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MDR- and XDR-TB in the Context of HIV Infection Lesotho program

Dr. Hind E. Satti Partners In Health, Lesotho March, 2008. MDR- and XDR-TB in the Context of HIV Infection Lesotho program. Myself and MDR TB. 12,275 TB cases notified in 2007 Estimated prevalence of 544 per 100,000 population

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MDR- and XDR-TB in the Context of HIV Infection Lesotho program

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  1. Dr. Hind E. Satti Partners In Health, Lesotho March, 2008 MDR- and XDR-TB in the Context of HIV Infection Lesotho program

  2. Myself and MDR TB

  3. 12,275 TB cases notified in 2007 Estimated prevalence of 544 per 100,000 population Estimated annual incidence for all cases is 691 per 100,000 population Estimated incidence of Sputum smear positive cases is 281 per 100,000 population 75% of new TB cases among age-group 15-44 years; Estimated all TB deaths is 107/100,000 annually The HIV prevalence rate in Lesotho stands at 23.2% in 2005; 80% of TB cases are HIV positive(NTP 2008); 109MDR-TB cases currently on treatment TB Situation in Lesotho

  4. National Guidelines and training • May 2007: National guidelines for management of MDR-TB • Collaboration with MOHSW and WHO • Developed from WHO global guidelines. • July 2007: Training of health staff • Training materials for health staff at district level. • Training materials for MDR-TB treatment supporters.

  5. Building national lab capacity • Equipment • Staffing • Training and supervision • infrastructure • Close relationship with SRL • Culture and DST while national capacity is being built • Proficiency testing Central TB laboratory is now performing culture and first line DST as well as the Rapid RIF testing. TB Culture and DST

  6. All NTP staff • TB Officers at district hospitals • Health centre nurses providing TB care • Routine HIV screening of MDR-TB patients, partners, family members • Protocol for “medium-risk” and “high-risk” • Sputum sent to national TB laboratory • Initially sent to MRC Pretoria (March 2007) • First-line DST now available in Maseru (Sept 2007) • Screening of household contacts Case Detection

  7. Outpatient • TB clinics and general outpatient clinics • Treatment supporters • Family members • Inpatient • Cross-infection of patients • Protection of health workers (TB and HIV) Infection Control

  8. Initiation of Treatment • MDR-TB Clinical Teams at all district hospitals • Medical Officer • ART Nurse • TB Officer • TB Coordinator • Empiric treatment for high-risk suspects • Early initiation of ART in all co-infected patients, regardless of CD4 • Referral to Maseru for complicated patients

  9. Community-Based Care • MDR-TB Treatment Supporters • Village Health Worker; community volunteer; KYS counselor • Accepted by the patient • Trained and supervised by District MDR-TB Clinical Team • Incentives

  10. Community-Based Care • Twice-daily DOT • Injections • Psychosocial support • Screening household contacts • Accompaniment to clinical visits

  11. Inpatient Care • Very sick patients • Bedridden • Severely wasted • Severe side effects • Severe hypokalemia • Acute renal failure • Severe OIs • Meningitis • Esophageal candidiasis

  12. Started on August 2007 • 109 patients enrolled. • 48 patients pre GLC cohort. • 72% HIV co-infection rate • History of multiple failed TB treatments • Average of 8 household contacts per patient Lesotho MDR-TB Programme

  13. Geography Advanced HIV disease Severe malnutrition/wasting Clinical complications and side effects Working through the “backlog” quickly Challenges

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