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Introducing fixed dose combination tablets into DR CONGO using the Global TB Drug Facility
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Country profile: DR Congo • DR Congo is one of the world’s 22 high burden TB countries • Size: 2 345 000 Km² • Population: 54 141 875 • Health organization: • 20 TB provincial agencies • 515 health districts • 738 health centers • DOTS coverage: 70%
Country profile: DR Congo(2) • Notification: • New case smear positive: 44 518 • All cases: 70 625 • Notification rate (new case): 82 / 100 000 Pop • Treatment outcome 2001(new case SS+): • Treatment success rate: 78% • Dead rate: 6% • Defaulted rate: 10 % • Failed: 1% • Transferred: 4% • Various donors are providing financial supports (USAID, EU, NGOs,etc). GFATM has provided DRC with additional funding to fight TB
Why did DR Congo apply to GDF? • DR Congo applied for assistance from the GDF because the National Programme (NTP) did not have enough drugs to treat TB patients. • In fact, the country had lacked buffer stocks for 10 years, some regions had no drugs, and the programme’s funding partners were unable to increase their budgets for drugs.
Why did DR congo apply to GDF? • As result of periodic shortages, DOTS could not be maintained or extended throughout the country even though DR Congo’s TB control programme was generally good. • The National Programme in DR Congo decided to shift to the 4FDC because of a need for simplified drug management and the compatibility of the existing TB drug treatment regimens in DR Congo.
How did the GDF assist DR Congo ? • Grant of TB drugs for 63,000 patients in Year 1 and 63,000 in Year 2 • Total approx value = $1.5 million • Quality assured FDCs • Technical support from GDF secretariat in Geneva and three in-country technical missions
Introducing of 4 fixed dose Combination with GDF grant • TB regimen in DRC NTP: • Category 1: 2RHZE/6HE • Category 2: 2SRHZE/1RHZE/5R3H3E3 • The DR Congo is a current recipient of GDF support, having been approved for a 3-year grant of TB drugs, including the 4 FDC, in november 2001. • Before this period, the National TB Programme (NTP) was using 3 FDCs (RHZ) and Ethambutol separately.
4FDC improve the use of drug by TB patients in NTP of DR Congo • Shifting from 3FDC to 4 FDC reduce the number of daily tablets to be taken by TB patients. • A TB patient weighting 50 Kg had 8 tablets with 3 FDCs and have now only 4 tablets. • 4FDC improved the treatment compliance of TB patients
4FDC improve TB drug management in NTP of DR Congo • Improve case finding because TB drugs are available • Simplified drug ordering • Simplified stocking and distribution • Reduced complex prescription • Minimised the potential error
4FDC improve TB drug management in NTP of DR Congo(2) • Sponsored by WHO DRC office, NTP organised a workshop in aim to get a guide for drug management. • A management committee, including NTP responsible, Health Minister representative and NGOs, was set up.
4FDC improve TB drug management in NTP of DRC(3) • As the NTP will manage TB drug for the first time, it was necessary to hire a pharmacist. • A guideline on the TB drugs management, named “PATIMED” is written. It describes TB drug recording and reporting system and how to use the 4 FDCs.
4FDC improve TB drug management in NTP of DRC(4) • Some of provincial TB manager were trained to use the guide. • The district health managers are not trained yet. • The supervision on the field work needs to be reinforced to make sure that drugs are used as recommended
4FDC improve DOTS strategy • In 2002 and 2003, 2 more provincial agencies expanded DOTS strategy. • In 2004, 2 other provincial agencies will expand DOTS strategy. • DR Congo plans to achieve 90% DOTS coverage by the end of 2004. • NTP is improving case finding
Conclusion • The provision of 4FDC drugs from GDF has made it possible to improve the drug management skills of TB control Programme personnel and primary health care workers who are responsible for the diagnosis and treatment of TB. • With available and consistent drug supply, the TB programme plans to extend DOTS in whole the country . • 4FDC improve the use of drug for TB patients • GDF ensured that there were drugs and buffer available for all TB patients