Current Issues in Infectious Disease Programming

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Current Issues in Infectious Disease Programming

• So Whats New About TB?
• Irene Koek Cora Manaloto
• TB Monitoring Evaluation
• Cheri Vincent
• Controlling Drug Resistance in Developing
  Countries
• Andrew Clements
• Questions Discussion

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So Whats New About TB?

• State of the Art Course
• October, 2002

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Tuberculosis Still

• Infects 1/3 of the worlds population, usually
  the poorest of the poor
• Results in 23,000 new active cases each day
• Kills 5000 people each day
• Increasing in regions of the world with high HIV
  burdens and high rates of drug resistance

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22 Countries Accounts for 80 of the TB Cases
in the World
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Key Issues in TB

• Political commitment increasing, but still need
  more
• Lack of in-country and internatl capacity
• Public/private sector interactions weak
• HIV/TB - rapidly expanding
• Need more attention to drug management
• No simple diagnostics
• Drug regimen - still 6-8 months long
• Information of poor quality

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International Political Commitment

• The Global Partnership to Stop TB
• The Global Plan to Stop TB
• Stop TB Working Groups on targeted topics
• DOTS Expansion Drugs
• MDR-TB Diagnostics
• TB-HIV Vaccines
• Drugs

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International Political Commitment

• Global Drug Facility (GDF)
• Donates quality drugs
• Bulk drug procurement by the GDF has resulted in
  a 30 cost decrease for TB drugs
• Procurement mechanism for governments/NGOs
• Green Light Committee (GLC)
• Access to quality, discounted 2nd line drugs
• Global Fund to Fight AIDS, TB, and Malaria

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DOTS Strategy Refresher

• Government commitment to sustained TB control
  activities
• Case detection by smear microscopy in symptomatic
  individuals
• Standardized 6-8 month regimes with DOT for at
  least first 2 months
• Regular, uninterrupted supply of TB drugs
• Standardized recording/reporting system

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DOTS Strategy

• Developed to address irrational care
• Not a one size fits all approach
• DOT does not require health workers
• OR to determine appropriate settings for
  alternate care delivery systems
• Community-based care (CBC) projects
• Private sector involvement

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DOTS Strategy Community Based Care

• CBC successful approaches include
• Good collaboration between general health
  services, the TB control program and the
  community
• Good education of the TB patient and his or her
  family
• Good training for community DOTS supporters as
  well as health workers
• Good systems of supervision of community DOTS
  supporters by TB program staff
• Guidelines for CBC implementation in future

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TB Control Program Philippines DOTS Strategy
Private Sector ACTION TAKEN BY TB SYMPTOMATICS
Hospitals,mostly private 4
Traditional healers 2
Public Health Centers 8
Private MDs 12
None 43
Self-medication 31
Source 1997 National Prevalence Survey,
Philippines
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TB Control Program Philippines Private-Public
Partnerships in TB Control

• Challenges/Constraints
• Stigma
• Overburdened public health sector
• Limited private sector participation
• Opportunities
• Philippine Coalition Against Tuberculosis
  (PhilCAT) - ground for collaboration
• Private sector models currently providing DOTS
  services

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TB Control Program Philippines
Expected Outputs (2002-2005) Baseline TB cure
rate data and scale of measurement
indicators Comprehensive pocket of policies,
guidelines and regulations OR strategies to
improve and expand TB DOTS in private
sector Private sector TB DOTS service models
implemented in specific areas, to
demonstrate potential for replication. TB DOTS
approaches/service models are implemented in at
least 25 strategic urban cities/ large
municipalities nationwide. Training of TB DOTS in
medical schools and behavior change campaigns to
improve the health seeking behavior of the
public. Appropriate guidelines and regulations
are developed to promote necessary reimbursement
program among private health groups.
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Regular, Uninterrupted Supply of TB Drugs

• Global Drug Facility
• Global Fund for AIDS, TB, and Malaria
• DOTS-Plus Working Group
• RPM-Plus/MSH

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HIV/TB

• Stop TB WG to coordinate global efforts
• New TB/HIV framework
• Not simply dual strategy for dual epidemics
• Intensified case finding where high HIV
• Strengthen health service providers to control
  TB as part of overall response to HIV/AIDS
• Innovative approaches to support treatment
  completion
• USAID support for OR - e.g. ProTEST

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Laboratory/Diagnostics Progress

• Microscopy is the primary for of diagnosis
• Limitations
• Non-infectious TB cases
• Laboratory maintenance
• Issue-- not reaching goals on case detection
• USAID supporting development of TB diagnostic
  tools
• dipstick - affordable, field appropriate, easy
  to use, sensitive in HIV and HIV- populations

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Surveillance Update

• Annual WHO Surveillance report
• Annually reported data
• Based on national reporting systems
• Trend analysis
• Biannual MDR report
• Current data and trend analysis
• Electronic surveillance system
• Expanded, translated regionally tailored

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TB Monitoring and Evaluation Systems

• Coordinated Effort on Expanded ME Guidelines
• National program monitoring and evaluation
• Multinational/donor program assessment
• USAID reporting requirements
• Evaluation of Operational Research
• Identify best practices
• Share lessons learned
• Capacity Building
• Enhance the quality of data collected
• Improve the interpretation and use

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USAID TB Strategy-draft revision

• Expanding and strengthening TB control in
  priority countries
• DOTS, MDR/TB, TB/HIV
• Strengthening of global and regional partnerships
•  
• Expanding the cadre of TB experts
•  
• Research to improve DOTS and TB control
•  
• Advocacy and communication
• Strengthening the monitoring and evaluation
  system

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USAID Primary Partners

• TB Coalition for Technical Assistance (TBCTA)
• Royal Netherlands TB Association (KNCV)
• International Union Against TB and Lung Disease
  (IUATLD)
• American Lung Association
• American Thoratic Society
• CDC
• WHO
• RPM-PLUS
• Gorgas Institute

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Child Survival Health Grants Program

• PVOs submitting a 100 TB Application are
  exempt from the rule of no more than six on-going
  grants
• PVOs will need to demonstrate a clearly defined
  role within the context of a NTP
• Demonstration of past performance / collaboration
• PVOs have the capacity to offer a
  community-centered approach
• DOT supporters
• Raise awareness / provide education training

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Resources

• www.usaid.gov/pop_health/id/index.html
• Join-stop-tb_at_healthdev.net
• www.stoptb.org
• www.iuatld.org
• www.artsen.net/kncv
• www.who.int/health_topics/tuberculosis/en/