Adamawa state TB and Leprosy Control Programme overview, 2014

ADAMAWA STATE TUBERCULOSIS AND LEPROSY CONTROL

A presentation @ the 1st Quarter Zonal TBL Review Meeting:

2014

By: Stephen John, MD, MPH/ICHDProgramme Manager

Outline…• Background• Activities planned & outcome• TB data presentation & analysis• EQA• STOP TB thematic areas• Leprosy data presentation & analysis• TB REACH • Challenges/Recommendations• Plans for 2nd Qtr, 2014

BACKGROUND INFORMATION• Land Mass 42,000 sq km• No of LGAs 21• State population 3.8 million• Total No of HF >1297• DOTS Expansion:

• Total # of DOTS Centers 142 (1/27,000 pop: G=12)

• 118 notified TB cases in Qtr, 1• 20 HFs detected between >10 TB patients

• Microscopy Center Coverage:• Total # of Microscopy Centers 44 (1/87,000 pop:

G=4)

• Total No of MDT clinics 98

Activities Implemented

Key activities planned & implementedPlanned Funding Source Outcome Remarks

Supervisions: State Team, LGTBLS &QA Supervisions

NLR, GFATM, TB CAREWHO

State Team: 19 LGAs reportedLGTBLS: 231QAO: 38 laboratories supervised

Improved reporting/feedback system

Meetings: TB/HIV TWG, Qtrly Prog. Review & QA Lab Meeting

GFATMIPs

Implemented (except TB/HIV TWG)

FHI 360 sponsors TB/HIV TWG

TB REACH: ACF, ACSM, GX, Supervision, OR

WHO Yr 1 & 2 successfully ended, No-cost extension approved

Improved TB case notification

Radio Jingles on TBL

TB REACH On-going

ACF in 2 Districts of Girei LGA

Janna Health Foundation /ATBLCP

Over 600 screened for TB. HIV & Leprosy: 12 TB cases detected

Adamawa TB Case Notification: 2005 - 2012

2005 2006 2007 2008 2009 2010 2011 2012 20130

500

1000

1500

2000

2500

3000

3500

4000

27522849

2623

29982866

2900

2644

3329 3460

1198 1293 12961184

984

1314

1122

1812

1667

197 209 178129 121 92 156 193 291

All TB SM +ve EPTB

TB Reach

TB case notification: Comparing Q4 of ‘12 and ‘13

Qtr 4 '12 Qtr 4, '130

100

200

300

400

500

600

700

800

900

1000787 781

441

367

48 65

All Cases Sm +ve EPTB

EQA Activities

EQA

• 36 Microscopy centers participated• 29 had >95% concordance• Rechecking/Panel testing• Labs with errors identified• Slide positivity rate among suspects: 11%

Trends of Cure Rate: 2006 – 2012

2006 2007 2008 2009 2010 2011 20120

20

40

60

80

100

77

83 82 83

77 82 82

7377 77 78

91

78 75

Cura Rate (CAT I) Cure Rate (CAT 2)

STOP-TB Thematic Areas

CTBC• 20 LGAs involved• Main role is TB suspect identification & referral• CV activities supported by:– HAF– TB Reach– ADSG– FHI360

CTBC Data: 2010 - 2013

2010 2011 2012 20130

500

1000

1500

2000

2500

479

515

1560

2225

134

176

257410

TB Suspects Refered TB Cases Notified

TB/HIV• Key Partners:– FHI360, Optimum Initiative, Janna Health Foundation– WHO/FMOH/NLR, TB CARE 1.

• DOTS/HCT sites:• 115 of 142 (81%) DOTS centers

TB/HIV Data: 2009 - 2013

2010 2011 2012 20130

500

1000

1500

2000

2500

3000

3500

2417 2518

3100 3164

18811942

2239

2419

487 475 423 426367 389 384 394

116 176 207 245

Counseled Tested Positive On CPT On ARV

TB/HIV Data: Comparing Q4, ‘12 & ‘13

Qtr 4, '12 Qtr 4, '130

100

200

300

400

500

600

700

800

900

1000

691747

501

586

77 9075 88

3964

Counseled Tested Positive CPT ART

Thematic Areas: Contd..• PPP:– 18 facilities: 12 had patients on treatment (9 in 3rd Qtr)– 58 TB cases notified in the Qtr (37 in 3rdQtr)

• TB in Congregate Settings:– 2 prisons & 1 barracks– 3 TB case notified (2 in the Barrack Med Centre)

• ACSM:– Advocacy on-going– Training on TB & ACF expected in 7 high endemic LGAs

• DR-TB:– Suspects have access to preliminary screening (Gx)

Leprosy

Leprosy Control Interventions…– Rapid Village Surveys (RVS)– Intensified Contact Examination (ICE)– Community Volunteers

Trends of Leprosy New Case Detection: 2006 - 2013

2006 2007 2008 2009 2010 2011 2012 20130

50

100

150

200

250

300

257 242 237

196

234

171

234

200

Leprosy NCD

Trends of MB & Child %: 2008 – 2013

2008 2009 2010 2011 2012 20130

20

40

60

80

100

5 5

7 40

4

92 91

9492

9896

Child % MB%

Buruli Ulcer

• Nil Cases in the Quarter

Update on TB REACH:Nomads/Koma Communities (Wave 2 Year 2)

Background• Target Population: 0.5m• Evaluation Population: 3.7m• Control Population: 2.6m• Objective:– To expand TB services in an innovative and highly

collaborative manner through the involvement of the Nomadic and Koma leadership to ensure that the communities have ownership over the design, implementation and sustainability of the project

– To determine whether or not the incidence rates of TB among the target population is higher as compared to the evaluation population

Key Interventions• Mainly 3:–ACSM:

• Committee exists; meets, plans and implement activities quarterly (mainly advocacy & resource mobilization to sustain the project)

• Radio jingles & TV programmes

–Active Case Search (Rapid surveys & Intensified Contact Examination)

• Community Health Education/Seminars on TB• Screening of community members for TB• Transport of TB suspect sputum where necessary

–Use of GeneXpert equipment:• Transportation of an early morning sputum specimen from SS-

TB suspects for GeneXpert analysis

TB Suspect Management: 2013

0

5000

10000

15000

20000

45100

6790

5287

549 893

TB Cases Notified (TB Reach) : 2013

20130

200

400

600

800

1000 893

486

45

All SS+ EPTB

Data from GeneXpert: 2012 (n = 1031)

11519

817

674

MTB+/Rif- MTB+/Rif+ MTB-/Rif- MTB+/Rifdt Inv/Err

11%7%0.6%

2%

79%

TB Reach & the Programme• Government:– Improved contribution

• Increased Stakeholder participation/support• Dissemination:– National Council on Health– Union Conferences– TB Reach meetings

• Other States & TB Control among Nomads• Sustainability…..

Key Challenges• DOTS: – Strengthening– Expanding PPM

• EQA:– Limited microscopes

• CTBC:– Attrition– Incentives

• TB/HIV:– Test Kits

Recommendations• State Team to ensure strategic expansion– Mainly private facilities (on-going)

• NTBLCP to provide microscopes (State Gov’t too)• CV motivation:– Standardize incentives?

• Continuous advocacy for HIV Test Kits

Plans for 2nd Qtr, 2014• NLR activities:– Training (low endemic)– Supervision

• GFATM Activities:– Meetings– Supervision

• TB Reach (No-cost extension approved):– ACF– Supervision

Thank You