Supervised TB therapy to be made more accessible

SINGAPORE - The Ministry of Health (MOH) is to step up its fight against rising cases of tuberculosis by making treatment more accessible.

The ministry will focus more on directly observed therapy (DOT) to tackle the problem. This mode of treatment is seen as the most appropriate because it requires patients to visit a polyclinic regularly to take their medication while being supervised by a health-care worker, who also monitors any side effects.

However only about six out of 10 TB patients here are doing so, with the rest opting to take their medicine on their own.

This can lead to some missing their allotted medication, causing further complications.

The MOH's move comes as rates for the airborne infection rose for the fifth year straight. There were 1,560 new cases last year, slightly higher than the 1,533 in 2011.

Details of the new initiatives are being finalised and will be announced in due course, an MOH spokesman told The Straits Times, adding that the measures will "further improve the accessibility of DOT for patients".

Health-care professionals, MPs and patients said they would like to see the supervised therapy made available at more places besides the 18 polyclinics here - such as at neighbourhood clinics and even public hospitals.

TB is spread through respiratory droplets from an infected person.

While potentially fatal, the disease is usually treatable with six to nine months of antibiotics.

Chairman of the Government Parliamentary Committee for Health, Dr Lam Pin Min, said that more channels for supervision means patients can be further encouraged to stick to treatment.

"The key to the treatment of TB is compliance with medication," said the MP for Sengkang West.

He noted that incomplete treatment can cause the disease to become resistant to antibiotics, making it harder to treat.

An estimated 50 people default on treatment every year.

National Healthcare Group Polyclinics' director for nursing services Chen Yee Chui said the involvement of general practitioners in particular may be useful as it will "significantly increase the number of locations that patients can go to".

She noted that younger patients appear to need closer monitoring, especially during the first two months of treatment.

"Most of them feel well physically and find it hard to accept that they have to come to the polyclinic daily to take their medications," said Ms Chen.

Dr Chia Shi-Lu, MP for Tanjong Pagar GRC, said setting up centres at hospitals will help patients with multiple ailments, such as the elderly.

"They prefer to continue going to one hospital for all treatments, including DOT," said Dr Chia.

Dr Lam suggested that patients be linked to the GP or hospital clinic nearest to where they live.

Both MPs also proposed installing surveillance cameras at patients' homes.

Those who could do with more support are frail and elderly patients without caregivers, said SingHealth Polyclinics' senior nurse manager Tan Ai Meng.

Shift workers have also experienced difficulties in getting to the polyclinic on time due to their work schedules, said Ms Tan.

Currently, polyclinics will inform the Tuberculosis Control Unit the day after patients fail to show up to take their medication.

Home visits are another option, although these can be resource-intensive, added Dr Chia.

Such services are already offered for free in Australia and one former DOT patient said they could help those who are confined to wheelchairs.

The 41-year-old unemployed woman, who does not wish to be named, said: "It is more convenient, but who will pay for it - the hospital, polyclinic or us?"


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