TUBERCULOSIS CONTROL Experience of Guyana Dr Jeetendra Mohanlall
Jan 14, 2016
TUBERCULOSIS CONTROL
Experience of GuyanaDr Jeetendra Mohanlall
The National Tuberculosis Programme
Mission Statement
To reduce the incidence and prevalence of tuberculosis and to mitigate its impact through a multisectoral response that provides high quality and equitable prevention, treatment and support services.
TB Clinics in Guyana
Progress from 1 central TB clinic in 2000 to 18 decentralized clinics in 2013
Laboratory Network NPHR Lab
•Linden
•NA•Skeldon
Quality Control
EX-QC
•WDRH •Suddie•Charity
•Bartica•Mahdia•Kato•Lethem•Annai•Aishalton•Karasabai•Sand Creek
•Fort Wellington
•Mabaruma
•Port Kaituma,
•Moruca
•Matthew’s Ridge
Pomeroon Supenaam
Demerara-mahaica
Essequibo Islands West Demerara
Mahaica Berbice
East Berbice Corentyne
Upper Demerara-Berbice
Barima-Waini
Cuyuni Mazaruni
Potaro-Siparuni
Areas DOTS being expanded
Areas DOTS Operational
Areas to be further integrated into the PHS
1
23 4561
0
9
8
7
Upper Takatu/ Upper Essequibo
TB/ HIV TRENDS 2005 -2012
Strengths of the NTPStrong political commitment Strong support from Technical Partners and
funding agencies (GF, CDC, PAHO etc.) Phase 2 of GF grant in the process of being implemented.
Implementation of the 5 components of DOTS Implementation of all 12 WHO recommended
TB/HIV Collaborative Activities - PPM, TB/HIV inclusion in HIV Vision 2013-2020 and HIV GF phase 2 proposal
National TB Guidelines, Strategic plan 2013-2020 and training tools developed
National TB M& E plan developed (2013-2015)and compendium of indicators
The Integration of TB servicesCoordination by a central management unit -
forecasting and budgeting for TB medication, development of guidelines and policies for TB control and supervision of TB services provided by TB clinics
Human Resource Capacity: Main Coordinators and most of the support staff employed in programme. Dedicated staff at Clinics in the regions.
Strong M&E function for informed decision making at the NTP.
Mobile teams – supporting DOTS programme daily in the high burden region and also involved in default tracking.
Laboratory Services: Robust network of 20 sputum microscopy sites around the country and the NPHRL has developed the capacity for TB cultures and DST.
TB CONTROL IN PRISONS
Interventions-
DOTS supervisor for prisons hired.Case detection - Respiratory Symptomatic
register at all FacilitiesDOTS (all facilities)Isolation Area (5 facilities)Enabler’s programme for inmates diagnosed
with TB.(milk supplement)Mass screening done periodically.Proposed procurement of mobile unit.Hiring of key staff by prison’s authority.Hiring of key staff by prison’s authority.
ChallengesThe need for further decentralization of TB
services into the PHC system.
Cure rate still at a level below the recommended WHO target (over 85%)
Default rates – especially among mobile population, substance abusers, homeless
Lack of a proper in patient facility for difficult TB patients (e.g. homeless MDR TB patient). TB step-down care facility on stream to be completed by end of 2013.
OpportunitiesPotential linkages with countries with successes
in TB management- Technical Co-operation (Suriname, French Guyana), Histoplasmosis study supported by CDC.
PPM – Davis and St. Joseph Mercy HospitalPhase 2 ,Round 8th Global Fund TB project
approval.Technical collaboration from PAHO and
technical assistance from CDC.Operational Research.Increased focus on TB/HIV in HIV GF proposalIMAI expansion for increased integration in PHC
services
RISKSMigration of Skilled Health Workers/ high
staff turn over
Potential reduction in available external funding
Patients continue to default on TB treatment.
Co-morbid Conditions including diabetes, HIV and TB
The emergence of MDR TB .
National Tuberculosis Strategic Plan 2013-2020
Projections Toward Universal Coverage
The overarching goal of the National Strategic Plan for Tuberculosis (NSPTB) is to reduce the incidence and prevalence of tuberculosis all across Guyana.
This goal takes cognizance of the targets set by international conventions including the Millennium Development Goals (MDG’s) and the Stop TB Partnerships.
Goals and Objectives
Pursue high-quality DOTS expansion and enhancement
1. Increase TB case detection rate of all forms of TB from 82% in 2012 to 90% by 2015.
2. Increase treatment success from 71% in 2010 to
85% by 2015 3. Decrease defaulters’ rate from 18% in 2010 to
7% in 2015 and to less than 5% in 2020.
Goals and Objectives Cont’d4. Strengthen the Supervision, M&E system at all
levels to ensure that at least 95% of all planned activities are implemented effectively and efficiently.
TB/HIV collaborative activities5. Increase and sustain the proportion of TB patients
tested for HIV from 96% in 2012 to 100% by end of 2015
6. Ensure that 100% of TB/HIV co-infected patients receive Co-trimoxazole prophylaxis.
7. Ensure that 100% of HIV patients receive INH preventive therapy (IPT) at their HIV Care & Treatment Sites.
Goals and Objectives Cont’d
8. Increase the proportion of TB/HIV co-infected patients who are receiving antiretroviral therapy (ART) from 92% in 2011 to 99% in 2020.
9. Establish infection control in all health care facilities (100%) providing both DOTS and ART services by 2020.
Establish MDR-TB services10.Establish a routine drug resistance
surveillance system by the end of 2013.
Goals and Objectives Cont’d
11.Ensure that all High Risk Groups including Category 2 failures have access to lab diagnosis services for MDR by the end of 2013 and all Category 1 failures by the end of 2013.
12.Provide second-line anti-TB drugs to 100% of diagnosed MDR cases annually and by the end of 2020.
Goals and Objectives Cont’dEngaging all care providers (PPM): Strategic alliances with academic, private and other members of civil
society.
13.Scale up PPM services within the private institutions, military, police, prisons, and chronic disease clinics such that it contributes to at least 20% of total TB cases detected by the end of 2020
Goals and Objectives Cont’d
Research
15.Develop and strengthen capacity for research on TB, TB/HIV, and MDR-TB at all levels.
-Nation wide KAPB study (knowledge ,Attitude, Practice and Belief)
-MDR study
Key Strategies
STRATEGY 1: Pursue high-quality DOTS expansion and enhancement
STRATEGY 2: Address TB/HIV, MDR-TB and the needs of poor and vulnerable populations
STRATEGY 3: Engaging all care providers (PPM): Strategic alliances with academic, private and other members of civil society.
STRATEGY 4: Advocacy, Communication and Social Mobilization (ACSM)
Thank you
Questions?