The implementation of the National Tuberculosis Control Program at a regional level: Voronezh TB Service JULY 13, 2015 Dr. Kornienko, Sergey
Dec 29, 2015
The implementation of the National Tuberculosis Control Program at a regional level:
Voronezh TB Service
JULY 13, 2015 Dr. Kornienko, Sergey
• The biggest region in the central belt of the
European part of Russia
• Distance from Moscow - 587 km
• The area 52,400 sq. km
• Area Population (2014) 2,328,959
• Administrative center –
the city of Voronezh with a population 1,014,600
Voronezh Region
Measures to optimize the TB service of the Voronezh Oblast
2005-2015
TB Site Number of beds2005-2010
2012-2014
From 2015
Total- Inpatient beds- Day Hospital- Hospital-at-Home
1590--
1005105
-
8108565
Oblast Dispensary- Inpatient beds- Day Hospital- Hospital-at-Home
1125--
82050-
7003040
District Dispensary (DD)- Inpatient beds- Day Hospital- Hospital-at-Home
9 DD465
-
4 DD22555-
4 DD1105525
Children Sanatorium -- 2 490 470 470
Adults’ Sanatorium -- 1 160 160 160
Up to 2012
From 2012г.
4
FSG.ORG
© 2012 FSGLilly 7 Team Meeting
Main TB epidemiological indicators in the RegionMain TB epidemiological indicators in the Region
Indicators, per 100 000Indicators, per 100 000 20002000 20052005 20102010 20122012 20132013 20142014
Territorial incidence of Territorial incidence of tuberculosistuberculosis
VRZVRZ
RFRF
7373..99
9090..77
7070..11
8383..88
5656..55
7777..22
4545..11
6868..11
3636..77
6363..00
3333..00
5959..55
TB incidence of residential TB incidence of residential populationpopulation
VRZVRZ
RFRF
4949..00
6565..55
5353..77
6767..99
4545..11
6969..66
3535..33
5757..66
2828..11
5353..44
2525..44
5050..77
TB incidence in childrenTB incidence in children VRZVRZ
RFRF
66..44
1717..99
77..11
1616..44
44..11
1515..22
44..66
1616..44
33..99
1414..55
33..55
1313..22Territorial TB mortalityTerritorial TB mortality VRZVRZ
RFRF
1111..99
2020..44
1414..88
2121..11
1111..00
1515..44
77..99
1212..44
66..00
1111..33
55..22
1010..00
TB mortality of residential TB mortality of residential populationpopulation
VRZVRZ
RFRF
99..66
1616..00
1010..99
18.218.2
88..77
1212..55
66..11
1010..11
44..99
99..22
44..00
88..33
7270,5
67,3
63,361,8
58,6
54,552,8
49,6
47,647,346,4 45,3 45,445,5
45,143,6 42,6
40,7
37,634,2 35,8
42,9
57,8
67,5
73,976
85,2
90,7
86,188,2
83,283,382,7
83,583,2 82,6
77,4
73,6
68,1
63
59,5
65,363,6
55,9
50,849,4
44,7
41,340,641,1
48,7 48,748,149,8
52,7
49,5
41,139,9 38,5
36,7 37,237,7
46,748,3
62,2
69,4
66
70,969,2
73,9
69,972
66,9
71,1
64,9
69,3 68,9
63,2
56,5
50,5
45,2
36,7
33
20
30
40
50
60
70
80
90
Заболеваемость РФ Заболеваемость ВО
TB Incidence (per 100 000 population)In 2014, the first time in 50 years, it has been achieved a reduction in TB Incidence 33.0 per 100 000 population
2005 2010 2014 Dynamics
RF 83.3 77.2 59.5 - 28.6%
CFD 60.6 55.4 39.0 - 35.6%
VRZ 70.1 56.5 33.0 - 52.9%
0
5
10
15
20
25
30
15.9
59.0
24.3 24.2 24.8
27.5
31.7
24.722.9
18.8
RF VRZ
Reducing the reservoir of MDR TB in Voronezh region
201420132012
TB/HIV situation
Reducing the burden of TB:Patient-Centered Service
Active TB Case Finding Strategy (operational data)Active TB Case Finding Strategy (operational data)
IndicatorsIndicators 20002000 20052005 20102010 20122012 20132013 20142014
Coverage with all types of screening methods
VRZVRZ
RFRF%%
63.4
57.1
66.1
57.9
89.0
63.6
89.1
65.7
86.6
65.8
85.6
66.5
Coverage with a chest radiography for population over 15 years old
VRZVRZ
RFRF %%
55.7 75.1 87.1
55.6
85.6
58.3
84.6
59.0
83.5
Detection per 1000 screened
VRZVRZ
RFRF
0.6
0.6
0.76
0.6
0.42
0.58
0.34
0.61
0.28
0.56
0.25
Passive TB detection (doctors’ visits)
VRZVRZ
RFRF %%
42.2
47.2
29.9
46.6
28.6
40.3
26.6
39.3
25.0
39.7
26.5
Detected “Post mortem” VRZVRZ
RFRF %%
0.4 0.8
2.8
0.8
1.8
0.9
1.6
0.7
1.6
0.7
1.7
International projects
2010 – 2012: Green Light Committee (World Health Organization)
2011 – Present: “Partners in Health” Eli Lilly MDR-TB Partnership– Major Initiative I: Improving tuberculosis
infection/transmission control in the Russian Federation
– Major Initiative II: Building a sustainable model for high-quality ambulatory MDR-TB care delivery
F-A-S-T:Improving tuberculosis transmission control
Administrative control new approach• Find cases • Actively (identifying MDR-TB patients)
GeneXpert MTB/RIF assay• Separate patients safely to reduce exposure to
drug-resistant strains (stopping nosocomial transmission), and
• Treat effectively with second-line drugs
Rapid Rif-susceptibility testing during the process of hospitalization, 2013 - 2015
Patient-Centered Approach (PCA)
Support Vehicles
2011 One PCA Team
2 nurses, designated TB doctor,
PCA Coordinator (deputy chief TB physician), social worker
Daily food packages, Mobile plans
One vehicle
2012 Two PCA Teams
2 nurses, 2 designated TB doctors,
PCA Coordinator (deputy chief TB physician), social worker, addiction specialist
Daily food packages, Mobile plans, symptomatic medications, в т.ч. АЗ
Two vehicles
2013 Three PCA Teams
2 nurses, 2 designated TB doctors,
PCA Coordinator (deputy chief TB physician), social worker, addiction specialist
Daily food packages, Mobile plans, symptomatic medications
Three vehicles
Treatment outcomes for PCA patients, 2011 - 2015
Advancing strategies for quality outpatient TB services
Main components to sustain effective TB program
PCA team
Social support: public transportation passes, daily food sets, monthly hygiene sets
Substance abuse specialist, psychologist and social worker
Rapid diagnostic methods, early start of treatment
Sufficient supply of TB drugs, second line drugs and side effect medications Treatment TB according to the national standards of care
DOT network: TB inpatient hospital, day-care TB hospital, TB policlinic, “Hospital at Home”, Patronage nurses,
TB DOT points at the city general medical service
Challenges Plans
• Strengthening of the default retrieval system
• Sustain the success of the regional TB Control Program
• Expanding intensified patient-centered care with prioritization of vulnerable populations, such as children and adolescents -- to create the family-centered accompaniment (FCA) model of care (oversee families with TB patients with children)
For the sake of children's health we still have so much to do !!!
THANKSContact details: [email protected]
The Lilly MDR-TB Partnership is funded by the Lilly Foundation