Scribd Logo
Upload

Welcome to Scribd!

  • 24 views

    Tuberculosis in Developing Countries: Dilemmas: Erik Post, MD MSC Royal Tropical Institute Amsterdam

    Uploaded by

    garuda unri
    1) The DOTS strategy aims to detect 70% of infectious tuberculosis cases and successfully treat 85% of detected cases by 2015. However, it is unclear if these targets will be met given current average rates of progress. 2) Expanding tuberculosis control requires addressing related issues like HIV/TB co-infection, multidrug-resistant tuberculosis, and health system strengthening. Engaging all healthcare providers, empowering communities, and promoting research are also important. 3) A funding gap exists for fully implementing the Global Plan to stop tuberculosis from 2006-2015. Securing political commitment and adequate funding is crucial to saving lives and expanding treatment.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    Tuberculosis in Developing Countries: Dilemmas: Erik Post, MD MSC Royal Tropical Institute Amsterdam

    Uploaded by

    garuda unri
    24 views23 pages
    1) The DOTS strategy aims to detect 70% of infectious tuberculosis cases and successfully treat 85% of detected cases by 2015. However, it is unclear if these targets will be met given current average rates of progress. 2) Expanding tuberculosis control requires addressing related issues like HIV/TB co-infection, multidrug-resistant tuberculosis, and health system strengthening. Engaging all healthcare providers, empowering communities, and promoting research are also important. 3) A funding gap exists for fully implementing the Global Plan to stop tuberculosis from 2006-2015. Securing political commitment and adequate funding is crucial to saving lives and expanding treatment.

    Original Title

    ICHD 3 TB dilemmas

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    1) The DOTS strategy aims to detect 70% of infectious tuberculosis cases and successfully treat 85% of detected cases by 2015. However, it is unclear if these targets will be met given current average rates of progress. 2) Expanding tuberculosis control requires addressing related issues like HIV/TB co-infection, multidrug-resistant tuberculosis, and health system strengthening. Engaging all healthcare providers, empowering communities, and promoting research are also important. 3) A funding gap exists for fully implementing the Global Plan to stop tuberculosis from 2006-2015. Securing political commitment and adequate funding is crucial to saving lives and expanding treatment.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    24 views23 pages

    Tuberculosis in Developing Countries: Dilemmas: Erik Post, MD MSC Royal Tropical Institute Amsterdam

    Uploaded by

    garuda unri
    1) The DOTS strategy aims to detect 70% of infectious tuberculosis cases and successfully treat 85% of detected cases by 2015. However, it is unclear if these targets will be met given current average rates of progress. 2) Expanding tuberculosis control requires addressing related issues like HIV/TB co-infection, multidrug-resistant tuberculosis, and health system strengthening. Engaging all healthcare providers, empowering communities, and promoting research are also important. 3) A funding gap exists for fully implementing the Global Plan to stop tuberculosis from 2006-2015. Securing political commitment and adequate funding is crucial to saving lives and expanding treatment.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 23

    Tuberculosis

    in Developing
    Countries:
    Dilemmas
    Erik Post, MD MSc
    Royal Tropical Institute Amsterdam
    Global Plan 2006-2015
    World Health Assembly:
    •Detect 70% of infectious TB
    •Treat successfully 85% of detected cases

    Millenium Development Goals 2015:


    •Halt and reverse TB prevalence and deaths
    by 2015, as compared to 1990
    DOTS - STRATEGY
    1. Political commitment

    2. Diagnosis by smear-microscopy

    3. DOT with standard regimen

    4. Continuous drug supply

    5. Standardised recording and


    reporting
    DOTS Strategy: on target?
    (a)
    C ase detection rate, smear-positive cases (% ) 70% case detection target
    80

    WHO target 70%


    70

    60
    All cases
    50
    All cases, DOTS only
    40

    30
    average rate of progress
    DOTS begins 1995–2000
    20

    10

    0
    1990 1995 2000 2005 2010 2015

    Year
    DOTS Strategy: unsuccessful
    treatment outcome

    Max. 15% bad outcome


    TB Global Plan 2006-2015
    Expansion of the DOTS strategy

    Additional, in view of MDG‘s:


    •Address TB-HIV and MDR-TB
    •Health system strengthening
    •Engage all health care providers
    •Empower patients and communities
    •Enable and promote research
    TB Global Plan 2006-2015
    Filling the funding gap will mean:
    14 million lives saved
    50 million people treated
    3 million HIV+ TB patients on ART

    Advocacy, communication and social mobilization integral


    part of TB control

    New drugs, new tests, new vaccine


    Political commitment: funding gap…
    Diagnosis: clinical considerations
    Correlation Between Extent of HIV-Induced Immuno-
    Suppression and Clinical Manifestation of Tuberculosis
    500 Pulmonary tuberculosis
    Median CD4 cell count / mm3

    400
    Lymphatic, serous tuberculosis

    300 Tuberculous meningitis

    D
    u
    ra
    tio
    n
    o
    fH
    IV
    in
    fe
    ctio
    n
    200 Disseminated tuberculosis

    100

    De Cock KM, et al. J Am Med Assoc 1992;268:1581-7


    Laboratory challenges

    Diagnosis under HIV conditions…...

    Capacities

    External Quality Assurance

    Culture + Drug Susceptibility Testing (DST)

    New diagnostic approaches


    •LED, concentration, serum,…
    DOT with standard treatment

    •Provider-observed
    •Caretaker-observed
    •Community based DOTS

    New standard treatment


    required, due to rising
    MDR?
    Continuous drug supply

    Not many problems:


    •Supplies nationally or through GDF
    •Financing nationally or through grants of
    GFATM or GDF or loans from World Bank
    •Sometimes problems in supply chain

    But….. quality of drugs….


    Rigorous Recording & Reporting
    Electronic TB Register (eRR)

    http://www.who.int/tb/err/catalogue/
    Expand TB-HIV
    National management priority programmes
    es
    a vi c
    H DS a ri er
    MC TB AI al s
    M H

    intermediate management priority programmes

    TB AIDS TB AIDS TB/AIDS ??


    intermediate management priority programmes

    PHC level
    MDR-TB: notified cases (2004–2006) and
    projected to be treated in 2007–2008.
    50 non-GLC
    47 46
    GLC
    40 500,000 MDR-TB yearly
    Target for MDR-TB patients on treatment:
    2006: 14 thousand
    30 2007: 52 thousand L !!
    2008: 98 thousand RO
    23 N T
    CO
    20 18 N
    18
    TIO
    EC
    10
    INF

    0
    2004 2005 2006 2007 2008
    Infection control
    Some points:
    •30% of TB staff likely to get infected
    •Cough hygiene
    •Reducing droplets
    •Sputum sampling outside!
    •Regular HIV and TB testing of at risk groups
    •MDR-TB outside HIV clinics
    Health systems strengthening
    National plan/framework
    25
    exists

    20 NTP plan and budget


    aligned with national plan or
    framework
    15

    10

    0
    Plan nat. health Poverty Plan nat. HR for Medium-term SWAp
    developm. reduction health expend. for
    strategy health
    Engage all health providers: PPP?
    None Some All No response
    Public gen.hosp.

    Teaching Hosp

    Military HFs

    Prison HFs

    NGO/mission

    HFs of HI inst.

    Corp h. services

    Priv hospitals

    Priv pract

    0 5 10 15 20 25
    countries
    Advocacy, Communication and
    Social Mobilisation (ACSM)
    •Advocacy to decision makers
    •Communication to civic society
    •Community mobilisation to increase service utilisation
    100

    80

    Community
    60
    participation
    40
    in TB control,
    all countries,
    20 2006
    0
    AFR AMR EMR EUR SEAR WPR HBCs World
    Yes No No response
    Enable & promote research

    Better vaccins

    New diagnostics

    New drugs

    Operational research to improve


    implementation of expanded DOTS strategy
    Information on TB

    www.findtbresources.org/
    www.who.int/tb/en/
    www.iuatld.org/
    www.stoptb.org/

    You might also like