MDR- and XDR-TB in the Context of HIV Infection Lesotho program

Dr. Hind E. SattiPartners In Health, LesothoMarch, 2008

12,275 TB cases notified in 2007 Estimated prevalence of 544 per 100,000

population Estimated annual incidence for all cases is 691

per 100,000 population Estimated incidence of Sputum smear positive

cases is 281 per 100,000 population 75% of new TB cases among age-group 15-44

years; Estimated all TB deaths is 107/100,000 annually The HIV prevalence rate in Lesotho stands at

23.2% in 2005; 80% of TB cases are HIV positive(NTP 2008); 109MDR-TB cases currently on treatment

May 2007: National guidelines for management of MDR-TB Collaboration with

MOHSW and WHO Developed from WHO

global guidelines. July 2007: Training of

health staff Training materials for

health staff at district level.

Training materials for MDR-TB treatment supporters.

• Building national lab capacity Equipment Staffing Training and supervision infrastructure

• Close relationship with SRL Culture and DST while national capacity is being

built Proficiency testingCentral TB laboratory is now performing culture and

first line DST as well as the Rapid RIF testing.

All NTP staff TB Officers at district hospitals Health centre nurses providing TB care

Routine HIV screening of MDR-TB patients, partners, family members

Protocol for “medium-risk” and “high-risk” Sputum sent to national TB laboratory

Initially sent to MRC Pretoria (March 2007) First-line DST now available in Maseru (Sept

2007) Screening of household contacts

Outpatient TB clinics and general outpatient clinics Treatment supporters Family members

Inpatient Cross-infection of patients Protection of health workers (TB and HIV)

MDR-TB Clinical Teams at all district hospitals Medical Officer ART Nurse TB Officer TB Coordinator

Empiric treatment for high-risk suspects

Early initiation of ART in all co-infected patients, regardless of CD4

Referral to Maseru for complicated patients

MDR-TB Treatment Supporters Village Health

Worker; community volunteer; KYS counselor

Accepted by the patient

Trained and supervised by District MDR-TB Clinical Team

Incentives

Twice-daily DOT Injections Psychosocial

support Screening

household contacts Accompaniment to

clinical visits

Very sick patients Bedridden Severely wasted

Severe side effects Severe hypokalemia Acute renal failure

Severe OIs Meningitis Esophageal

candidiasis

Started on August 2007 109 patients enrolled. 48 patients pre GLC cohort. 72% HIV co-infection rate History of multiple failed TB treatments Average of 8 household contacts per

patient

Geography Advanced HIV disease Severe malnutrition/wasting Clinical complications and side effects Working through the “backlog” quickly