmes. Benefits include: expert medicines care and support, ‘walk-in' centre convenience, and greater patient choice. If TB is to be eradicated globally, greater efforts need to be directed towards identifying and treating TB infection as well as swifter diagnosis of TB disease to reduce the spread. This may be achieved with a concerted effort by community sector involvement including pharmacists. Pharmacies are often the first port of call and can play important role in TB control and eradication.

Pharmacists have a role in following capacity:

Creating awareness
1 Create awareness among all consumers about TB; distribution of TB information fact cards/leaflets in local language
2 Display of posters about TB at prominent place in or outside of pharmacy; TB awareness campaigns can be organized around World TB Day, 24th March each year, if possible throughout the year
3 Creating awareness among the patients about access to care including free diagnosis treatment facility

Case detection of pulmonary symptomatic cases and latent TB infection (LTBI):
1 Clinical suspicion - symptoms observation - and encouraging referral for efficient diagnosis, education and advise regarding the spread of TB
2 Organising sputum test (microscopy) centres and Mantoux testing

Monitoring of treatment and supportive care:
1 Targeted and specific counselling on various aspects of treatment such as dosage instructions, importance of treatment completion, side effects of drugs, nutrition during TB, follow up with physician
2 Treatment monitoring to improve patient compliance (adherence) by keeping patient records, telephonic or personal follow up
3 Monitoring of body weight on regular basis and keeping records

Participating in TB Control as DOTS provider:
1 Active participation in Governmental TB control programme by becoming DOTS provider after the required training
2 Provision of DOTS medicines, counselling, supportive care and monitoring at pharmacy
3 Maintaining documentation required for DOTS and rigorous follow-up in instances of patient default from treatment
4 Continued communication with nearby Government centres/health posts through whom patient was directed to Pharmacy

In order to perform the roles above, pharmacists will require training to ensure that they are proficient in recognising symptoms of TB as well as side effects of TB medications, diagnosis and treatment of TB, identification and referral of TB/LTBI patients where necessary, and familiarity with the wider Government programmes and relevant guidelines.

Pharmacy associations in different countries - especially those with a high burden of TB - should take a lead in collaborating with Government TB authorities and organise training programmes to motivate pharmacists for this socio-professional activity. Positive experiences in Mumbai and London indicate that there is great potential for pharmacist roles and, if integrated into TB control programmes, could make a significant contribution to achieving the millennium development goals for TB control.

Author contacts:
Manjiri S Gharat,Hon.Secretary,Community Pharmacy Division, Indian Pharmaceutical Association, Mumbai
Email :symghar@yahoo.com

Timothy Rennie, Research Fellow, FIPCC, School of Pharmacy
Email: timothy.rennie@pharmacy.ac.uk