Related live sync files: 

\Clinic\Data\CHWs\Training in English\TB

\Clinic\Data\HMIS\HMIS_all.pdf

Achham TB data (based on Department of Health Services 2007/2008 Report): Achham TB Data 2007-2008 

Key protocols:

WHO Guideline: http://whqlibdoc.who.int/hq/2003/WHO_CDS_TB_2003.313_eng.pdf

PIH MDR Guideline: http://model.pih.org/mdr-tb_curriculum

Current protocol at clinic:

(1) TB training: 

-for each CHW, training manual and powerpoint are in Foldershare > Clinic > CHWs > Training in English > TB

and checklist for CHWs 

-screenings (ask about cough, night sweats, weight loss) as part of our initial routine intake procedure

(2) New diagnoses: 

-sputum smear microscopy at clinic

-drugs obtained from pharmacy

-HMIS form 20A is filled out and the information on the front side is entered into Access database immediately (demographic data)

-HMIS form 20B is given to patient

-CHW coordinator will assign CHW for that patient for DOTS; if pt outside of geographic area, referral to nearest health post. when a patient comes in from a given ward and VDC, we look up where the nearest reliable DOTS site is. contact that site. contact DHO. email jason@nyayahealth and sanjay@nyayahealth describing case, cc director.

-CHW takes HMIS form 20A, fills out the back with each DOTS day; form 20B is similarly completed

-patient comes in for sputum (brought by CHW): 2 months and 6 months -> entered into Access database

-if sputum conversion not achieved, or if extrapulmonary tb/complications email goes to jason@nyayahealth and sanjay@nyayahealth describing case, cc director

-HMIS data is input by shefali and emailed to US team as per DataManagement

(3) introduce CXR when available

(4) national program monitoring

-collect form 20A and sputum slide samples (all positives and 10% of negatives) every 4 months

-MOH Manoj is contact

(5) expansion

(a) survey every health post and subhealth post - summer fluent nepali volunteer to finish chhitij's start to this

-involves visiting every health post and/or holding a large forum and training session in Sanfe

-working with health posts to ensure referral of pts with TB symptoms to sputum microscopy center

(b) establishing another sputum microscopy site in the district - talk to MOH via Jason

(3) establish MDR testing through GENETUP (German Nepal Tuberculosis Project). Shefali met with them, will likely cost ~ Rs 200/sample plus transport.

Key figures:

Treatment regimens:

for MDR:

Actions in case of interruption:

In children: