Tuberculosis (TB) remains a major global health problem, responsible for ill

health among millions of people each year. It ranks as the second leading
cause of death from an infectious disease worldwide, after the human
immunodeficiency virus (HIV). The latest estimates included in this report are
that there were 9.0 million new TB cases in 2013 and 1.5 million TB deaths
(1.1 million among HIV-negative people and 0.4 million among HIV-positive
people) 1
TB is an infectious disease caused by the acid fast bacillus Mycobacterium
tuberculosis. It typically affects the lungs (pulmonary TB) but can affect other
sites as well (ie., extrapulmonary TB, ,military TB). The disease is acquired
through airborne transmission usually caused by coughing and sneezing of
infected patients. Overall, a relatively small proportion of people infected
with M. tuberculosis will develop TB disease. However, the probability of
developing TB is much higher among people infected with HIV.
TB is also more common among men than women, and affects mainly adults
in the most economically productive age groups. The most common method
for diagnosing TB worldwide is sputum smear microscopy (developed more
than 100 years ago), in which bacteria are observed in sputum samples
examined under a microscope.
In countries with more developed laboratory capacity, cases of TB are also
diagnosed via culture methods (the current reference standard). Without
treatment, TB mortality rates are high. In studies of the natural history of the
disease among sputum smear-positive/HIV-negative cases of pulmonary TB,
around 70% died within 10 years; among culture-positive (but smearnegative) cases, 20% died within years.2
Worldwide tuberculosis transmission continues despite intensive control
efforts and availability of highly effective, relatively inexpensive treatment
regimens [3-5]. There are multiple reasons for the continued threat. The time
commitment for successful treatment of tuberculosis is longer than required
for most acute medical conditions [6-7]. Additional tuberculosis transmission
and the development of drug resistance can result when tuberculosis
treatment fails due to noncompliance[8].
Compliance to therapy is one of the important factors that affect the
outcome of therapy. Compliance can be defined as the extent to which a
patients behavior coincides with medical advice. Non-compliance to self
administered multi-drug tuberculosis treatment regimens is common and
most important cause of failure of initial therapy and relapse. Noncompliance may also result in acquired drug resistance, requiring more
prolong and expensive therapy
that is less likely to be successful than the treatment of drug susceptible
tuberculosis. 9,10

In the Philippines, Tuberculosis is a major public health problem in the

Philippines and ranked ninth among the 22 high TB burden countries. DOTS
(Direct Observed Treatment Shortcourse) strategy, introduced in 1996, is
available in almost all the Rural Health Units and the Health Centers.
However, other health care providers such as the hospitals, private
practitioners and other government health facilities generally provide TB
services that are not in accordance with NTP policies and standards.
Direct sputum smear microscopy (DSSM) is generally available in most of the
municipalities
but relatively inaccessible in some cities and underserved areas. Awareness
of TB is high among the general population, knowledge on causation,
transmission and DOTS is generally low. 11
1

www.who.int., Library Catalogue-in-Publication Data; Global Tuberculosis

Report 2014
2

Tiemersma EW et al. Natural history of tuberculosis: duration and fatality of

Untreated pulmonary tuberculosis in HIV negative patients: A systematic
review. PLoS ONE, 2011, 6(4):e17601.
3

Cohn DL, Catlin BJ, Peterson KL, Judson FN, Sbarbaro JA: A 62-dose, 6month therapy for pulmonary and extrapulmonary tuberculosis. A
twice-weekly, directly observed, and cost-effective regimen.
Ann Intern Med 1990, 112:407-415. PubMed Abstract
4

Dutt AK, Moers D, Stead WW: Short-course chemotherapy for

tuberculosis with mainly twice-weekly isoniazid and rifampin.

Community physicians' seven-year experience with mainly
outpatients.
Am J Med 1984, 77:233-242. PubMed Abstract | Publisher Full Text
5

Horsburgh CR Jr: The global problem of multidrug-resistant

tuberculosis: The genie is out of the bottle.

JAMA 2000, 283:2575-2576. PubMed Abstract | Publisher Full Text
6

Combs DL, O'Brien RJ, Geiter LJ: USPHS tuberculosis short-course

chemotherapy trial 21: Effectiveness, toxicity, and acceptability. The

report of final results.
Ann Intern Med 1990, 112:397-406. PubMed Abstract

Benator D, Bhattacharya M, Bozeman L, et al.: Rifapentine and isoniazid

once a week versus rifampicin and isoniazid twice a week for

treatment of drug-susceptible pulmonary tuberculosis in HIVnegative patients: A randomised clinical trial.
Lancet 2002, 360:528-534. PubMed Abstract | Publisher Full Text
8

Centers for Disease Control and Prevention: Outbreak of multi-drug

resistant tuberculosis-Texas, California, and Pennsylvania.

MMWR 1990, 369-372. PubMed Abstract
Globe M, Isheman MD, Madsen LA, et al. Treatment of 171 patients with
pulmonary tuberculosis resistance to isoniazid and rifampicin.
N England J Med 1993; 328, 527-32.
9

10

Weis SE, Slocum PC, Blais FX, et al. The effect of directly observed
therapy on rate of drugs
resistance and relapse intuberculosis.
N England J Med 1994; 330: 1179-84.
11

Philippine TB Plan 2010-2015