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Components of a TB program. Capacity Building for Tuberculosis control, with a specific focus on TB/HIV in CAREC Member Countries. Many questions arise when we speak about TB control. Aims of this presentation. To set the main components for TB control

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Components of a tb program

Components of a TB program

Capacity Building for Tuberculosis control, with a specific focus on TB/HIV in CAREC Member Countries

Montego Bay, Jamaica



Aims of this presentation
Aims of this presentation

  • To set the main components for TB control

  • To describe the classic principles of the DOTS strategy and its achievements

Montego Bay, Jamaica

Stop TB Department


The tb program
The TB Program

…is a join effort of the goverment and the community, acting to reduce, and in the long term to eliminate, the epidemiological, social and economic problems, and the human suffering caused by tuberculosis, by means of the rational use of technical knowledge and available resources.

WHO, Standard Procedures Manual, Scientific Publication, No 418

Montego Bay, Jamaica


Components of a tb program1
Components of a TB program

  • ?

  • ?

  • ?

  • ?

Montego Bay, Jamaica


Components of a tb program2
Components of a TB program

  • Structure, human resources and integration in the health services

    • Strategic Plan

    • Budget

  • Technical guidelines, norms and protocols

  • Activities:

    • Case Detection

    • Laboratory Services

    • Treatment (including cohort analysis)

  • Drug supply

  • Information system – Epidemiological surveillance

  • Supervision

  • Training

  • Research

  • Health promotion

Montego Bay, Jamaica


Components of a TB program

Coordination

Strategies & Policies

  • Drug supply

  • Human Resources

  • Laboratory

  • Information System

Montego Bay, Jamaica


Areas of ntp activities
Areas of NTP activities

  • Organizational and budgetary decisions

  • Technical policies

  • Information systems

    4. Laboratory services

  • Supplies and logistics

  • Training, communication and advocacy

Montego Bay, Jamaica


TB Care for All:

Evolution of

the DOTS Strategy

Montego Bay, Jamaica


History of DOTS

80s : Styblo defines IUATLD model to control TB in Tanz.

1991: WHA establishes the 70/85 targets for 2000

1993: WHO declares TB as a global emergency

1994: New TB control framework

1995: DOTS launched as a WHO strategy

1998: London committee,StopTB Partnership launched

2000: Amsterdam declaration; targets in 2005

2001: 6 Working Groups and GDF launched

2001: GFATM, MDGand Washington Commitment

2002: Expanded Framework DOTS Brand Name

Montego Bay, Jamaica


The dots strategy
The DOTS Strategy

is a comprehensive strategy which ensures cure to majority of tuberculosis patients presenting to primary health care services.

Source: Stop TB at the source, WHO/TB/95.183

Use DOTS more widely, WHO/TB/97.224

Montego Bay, Jamaica


Dots components
DOTS Components

  • Government commitment to ensuring sustained, comprehensive TB control activities

  • Case detection by sputum smear microscopy among symptomatic patients self-reporting to health services

  • Standardized short-course chemotherapy using regimens of six to eight months, for at least all confirmed smear positive cases. Good case management includes directly observed therapy (DOT) during the intensive phase for all new sputum positive cases, the continuation phase of rifampicin-containing regimens and the whole re-treatment regimen.

  • A regular, uninterrupted supply of all essential anti-TB drugs

  • A standardized recording and reporting system that allows assessment of case-finding and treatment results for each patient and of the TB control program performance overall

    Int J Tuberc Lung Dis 2001; 5(3):213-215

Montego Bay, Jamaica


Aspects of dots
Aspects of DOTS

  • Technical

  • Logistical

  • Operational

  • Political

Montego Bay, Jamaica


Aspects of dots technical
Aspects of DOTS: Technical

  • Case detection and diagnosis

  • Standardized short-course chemotherapy

  • Direct observation during the initial phase of treatment (DOT)

  • Recording and reporting of progress and cure

Montego Bay, Jamaica


DOT

Approximately one third of patients do not take medications regularly as prescribed, and perhaps one third of patients who do take medications make errors in self-administration.

Sbarbaro JA. Ann. Allergy 1990

Montego Bay, Jamaica


Aspects of dots logistical
Aspects of DOTS: Logistical

  • Dependable drug and diagnostic supply

  • Laboratories for microscopy

  • Supervision and training of health workers

Montego Bay, Jamaica


Aspects of dots operational
Aspects of DOTS: operational

  • Five basic core elements

  • Flexibility in implementation

Montego Bay, Jamaica


Aspects of dots political
Aspects of DOTS: political

  • Government commitment

  • Policy formulation

  • Resource mobilization

Montego Bay, Jamaica


Three phases to gradual dots implementation
Three phases to gradual DOTS implementation

1. A pilot project phase (emphasis in technical and operational aspects)

2. An expansion phase (emphasis in logistical and training aspects)

3. A maintenance phase

Montego Bay, Jamaica


An efficient system of tb control should be an integral part of primary health care
An efficient system of TB control should be an integral part of Primary Health Care

Montego Bay, Jamaica


DOTS of Primary Health Care is more than:

  • DOT

  • Only 5 components (but: planning, budgeting, financing, training, supervision, mapping, staff management, data analysis, assessment)

  • Strictly 5 components (but: flexible DOT in low incidence, culture, X-ray, DOTS Plus)

Montego Bay, Jamaica


DOTS Expansion 1990-2002: of Primary Health CareRapid and Impressive

180

155

DOTS launched

147

126

122

104

98

New Framework

73

19

15

10

Montego Bay, Jamaica

Global Tuberculosis Control. WHO Report 2003. WHO/HTM/TB/2004.331


Montego Bay, Jamaica of Primary Health Care


Montego Bay, Jamaica of Primary Health Care


Montego Bay, Jamaica of Primary Health Care


Montego Bay, Jamaica of Primary Health Care


Treatment Outcomes by WHO Region of Primary Health Care: DOTS vs. non-DOTS2001 Cohort

DOTS

Non-DOTS

Not treated successfully

Treated successfully

Not evaluated

Montego Bay, Jamaica

Global Tuberculosis Control. WHO Report 2003. WHO/HTM/TB/2004.331


Where are we going with dots
Where are we going with DOTS? of Primary Health Care

Montego Bay, Jamaica


Global tb control targets
Global TB Control Targets of Primary Health Care

  • WHA (year 2005):

    - To detect 70% of infectious TB cases

    - To treat successfully 85% of detected cases

  • MDGs (2015) – Goal 6: Combat HIV/AIDS, malaria and other diseases

    Target 8: to have halted by 2015 and begun to reverse the incidence of malaria and other infectious diseases

    - Indicator 23: reduction in prevalence and deaths

    - Indicator 24: proportion of cases detected and cured under DOTS

    In practice: 50% reduction in TB prevalence and deaths by 2015

Montego Bay, Jamaica

Stop TB Department


Progress towards global targets 70 85 by 2005
Progress towards Global Targets of Primary Health Care70/85 by 2005

  • Case detection rate: 43%

  • Treatment success rate: 82%

    Best forecast:

    treatment success achieved

    case detection close, but not achieved

Montego Bay, Jamaica

Stop TB Department


Montego Bay, Jamaica of Primary Health Care


Progress towards the 70 85 targets selected caribbean countries 2003
Progress towards the 70/85 targets, selected Caribbean Countries, 2003

Montego Bay, Jamaica


Quality tb care for all ensure a high standard
Quality TB care for all: Countries, 2003Ensure a high standard

  • Patient care to cure and prevent TB is the ultimate goal of DOTS

  • The foundation of DOTS is effective patient care which alleviates suffering, as well as controls and prevents TB in a community

  • A standard of care for TB exists already, and is evidence-based, but needs further promotion among all care providers

  • Simply, each care provider, public or private, should:

    1- Diagnose TB quickly (i.e., bacteriological confirmation)

    2- Treat TB properly (i.e., SCC and treatment support)

    3- Report TB cases and treatment outcomes

  • If all providers did the right thing, we would control TB

Montego Bay, Jamaica

Stop TB Department


Conclusion
Conclusion Countries, 2003

If all providers did the right thing, we would control TB

If all the NTP could ensure the DOTS components in place, we would control TB

Montego Bay, Jamaica


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