1 / 8

Giampaolo Mezzabotta Medical Officer / Tuberculosis World Health Organization

PMDT expansion is first of all expansion of DR-TB detection services W orkshop on the development and implementation of supervision and patient support approach in Drug Resistant programme in Nepal organized by HERD Kathmandu - April 30, 2014. Giampaolo Mezzabotta

kina
Download Presentation

Giampaolo Mezzabotta Medical Officer / Tuberculosis World Health Organization

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. PMDT expansion is first of all expansion of DR-TB detection servicesWorkshop on the development and implementation of supervision and patient support approach in Drug Resistant programme in Nepal organized by HERDKathmandu - April 30, 2014 Giampaolo Mezzabotta Medical Officer / Tuberculosis World Health Organization Country Office for Nepal

  2. Fresh from HQs • http://www.who.int/tb/laboratory/xpert_launchupdate/en/

  3. Overview of DR-TB in Nepal MDR−TB burden (from WHO Global TB Report 2013) Estimated total burden: 990 (among notified TB cases) Total confirmed cases: 354 (35.8% of estimated) Enrolled on treatment: 288 (81.4% of confirmed) Treatment Success Rate (from NTP Annual report 2014) 61.3%, reaching a peak of 72% in the cohort enrolled in March – July 2010* Key features of PMDT in Nepal • standard treatment protocol for all MDR-TB cases; individualized Tx for pre- and XDR-TB • treatment administered by DOT at DR-TB centres and sub-centres throughout its duration; • two NRL, supervised by SRL (Gauting, Germany), both of them located in Kathmandu; • supply of quality-assured SLD from GDF; • no stock-out of SLD so far; • travel & nutrition bonus (NPR 1500 (~ 15US$)/month) provided to patients. * = In the second quarter of 2013-14 the TSR reached 80%.

  4. From field to lab to Tx Diagnostic pathway to MDR-TB in 431 retreatment cases reported in Mid-West Region from July 2011 to July 2012 -62% -60% -5% From: “Screening retreatment tuberculosis patients for drug resistance in mid-west Nepal: how well are we doing?”, MB Tharu et al, PHA 2014; 4(1): 60-65 -38% -38%

  5. Has the situation improved ever since? • NTC and partners are currently running 22 GeneXpertmachines, one of them in MWDR; 7 more machines in the pipeline for 2014. • Guidelines and algorithms on the rational use of GeneXpert have been developed; • WHO 2013 policy recommendations: “Xpert MTB/RIF should be used rather than conventional microscopy, culture and DST as the initial diagnostic test in adults suspected of having MDR-TB or HIV-associated TB (strong recommendation, high-quality evidence)” • Strategic positioning of GeneXpert across the country, along with adequate logistic for sputum transport, should ensure equitable and early access to DR-TB diagnosis.

  6. Realistic targets? Based on current estimates, notification data, projections and case-finding strategy (Xpert C/DST), in the year 2014 NTP should aim at detecting: 710 MDR-TB cases among notified DR-TB suspects(1) 185 MDR-TB cases among initially SS- patients(2) 125 MDR-TB cases among DR-TB contacts(3) 100 XDR-TB and pre-XDR cases(4) TOTAL = 1120 DR-TB cases Notes (1): considering as DR-TB suspects the 2800 expected relapse, failure and defaulter cases; (2): assuming to test with GeneXpert all 8400 expected new SS- cases; (3): assuming 5 contacts per current DR-TB case and a prevalence of 5% among them; (4): estimating an incidence of XDR equivalent to 10% the incidence of MDR-TB

  7. Conclusions Even if the target of 1120 DR-TB cases enrolled on treatment in 2014 will not be achieved, we can certainly forecast a substantial increase in the number of DR-TB patients. Adopting new treatment approaches, tapping the huge potential for community-based PMDT in Nepal, is more of a “must” than a choice.

  8. Thank you for the attention

More Related