Standard of Care for MDR-TB Standard of Care for MDR-TB Dr Hind Satti Partners In Health Lesotho
Dec 23, 2015
Standard of Care for MDR-TB Standard of Care for MDR-TB
Dr Hind SattiPartners In Health
Lesotho
Lesotho: Basic FactsLesotho: Basic Facts
• Landlocked country located within South Africa (bordering Free State and KwaZulu-Natal)
• Population 1.8 million• 12,275 TB new cases notified in 2009• Over 2000 re treatment cases • HIV prevalence rate: 23.2% in 2005• 80% of TB cases are HIV positive (NTP
2008)
Lesotho MDR-TB ProgrammeLesotho MDR-TB Programme
• A comprehensive response to MDR-/XDR-TB in Lesotho, established by the MOHSW.
• International partners include PIH, WHO, FIND, OSI
• Community-based treatment and care model that includes all 10 districts
• First patients enrolled in August 2007; 500 patients enrolled to date
National TB Reference LaboratoryNational TB Reference Laboratory
Case DetectionCase Detection
• All HCWs including NTP staff– TB/HIV coordinators/Officers at district
hospitals – Health centre nurses providing HIV/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 • Screening of household contacts
Botsabelo MDR-/XDR-TB HospitalBotsabelo MDR-/XDR-TB Hospital
Patient CharacteristicsPatient Characteristics
• Approximately 78% HIV-positive with advanced AIDS-defining conditions
• Severe malnutrition• Multiple failed TB
treatment regimens• Extensive TB disease• Mostly smear-
positive
Lesotho vs. rest of the worldLesotho vs. rest of the world††
*Tomsk, Latvia, Estonia, Peru, Philippines
† Nathanson et al. Adverse events in the treatment of multidrug-resistant tuberculosis: results from the DOTS-Plus initiative. Int J Tuberc Lung Dis 2004. 8(11):1382–1384
Infection ControlInfection Control
• Outpatient– TB clinics and general outpatient clinics– Treatment supporters– Family members
• Inpatient– Cross-infection of patients– Protection of health workers (TB and
HIV)
Social assistanceSocial assistance
MDR-TB/HIV MDR-TB/HIV
• 100% HIV testing during the first visit.• Early initiation of HARRT for MDRTB/HIV
(10-21 days), regardless of CD4 count.• Aggressive management of side effects. • Home assessment visit before initiation.• Household contact screening and testing
for TB and HIV.
Role of Treatment SupporterRole of Treatment Supporter
• Observe all doses • Report side effects• Provide injections.• Accompany patient
for clinical evaluations• Screen for TB and HIV
in household contacts.
• Offer psychosocial support to the patient and the family.
Effect of HIV on MDR-TB mortalityEffect of HIV on MDR-TB mortality
Seung KJ, Omatayo DB, Keshavjee S, Furin JJ, Farmer PE, Satti H. Early outcomes of MDR-TB treatment in a high HIV-prevalence setting in Southern Africa. PLoS One. 2009 Sep 25;4(9):e7186.
ConclusionConclusion
• Diagnosis and management of MDR-TB in high HIV-prevalence settings is challenging but possible
• Empiric treatment of MDR-TB is needed to decrease early mortality
• Side effects are more common and earlier• Infection control at all levels: hospital, clinic,
community is critical.• Community-based MDR-TB/HIV allows for
rapid enrollment and closer monitoring of side effects