3. Tuberculosis is a disease caused by
a bacterium called Mycobacterium
tuberculosis.
Mainly acquired by
⢠inhalation of infectious droplets
containing viable tubercle bacilli.
5. In 2007, there are 9.27 million
incident cases of TB worldwide and
Asia accounts for 55% of the cases.
Through the National TB Program
(NTP), the Philippines achieved the
global targets of 70% case detection
for new smear positive TB cases and
89% of these became successfully
treated.
6. The various initiatives undertaken
by the Program, in partnership with
critical stakeholders, enabled the
NTP to sustain these targets.
7. Nonetheless, emerging
concerns like drug
resistance and co-morbidities
need to be
addressed to prevent rapid
transmission and future
generation of such threats.
8. Coverage should also be
broadened to capture the
marginalized populations
and the vulnerable groups
namely, urban and rural
poor, captive populations
(inmates/prisoners), elderly
and indigenous groups.
9. Vision:
TB-free Philippines
Goal:
To reduce by half TB
prevalence and mortality
compared to 1990 figures by
2015
10. Objectives:
The NTP aims to:
⢠Reduce local variations in TB control
program performance
⢠Scale-up and sustain coverage of
DOTS implementation
⢠Ensure provision of quality TB
services
⢠Reduce out-of-pocket expenses
11. Elements of DOTS
⢠Political commitment with
increased and sustained financing
âPolitical commitment is needed to
foster national and international
partnerships, which should be linked to
a long-term strategic action plan.
Adequate funding is necessary to
improve the motivation of healthcare
workers.
12. ⢠Case detection through quality-assured-
bacteriology
âBacteriology remains to be
confirmatory diagnostic test for
tuberculosis. Properly equipped
laboratories and trained personnel
are necessary for quality-assured
sputum smear microscopy.
13. ⢠Standardized treatment with
supervision and patient support
âThe primary means of controlling
TB is organizing and administering
a standardized treatment for all
ages and for all types of
tuberculosis. This includes the use
of standardized treatment, such as
short-course chemotherapy (SCC)
14. and the fixed dose combination (FDC), to
facilitate adherence to treatment and to
reduce the risk for developing drug
resistance.
âSupervised treatment (directly observed
treatment by a health care provider)
ensures that patients take their drugs
regularly and completely. Particular
attention should be given to the poorest
and most vulnerable groups.
15. ⢠An effective drug supply and
management system
âAn uninterrupted and sustained supply
of quality-assured anti-TB drugs is
fundamental to TB control. Anti-TB
drugs should be available free of charge
to all TB patients, especially the poor,
because treatment has benefits that
extend to society. The use of anti-TB
drugs by all providers should be strictly
16. The use of FDCs of proven
bioavailability and of
innovative packaging, such as
patient kits, can help improve
drug supply logistics and drug
administration, promote
adherence to treatment, and
prevent development of drug
17. ⢠Monitoring and evaluation
system, ad impact measurement
âThis requires the standardized
recording of individual patient data,
including information on treatment
outcomes, which are then used to
compile quarterly treatment
outcomes in cohorts of patient.
These data, when compiled and
analyzed, can be used:
18. a)At the facility level to monitor
treatment outcomes;
b)At the district level to identify
local problems as they arise;
c)The provincial or national level to
ensure consistently high-quality
TB control
19. d) Nationally and internationally to
evaluate the performance of each
country
Regular programmed
supervision should be carried out to
verify the quality of information
and to address performance
problems.
20. Prevention and Control
⢠Submit all babies for BCG
immunization
⢠Avoid overcrowding
⢠Improve nutritional and health status
⢠Advise persons who have been
exposed to infected persons to
receive the tuberculin test and, if
necessary, chest x-ray and
21. STRATEGIES IN CONTROLLING TB
1. LOCALIZED IMPLEMENTATION OF TB CONTROL
2. MONITOR HEALTH CARE SYSTEM PERFORMANCE
3. ENGAGE ALL HEALTH CARE PROVIDER PUBLIC & PRIVATE
4. PROMOTE & STRENGTHEN POSITIVE BEHAVIOR OF
COMMUNITIES
5. ADDRESS MDR, TB, HIV & NEEDS VULNERABLE
6. REGULATE & MAKE QUALITY TB DIAGNOSTIC TEST & DRUGS
7. CERTIFY & ACCREDIT TB CARE PROVIDERS
8. SECURE ADEQUATE FUNDING & IMPROVE ALL ALLOCATION &
EFFICIENCY OF FUND UTILIZATION
23. ⢠Vision: Empowered primary
stakeholders in leprosy and eliminated
leprosy as a public health problem by
2020
⢠Mission: To ensure the provision of a
comprehensive, integrated quality leprosy
services at all levels of health care
⢠Goal: To maintain and sustain the
24. ⢠Objectives:
The National Leprosy Control Program
aims to:
Ensure the availability of
adequate anti-leprosy drugs or multiple
drug therapy (MDT).
Prevent and reduce disabilities
from leprosy by 35% through
Rehabilitation and Prevention of
Impairments and Disabilities (RPIOD)
25. Improve case detection and post-elimination
surveillance system using the
WHO protocol in selected LGUs.
⢠Beneficiaries:
The NLCP targets individuals,
families, and communities living in hyper
endemic areas and those with history of
previous cases.
http://www.doh.gov.ph/node/1071.html
29. Schistosomiasis
Bilharziasis/Snail Fever
⢠A slowly, progressive disease
caused by blood flukes of class
Trematoda. It is a chronic wasting
disease common among farmers
and their families in certain parts
of Philippines.
30. Etiologic agent
⢠Schistosoma japonicum
âThis agent infects the intestinal tract
(Katayama disease)
âIt is found to be the only type that is
endemic in the Phil.
âThis is also known as âoriental
schistosomiasisâ
31. ⢠Schistosoma mansoni
âAlso affects intestinal tracts
âCommon in some parts of Africa
⢠Schistosoma haematobium
âAffects the urinary tract
âCan be found in some parts of the
Middle East
32. Incubation period is at least 2 months.
SOURCES OF INFECTION:
⢠Feces of infected persons
⢠Dogs, pigs, carabaos, cows, monkeys, and
wild rats have been found infected ad,
therefore, also serve as host
33. Mode of transmission
⢠Ingestion of contaminated water
⢠Transmitted through skin pores
⢠Transmitted through intermediary
host, a tiny snail called Oncomelania
quadrasi
34. Clinical manifestations
⢠Pruritic rash, known as âswimmerâs itchâ,
develops at the site of penetration
⢠Low-grade fever, myalgia, and cough
⢠Abdominal discomfort due to hepatomegaly,
splenomegaly and lymphadenopathy
⢠Bloody-mucoid stools, similar to those in
dysentery, that comes on and off for weeks
⢠Becomes icteric and jaundice
35. ⢠Later, belly becomes big because of an
inflamed liver, resulting from
accumulation of eggs in the organ.
⢠After some years suffering from this
chronic disease the patient becomes
weak and pale and there is marked
muscle wasting.
⢠When the parasites reach the brain, the
victim experience severe headaches,
dizziness and convulsions.
36. Modalities of Treatment
⢠Praziquantel tablet for 6 months; 1 tab 2x
a day for three months, then 1 tab a day
for another three months.
⢠Fuadin injection given either IM or IV.
The patient should consume 360mg for
the entire treatment.
⢠If the patient continues to live in the
endemic area, he frequentl gets
reinfected and has to be treated.
37. Prevention and Control
To prevent schistosomiasis, one
must have thorough knowledge of
how the disease spreads. The basic
principle of its prevention and
control is interrupting the life cycle
of the worm and protecting people
from infection.
38. ⢠Have a stool examination
⢠Reduce snail density by:
â Clearing vegetation, thus exposing the
snails to sunshine
â Constructing a drainage system (canals) to
dry the areas where the snails thrive; and
â Improve farming through proper irrigation
and drainage, crop rotation and removal of
weeds, thus disturbing the living conditions
of the snail.
39. ⢠Diminish infection rate through:
âProper waste disposal
âControl of stray animals
âProhibition of people, especially children,
from bathing in infested streams
âThe construction of footbridges over
snail-infested streams
âProvision of an adequate water supply for
bathing and laundering and safe water
for drinking
40. Schistosomiasis Control
Program
Goal: To reduce the disease prevalence by 50%
with a vision of eliminating the disease
eventually in all endemic areas
41. Objectives:
The Schistosomiasis control Program has the
following objectives:
1. Reduce the Prevalence Rate by
50% in endemic provinces; and
2. Increase the coverage of mass
treatment of population in endemic
provinces.
43. Filariasis
⢠A parasitic disease caused by microscopic,
threadlike African eye worm. The adult worm
can live only in the human lymphatic system.
The disease is an extremely debilitating and
stigmatizing and affects men, women, and
children. It affects the poor in both rural and
urban areas. The disease is rarely fatal;
however, it causes extensive disability, gross
disfigurement, ad untold suffering in millions
of men, women, and children.
44. Causative organism
⢠Wuchereria bancrofti â a thread worm
four to five centimeters long and affects
the lymph nodes and lymph vessels of
the legs. Arms, vulva, and breast.
⢠Brugia malayi â shows manifestations
resembling that of the bancroftian, but
swelling of the extremities is confined to
the areas below the knees and below the
elbow
45. ⢠Brugia timori â rarely affects the
genitals
⢠Loa loa â filarial parasite transmitted
by the deer fly.
46. Mode of Transmission
⢠Transferred from person to person through
mosquito bites.
⢠Persons having circulating microfilariae are
outwardly healthy but transmit the infection
to others through mosquito bites.
⢠Persons w/ chronic filarial swellings suffer
severely from the disease but no longer
transmit the infection.
47. Symptoms
⢠On-and-off chills
⢠Headache
⢠Fever that lasts between months and one year
after the insect bite
⢠Swelling
⢠Redness
⢠Pain in the arms, legs or scrotum
⢠Areas of abscesses may appear as a result of
dying worms or a secondary bacterial
infection
48. Diagnostic procedure
⢠Circulating filarial antigen (CFA) test â
finger-prick blood droplet
Modalities of Treatment
⢠Ivermectin, albendzol, or
diethylcarbamazine (DEC)
⢠Surgery may be performed
49. Nursing management
⢠Health education and information
dissemination as to be the mode of
transmission must be carried out.
⢠Environmental sanitation ad the
destruction of breeding places of
mosquitoes must be emphasized
50. ⢠Psychological and emotional support
to client and the family are necessary
⢠Personal hygiene must be
encouraged
⢠The course of the disease must be
explained
51. Prevention and Control
⢠Mosquitoes that carry the microscopic
worms usually bite between the hours of
dusk and dawn. It is therefore advised that
people living in an area with filariasis should:
âSleep under mosquito net
âUse mosquito repellant in the hours
between dusk and dawn
âTake a yearly dose of medicine that kills
the worms circulating in the blood
52. ⢠Filariasis is a major parasitic
infection, which continues to be a
public health problem in the
Philippines.
⢠It was first discovered in the
Philippines in 1907 by foreign
workers.
53. ⢠Consolidated field reports showed a
prevalence rate of 9.7% per 1000
population in 1998.
⢠It is the second leading cause of
permanent and long-term disability.
The disease affects mostly the poorest
municipalities in the country about
71% of the case live in the 4th-6th class
type of municipalities.
54. ⢠The World Health Assembly in
1997 declared âFilariasis
Elimination as a priorityâ and
followed by WHOâs call for global
elimination.
55. ⢠A sign of the DOHâs commitment
to eliminate the disease, the
programâs official shift from
control to elimination strategies
was evident in an Administrative
Order #25-A,s 1998 disseminated
to endemic regions.
56. National Filariasis
Elimination Program
Goal: To eliminate Lymphatic Filariasis as a
public health problem in the Philippines by
year 2017
57. Vision: Healthy and productive individuals
and families for Filariasis-free Philippines
Mission: Elimination of Filariasis as a
public health problem thru a
comprehensive approach and universal
access to quality health services
58. General Objectives: To decrease
Prevalence Rate of filariasis in endemic
municipalities to <1/1000 population.
Specific Objectives:
The National Filariasis Elimination
Program specifically aims to:
1. Reduce the Prevalence Rate to
elimination level of <1%;
59. 2. Perform Mass treatment in all
established endemic areas;
3. Develop a Filariasis disability
prevention program in established
endemic areas; and
4. Continue surveillance of
established endemic areas 5 years
after mass treatment.
60. Program Strategies:
STRATEGY 1. Endemic
Mapping
STRATEGY 2. Capability Building
STRATEGY 3. Mass Treatment
(integrated with other existing
parasitic programs)
STRATEGY 4. Support Control
61. STRATEGY 5. Monitoring
and Supervision
STRATEGY 6. Evaluation
STRATEGY 7. National Certification
STRATEGY 8. International
Certification
63. Malaria is a parasite-caused
disease that is usually acquired
through the bite of a female
Anopheles mosquito.
64. Etiologic agent
⢠Plasmodium falciparum
⢠Plasmodium vivax â non-life
threatening, except for the very young
and very old
⢠Plasmodium malariae
⢠Plasmodium ovale
65. Incubation period
⢠12 days for P. Falciparum
⢠14 days for P. vivax and vale
⢠30 days for P. malariae
66. It can be transmitted in the following
ways:
(1) blood transfusion from an infected
individual;
(2) sharing of IV needles;
(3) transplacenta (transfer of malaria
parasites from an infected mother to
its unborn child).
67. Clinical manifestations
⢠Paroxysms with shaking chills
⢠Rapidly rising fever with severe headache
⢠Profuse sweating
⢠Myalgia, with feelings of well-being in
between
⢠Splenomegaly, hepatomegaly
⢠Orthostatic hypotension
⢠Paroxysms may last for 12 hours and may
attack daily or every two days
68. ⢠In children:
â Fever may be continuous
â Convulsions and gastrointestinal symptoms
are prominent
â Splenomegaly is present
⢠In cerebral malaria:
â Severe headache, vomiting and changes in
sensorium
â Jacksonian or grand mal seizure may occur
71. This parasite-caused disease is
the 9th leading cause of morbidity in
the country.
Goal: To significantly reduce malaria
burden so that it will no longer affect
the socio-economic development of
individuals and families in endemic
areas.
72. Vision: Malaria-free Philippines
Mission: To empower health
workers, the population at risk and
all others concerned to eliminate
malaria in the country.
73. Objectives:
Based on the 2011-2016 Malaria
Program Medium Term Plan, it
aims to:
1. Ensure universal access to
reliable diagnosis, highly effective,
and appropriate treatment and
preventive measures;
74. 2. Capacitate local government
units (LGUs) to own, manage, and
sustain the Malaria Program in
their respective localities;
3. Sustain financing of anti-malaria
efforts at all levels of operation;
and
75. 4. Ensure a functioning quality
assurance system for malaria
operations.
76. Program Strategies:
The DOH, in coordination with its
key partners and the LGUs,
implements the following
interventions:
1.Early diagnosis and prompt
treatment
77. ⢠Diagnostic Centers were
established and strengthened to
achieve this strategy.
⢠The utilization of these
diagnostic centers is promoted
to sustain its functionality.
78. 2. Vector control
The use of insecticide-treated
mosquito nets,
complemented with indoor
residual spraying, prevents
malaria transmission.
79. 3. Enhancement of local
capacity
LGUs are capacitated to
manage and implement
community-based malaria
control through social
mobilization.
81. Rabies
⢠A specific, acute viral infection
communicated to man by the
saliva of an infected animal
82. Etiologic agent
⢠Rhabdovirus
âBullet-shaped
âSensitive to sunlight, ultraviolet
light, ether, formalin, mercury and
nitric acid
83. Incubation period
⢠One week to seven-and-a-half months
in dogs
⢠Ten days to fifteen years in human
âDepends on the distance of bite to the
brain, extensiveness of bite, species of the
animal, richness of the nerve supply in the
are of the bite, resistance of the host
84. Modes of Transmission
⢠An infected animal carries the rabies
virus in its saliva and transmits it to
humans by biting.
⢠Virus spread when the saliva comes
in contact with the personâs mucus
membranes
85. Clinical manifestations
⢠Prodromal/ invasion phase
â Fever, anorexia, malaise, sore throat, copious
salivation, lacrimation, perspiration, irritability,
hyperexcitability , apprehensiveness,
restlessness, mental depression, melancholia
and marked insomia
â Pain at the site of bite, headache and nausea
â Pt. becomes sensitive to light, sound and
temperature
86. Nursing manangement
⢠Isolate the patient
⢠Give emotional and spiritual support
⢠Provide optimum comfort and prevent injury,
especially during hyperactive episodes
⢠Darken the room and provide a quiet environment
⢠Pt. should not be bathed and there should not be
any running water in the room or within the hearing
distance of the pt.
⢠Concurrent and terminal disinfection should be
carried out
88. Rabies is considered to be a
neglected disease, which is
100% fatal though 100%
preventable.
It is not among the leading
causes of mortality and
morbidity in the country but it is
regarded as a significant public
health problem because (1) it is
89. acutely fatal infection and (2) it
is responsible for the death of
200-300 Filipinos annually.
Vision: To Declare Philippines
Rabies-Free by year 2020
90. Goal: To eliminate human rabies by
the year 2020
Program Strategies:
To attain its goal, the program
employs the following strategies:
1. Provision of Post Exposure
Prophylaxis (PEP) to all Animal Bite
Bite Treatment Centers (ABTCs)
91. 2. Provision of Pre-Exposure
Prophylaxis (PrEP) to high
risk individuals and school
children in high incidence
zones
3. Health Education
92. Public awareness will be
strengthened through the Information,
Education, and Communication (IEC)
campaign.
⢠Program shall be integrated into the
elementary curriculum and the
Responsible Pet Ownership (RPO)
shall be promoted.
93. ⢠In coordination with the
Department of Agriculture, the
DOH shall intensify the
promotion of dog vaccination,
dog population control, as well
as the control of stray animals.
94. RA 9482 or
âThe Rabies Act of 2007â
rabies control ordinances shall
be strictly implemented. In the
same manner, the public shall be
informed on the proper
management of animal bites
and/or rabies exposures.
95. 4. Advocacy
The rabies awareness
and advocacy campaign is a year-round
activity highlighted on two
occasions â March as the Rabies
Awareness Month and September
28 as the World Rabies Day.
96. 5. Training/Capability Building
Medical doctors and
Registered Nurses are to be
trained on the guidelines on
managing a victim.
97. 6. Establishment of ABTCs by
Inter-Local Health Zone
7. DOH-DA joint evaluation
and declaration of Rabies-free
islands
http://www.doh.gov.ph/content/national-rabies-prevention-and-control-program.html
98. Dengue
⢠An acute febrile disease caused by infection
with one of the serotypes of dengue virus,
which is transmitted by mosquito genus
Aedes.
⢠Dengue hemorrhagic fever is a severe,
sometimes fatal manifestation of the dengue
virus infection characterized by a bleeding
diathesis and hypovolemic shock.
99. Etiological agent
⢠Flaviviruses 1, 2, 3, 4, a family of
Togaviridae, are small viruses that
contain single-stranded RNA.
⢠Arboviruses group B
100. Mode of Transmission
⢠Bite of an infected mosquito,
principally the Aedes aegypti
âAedes aegypti is a day-biting mosquito
âBreeds in areas of stagnant water
âHas limited, low flying movement
âIt has fine white dots at the base of the
wings and white bands on the legs
101. ⢠Aedes albopictus may contribute to
the transmisson of the degree virus
in rural areas
⢠Other contributory mosquitoes:
âAedes polynensis
âAedes scutellaris simplex
102. Incubation period
⢠The incubation period is three to fourteen
days; commonly seven to ten days
Sources of Infection
⢠Infected persons â the virus is present in the
blood of patients during the acute phase of the
disease and will become a reservoir of the virus,
sucked by mosquitoes, which may then transmit
the disease.
103. ⢠Standing water â any stagnant water in
the household and its premises are usual
breeding places of these mosquitoes.
104. Clinical Manifestations
⢠Dengue fever
â Malaise
â Anorexia
â Fever and chills accompanied by severe frontal
headache, ocular pain, myalgia with severe
backache, and arthralgia
â Fever is non-remitting and persists for 3-7 days
â Nausea and vomiting
â Rash is prominent on the extremities and the
trunk
â Petechiae
105. ⢠Dengue Hemorrhagic Fever (DHF)
â This severe form of dengue virus infection is
manifested by fever, hemorrhagic diathesis,
hepatomegaly and hypovolemic shock.
106. Phases of the Illness
⢠Initial febrile phase lasting from two to three
days
â Fever (39-40°C) accompanied by headache
â Febrile convulsions may appear
â Palms and sole are usually flushed
â Positive tourniquet test
107. â Anorexia, vomiting, myalgia
â Maculopapular or petechial rash may be
present and usually starts in the distal
portion of the extremities, the skin appears
purple, with blanched areas of varying size.
â Generalized or abdominal pain
â Hemorrhagic manifestations like positive
tourniquet test, purpura, epitaxis, and gum
bleeding may be present
108. ⢠Circulatory phase
â There is a fall of temperature accompanied
by profound circulatory changes, usually on
the 3rd to 5th days
â Patient becomes restless, with cool, clammy
skin
â Cyanosis is present
â Profound thrombocytopenia accompanies
the onset of shock
â Bleeding diathesis may become more
severe and lead to GIT hemorrhage
109. â Shock may occur due to loss of plasma from
intravascular spaces; hemoconcentration
with markedly elevated hematocrit is
present
â Pulse is rapid and weak; pulse pressure
becomes narrow and blood pressure may
drop ti an unobtainable level
â Utreted shock may result in com; metabolic
acidosis and death may occur within two
days
â With effective therapy, recovery may follow
in two to three days
110. Classification according to severity
⢠Grade I
â There is fever accompanied with non-specific
constitutional symptoms and the only
hemorrhagic manifestation is positive (+) in the
tourniquet test.
⢠Grade II
â All signs of Grade I, plus spontaneous bleeding
from the nose, gums, and GIT, are present
111. ⢠Grade III
â There is the presence of circulatory failure,
as manifested by a weak pulse, narrow
pulse pressure, hypotension, cold, clammy
skin, and restlessness
⢠Grade IV
â There is profound shock, and undetectable
blood pressure and pulse
113. Nursing Management
⢠Patient should be kept in a mosquito-free
environment to avoid further transmission of
infection
⢠Keep patient at rest during bleeding episodes
⢠Vital signs must be promptly monitored
⢠In cases of nose bleeding, keep the patientâs
trunk elevated; apply ice bag to the bridge of
nose and to the forehead
⢠Observe for signs of shock, such as slow pulse,
cold, clammy skin, prostration, and fall of blood
pressure
114. ⢠Restore blood volume by putting the
patient in Trendelenberg position to
provide greater blood volume to the
head part
⢠Patient with dengue is not infectious;
therefore, isolation is not required.
115. Prevention and Control
⢠Health education
⢠Early detection and treatment of cases will not
worsen the victimâs condition
⢠Treat mosquito nets with insecticides
⢠House spraying is advised
â Changing water and scrubbing sides of flower vases once
a week,
â Destroying the breeding places of mosquitoes by
cleaning the surroundings, and
â Keeping the water containers covered
⢠Avoid hanging too many clothes inside the house
⢠Case finding
117. The National Dengue Prevention
and Control Program was first
initiated by the Department of
Health (DOH) in 1993.
Region VII and the National
Capital Region served as the
pilot sites.
118. It was not until 1998 when the
program was implemented
nationwide.
The target populations of the
program are the general
population, the local government
units, and the local health workers.
119. Vision: Dengue Risk-Free
Philippines
Mission: To improve the quality of
health of Filipinos by adopting an
integrated dengue control approach in
the prevention and control of dengue
infection.
120. Goal: Reduce morbidity and mortality
from dengue infection by preventing
the transmission of the virus from the
mosquito vector human.
Objectives: The objectives of the
program are categorized into three:
health status objectives; risk reduction
objectives; and services & protection
objectives.
121. Health Status Objectives:
⢠To reduce incidence from 32
cases/100,000 population to 20
cases/100,000 population;
⢠To reduce case fatality rate by
<1%; and
⢠To detect and contain all
epidemics.
122. Risk Reduction Objectives:
⢠Reduce the risk of human exposure to
aedes bite by House index of <5 and
Breteau index of 20;
⢠Increase % of HH practicing removal
of mosquito breeding places to 80%;
and
⢠Increase awareness on DF/DHF to
100%.
124. It may be acquired through:
⢠Sexual contact (orogenital,
anogenital) between
opposite sexes, as well as of
the same sex.
125. ⢠Bacteria are transmitted
through direct contact with
contaminated vaginal
secretions of the mother as
the baby comes out of the
birth canal.
126. Objective:
⢠Reduce the transmission of
HIV and STI among the Most
At Risk Population and
General Population and
mitigate its impact at the
individual, family, and
community level.
127. Program Activities:
With regard to the prevention and
fight against stigma and
discrimination, the following are the
strategies and interventions:
1. Availability of free voluntary HIV
Counseling and Testing Service;
128. 2. 100% Condom Use Program
(CUP) especially for
entertainment establishments;
3. Peer education and outreach;
4. Multi-sectoral coordination
through Philippine National
AIDS Council (PNAC);
129. 5. Empowerment of communities;
6. Community assemblies and for
a to reduce stigma;
7. Augmentation of resources of
social Hygiene Clinics; and
8. Procured male condoms
distributed as education materials
during outreach.