Journal of Infectious Diseases & Therapy
Open Access

Abstract

Introduction: The problem of tuberculosis disease is global and the Philippines are 9thout of the 22 highest TB-burden
countries in the world. Effects of the disease go beyond health, but also cause pronounced burden in the country’s economy.
Aside from immediate loss of income for the in-fected household member, other family members are also affected in their
efforts to provide care. Hence, it is estimated that some countries lose from four to seven percent of their GDP because of the
disease. In our country, the individual economic losses are about 7.9 billion pesos (US$145 mil-lion) in lost wages from illness
or disability and premature deaths. Definitely, care of people with TB is extremely important thus strategies to control TB are
crucial to both confirmed and suspected individuals who harbour this disease.
Various guidelines have been published in an effort to standardize the management of TB world-wide. Efforts have
been made to encourage adherence of physicians to these guidelines. Thus, the World Health Organization (WHO) and the
American Thoracic Society (ATS) published the first edition of the International Standards for Tuberculosis Care (ISTC) in
2006. Its purpose was to pro-vide a widely accepted level of care that all practitioners should follow to in managing patients
who have, are suspected of having, or are at increased risk of developing TB.The first version of the ISTC set 17 standards: six
on TB diagnosis, nine on treatment, and two for the public health respon-sibilities that every health provider who care for
persons afflicted with TB should adopt. At the time the first edition was published, a commitment was made to ensure that
the ISTC became a living document that would be updated as new information emerged. Hence, in 2009 a second edition
was made to encourage associated health professionals to endorse the standards and promote engagement of non-National
Tuberculosis Program (NTP) care providers.This time, it incorporated 21 standards, which included revisions and expansion
of some of the original standards and four completely new standards addressing co-morbid conditions, isoniazid preventive
therapy in children and HIV-infected persons, and prevention of infection transmission in health care facilities.The consistent
adoption of these new standards is perceived to enhance the care of TB persons and reduce morbidity and mortality of the
disease worldwide.
Recent studies showed that in the 22 countries with the highest prevalence of TB including the Phil-ippines, a mean of 62.6%
of the total health expenditure is spent on private health professionals. Furthermore, 1/3 of all Filipinos with TB symptoms
prefer to consult private physicians for treatment. And lots of these private practitioners (PPs) prefer to use management
options other than TB DOTS, a treatment strategy which may have serious implications on the quality of TB care.
With the activities and initiatives started in 2009 to reinforce the standards embodied in the ISTC since 2006, the
investigators would like to describe the adherence of third year residents –in- train-ing (Internal Medicine and Family Medicine
from University of the Philippines, Philippine General Hospital, 2012-2013) to the ISTC 2009 guidelines. These trainees had
been through multiple CMEs, round table discussions, and TB seminars during their training, hence it is the aim of this paper
to determine if the efforts made since 2009 were translated into knowledge and actual practices of the physicians especially
those who are in-training. These residents-in-training acts as front liners in the delivery of primary health care services in the
various points-of-care in hospitals and are probably expected to pursue private practices in the future.
Specific Objectives of this study are: (1) to determine the proportion of physicians-in-training under Internal Medicine,
and Family Medicine from the University of the Philippines- Philippine General Hospital from 2012 to 2013 adhering to
International Standards for Tuberculosis Care (ISTC) 2009 based on: Standards 2, 3(Diagnosis); Standards 8, 10,13 (Treatment);
Standard 14 (Addressing HIV Infection and other Co-morbidities); Standard 21 (Public Health and Prevention). These
standards were selected based on the common practices and considered by investigators deemed important in tuberculosis
care. 2) To determine the most and the least adhered to standards among the said population.

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