5. In‐patient
Patients can be isolated from their communities
Although care is available, they may not be able to access it if
it is not available close to where they live
Less risk of nosocomial transmission
Care in the community
Community member’s can become health promoters
May understand/relate better to issues faced by patients
Share language and culture
Provides work to people in the local community
6. Historical tendency to treat everyone in
hospitals since 1920th.
In late 1990th new system of TB care
introduced, new rules and regulations,
but less focused on ambulatory care.
Since 2000 PIH launched MDRTB
program in Tomsk
7. Based on a MoH report on
TB situation on Russia,
treatment success rate
(cured + completed) among
2007 cohort was (for S+ and
S-) 68,8% on average.
9.1% defaulted and 4.1%
transferred out.
7
8. S+/S‐ treatment
results
Treatment results for new
S+/S‐ TB cases in Siberia
and Far East
Data from MoH TB Report. 2008
8
9. Patients should be treated out patient for at
least continuation phase; Ideally for the
whole duration.
DOT points should be in a close proximity to
patients.
Treatment at home should be provided in
most cases.
For high‐risk TB patients patient‐centered
approach needs to be established.
10. Some patients require assistance to finish treatment
Need a system of accompaniment to help overcome
barriers to treatment (this is different from simple
DOT)
▪ Social supports
▪ Nutritional supports
▪ Family support
One Sputnik will look after three to five patients
Changes the burden of responsibility for adherence
from the patient (“non‐compliant”) to the program
(programmatic failure)
11. Responsibility for adherence rests with the
program, not the patient.
Creation of patient‐centered, convenient and
pleasant treatment atmosphere.
The name “Sputnik” is a translation of
“accompagnateur”, which emphasize the role
of nurses as patients’ companions or friends.
12. “SPUTNIK” Program
54 non‐adherent patients were enrolled on
Sputnik program from December 17, 2006 to
November 31, 2008 3 patients were excluded
later from Sputnik:
‐ 2 patients refused to
continue treatment
(program failure)
‐ 1 patient was re‐
examined and active TB
was ruled out.
51 patients finished the Sputnik program
9 patients restarted new 42 patients continued previous treatment.
treatment course with Adherence increased from 54% before
94.5% adherence enrolment on the program to 88% while on
[baseline adherence 0%] Sputnik, p<0.0001
