Dr. Suha ÖZKAN Ankara Provincial Tuberculosis Coordinater

11

THE EXPERIENCES AND PROBLEMS

OF MULTIDRUG RESISTANT

TUBERCULOSIS PATIENTS AT

DISPENSARIES IN TURKEY

Dr. Suha ÖZKANAnkara Provincial Tuberculosis Coordinater

22

The Research of Treatment with Second-line TB Drugs in Teaching Hospitals, 2005

Number of patients

Ankara Atatürk H. 63

İstanbul Süreyyapaşa H. 68

İstanbul Yedikule H. 34

İstanbul Heybeliada H. 14

İzmir Suat Seren H. 18

TOTAL 197Source: TB Control Department, MoH

In National Surveillance

25 %40

24 %35

16 %47

6 %43

14 %78

85 %43

33

155 (79%) of 197 patients were male.

126 had history of treatment failure.

19 had defaulted previously.

MDR had found in 172 patients.

63 patients from İstanbul, 11 from İzmir, 5 from Ankara . (Bursa 10, Adana 8, Mersin 6, Trabzon 6)

Source: TB Control Department, MoH

The Research of Treatment with Second-line TB Drugs in Teaching Hospitals, 2005

44

The Process of Diagnose and Treatment of MDR-TB Patient

DIA

GN

OSE

BEFORE DIAGNOSE STAR

T TR

EATM

ENT

HOSPITAL OUTPATIENT FOLLOW UP

DISPENSARY

THE CONTROLS IN HOSPITALS AND DISPENSARIES

CO

MPLE

TIO

N

OF

TREATM

ENT

DISPENSARY

55

The Diagnose of MDR-TB in Dispensaries

In pulmonary tuberculosis;

Mycroscopy of smear

Culture

Drug Susceptibility Test

The Type of Bacillus

Quality Controlled

66

The history of treatment out of order

No bacteriological conversion during treatment

No improve in signs and symptoms

The history of contact to MDR-TB patient

Going to fail in treatment

With DOT

MDR in which patient ?

77

The bacteriology in diagnose and follow up

Directly Observed Treatment

Not to add any new drug during treatment

To transfer the patient to hospital which is specialized on MDR-TB treatment

To send history of patient and information about diagnose and treatment, to hospital with patient

The Obligations of Dispensaries

88

The Problems about Diagnose of MDR-TB in Dispensaries

The deficiency of bacteriology

Treatment out of order (DOT ?)

Non-Standardize regimens

Not to understand treatment failure

The mistake of adding new drugs

The doctors and hospitals who had no experimentation on MDR-TB

The echonomics and social problems in management

99

Recording MDR-TB Patient in Dispensary

All MDR-TB patients must be recorded in Dispensary

Previous record must be closed, and the patient must be re-recorded with appropriate case defination in treatment failure

The history of disease, bacteriological results and knowledge about treatment must be recorded in patient files

The notes about follow up

1010

The prescriptions and the health report for drugs

Inadequancy transfer Dispensary from hospital

Inadequte knowledge in Discharge Report

The Problems in MDR-TB Registrations

Non registration and out of National Surveillance

No DOT

The deficiency in drugs

No compliance, problems about side-effects

1111

The Follow up MDR-TB Patient in Dispensary

Daily DOT with health staff

Bacteriology in every control

To ask side-effects of second-line drugs during examination

To agree the orders of hospital about treatmen, not to make any change

To advise patient to be controlled in hospital

1212

The Problems in Pursuit and DOT of MDR-TB Patient

Shortages of drugs (sometimes)

Long treatment duration and disgust

Difficulties in DOT because of applying 2 or 3 times in a day

Prevention of health staff and public from transmission

Inadequate knowledge about side-effects

No limitation to drugs in Pharmacies

What to do for contacts ?

1313

The Support of MOH for Second-line Drugs

MOH had supplied second-line drugs since 2003. Ankara Dispensary had delivered with the request of all dispensaries in Turkey, from 2003 to 2008.

The repuests from dispensaries are increasing.

But some patients are still taking drugs from pharmacies with prescription.

The second-line drugs for two or three months were sent to dispensary with the prescription and referral report of patient from hospital.

1414

The Second-line Drug Supply

2006

• 615 request

• Total 212 patients

• 188 of them are MDR/failure

Treatment start year

31 patients before 2005,

89 patients in 2005,

66 patients in 2006.

2 unknown.

2007

• 747 request

• Total 212 patients

•187 of them are MDR/failure

•Treatment start year

49 patients before 2006i,

68 patients in 2006,

68 patients in 2007,

2 unknown.Source: The records of second-line drug supply

1515

The total number MDR/treatment failure patients were 272 in txo year.

92 patients from 2005, 79 from 2006, 68 from 2007.

Most of the patients diagnosed in Ankara Atatürk C.D. Hospital(164). 46 in Süreyyapaşa H, 27 in İzmir Dr. Suat Seren H, 17 in Yedikule H, 6 in Heybeliada Hospital.

Treatment of 12 patients were started in other hospitals.

Nearly the drugs of half of the patients were requested systematicly.

The Records of second-line drug supply

in 2006-2007

Source: The records of second-line drug supply

1616

MDR

Treated with second-line drugs

Treatm

ent failu

re

Recorded in Dispensary

The drug supply from MOH

Dispensary and MDR-TB Patient

1717

THE RESEARCH OF TREATMENT WITH SECOND-LINE DRUGS IN TURKEY-2009

Directorate of Tuberculosis Control in MOH.

The patients of 2007 and 2008 are in study.

The data of the patients who were treated with second-line drugs are collected and recorded systematicaly.

Study covered all Turkey.

1818

Recorded and analized in MOH

Chest Diseases Teaching Hospital

Tuberculosis Control Dispensary

Records of Drug Supply

The records of Pharmacies (Social Security)

THE RESEARCH OF TREATMENT WITH SECOND-LINE DRUGS IN TURKEY-2009

1919

MDR-TB Registries in Ankara TB Dispensaries, 2006-2007-2008

8 patients in 2006, 3 patients in 2007, and 13 patients in 2008 were registered in dispensaries (Total 24).

All of them are diagnosed in Atatürk C. D. Hospital.

17 of them are MDR. 10 of MDR caes had previously treatment failure history.

4 patients were treated because of treatment failure.

2 patients were treated because of mycobacterium other than tuberculosis.

There is 1 XDR case.

2020

14 patients are male.

9 patients had SSK, 6 had greencard, 4 patients had no health insurance.

18 had treated under DOT (16 them with health staff)

21 patients drugs were supplied from MOH.

12 patients are still under treatment, 6 patients are cured, 4 patients are defaulted, 1 patient is treatment failure, 1 patient was transfer out.

MDR-TB Registries in Ankara TB Dispensaries, 2006-2007-2008

2121

In Memory Of Dr. Hamdi ECEVİT...1952 – 04.04.2009