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

2. DOT Curriculum Session 22 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. DOT Curriculum Session 23 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. DOT Curriculum Session 24 Risks for Nonadherence (3) Persons at especially high risk: Homeless or people who don’t have permanent housingHomeless or people who don’t have permanent housing Persons who use alcohol or other substancesPersons who use alcohol or other substances

5. DOT Curriculum Session 25 Risks for Nonadherence (4) Persons at especially high risk (continued): Persons who have mental, emotional, or physical disabilitiesPersons who have mental, emotional, or physical disabilities Children and teenagersChildren and teenagers Persons who previously did not adhere to TB treatmentPersons who previously did not adhere to TB treatment

6. DOT Curriculum Session 26 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. DOT Curriculum Session 27 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. DOT Curriculum Session 28 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. DOT Curriculum Session 29 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. DOT Curriculum Session 210 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. DOT Curriculum Session 211 Skills That Contribute to Good Communication (4) 10.Use concrete examples 11.Ask open-ended questions

12. DOT Curriculum Session 212 Common Adverse Reactions to TB Drugs Caused by: Any drug Adverse reaction:Allergic reactions Signs/symptoms:Skin rash

13. DOT Curriculum Session 213 Common Adverse Reactions to TB Drugs (2) Caused by: Ethambutol Adverse reaction:Eye damage Signs/symptoms:Blurred or changed vision; changed color vision

14. DOT Curriculum Session 214 Common Adverse Reactions to TB Drugs (3) Caused by: INH, PZA, RIF Adverse reaction:Hepatitis Signs/symptoms:Abdominal pain Abnormal LFTs Dark urine

15. DOT Curriculum Session 215 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. DOT Curriculum Session 216 Common Adverse Reactions to TB Drugs (5) Caused by: INH, PZA, RIF Adverse reaction:Hepatitis Signs/symptoms:Nausea Vomiting Yellowish skin or eyes

17. DOT Curriculum Session 217 Common Adverse Reactions to TB Drugs (6) Caused by: Isoniazid Adverse reaction:Nervous system damage Signs/symptoms:Dizziness Tingling/numbness around mouth

18. DOT Curriculum Session 218 Common Adverse Reactions to TB Drugs (7) Caused by: Isoniazid Adverse reaction:Peripheral neuropathy Signs/symptoms:Tingling/numbness in hands and feet

19. DOT Curriculum Session 219 Common Adverse Reactions to TB Drugs (8) Caused by: Pyrazinamide Adverse reaction:Stomach upset Signs/symptoms:Stomach upset Vomiting Lack of appetite

20. DOT Curriculum Session 220 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. DOT Curriculum Session 221 Common Adverse Reactions to TB Drugs (10) Caused by: Rifampin Adverse reaction:Bleeding problems Signs/symptoms:Easy bruising Slow blood clotting

22. DOT Curriculum Session 222 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. DOT Curriculum Session 223 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. DOT Curriculum Session 224 Common Adverse Reactions to TB Drugs (13) Caused by: Rifampin Adverse reaction:Sun sensitivity Signs/symptoms:Frequent sunburn

25. DOT Curriculum Session 225 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. DOT Curriculum Session 226 Common Adverse Reactions to TB Drugs (15) Caused by: Streptomycin Adverse reaction:Kidney damage Signs/symptoms:Abnormal kidney function test results

27. DOT Curriculum Session 227 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. DOT Curriculum Session 228 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. DOT Curriculum Session 229 Review Questions (3) 5.What are 3 commonly observed adverse reactions to anti-TB medications?