TB Control in EMR

1
TB Control in EMR

• Where do we want to go?
• Brief review of the progress future outlook
• How do we go there?
• Brief outline of strategic plan exercise

2
DOTS Basic TB Care Package

• Good diagnosis
• access to quality-assured TB sputum microscopy
• Good treatment
• SCC under DOT
• Good drug supply
• Good recording reporting
• Sustained political will to do the above
• (An Expanded DOTS Framework)

3
Where do we want to go?

• 18 countries achieved DOTS ALL OVER
• 5 Countries are lagging in DOTS expansion
• Pakistan Afghanistan
• Very high TB burden
• Low DOTS coverage
• PAK 24, AFG 15(end 2001)
• Low case detection
• PAK 3, AFG 10

Others
PAK43
AFG12
4
Case detection vs. Treatment outcome
5
Low DOTS Case Detection Rate in EMR (in
comparison with global average)
6
EMR Starting Point

• Low case detection rate 21 (EMRO) vs 27
  (global)
• CDR N (Notifications) / E (Estimations)
• Improve N
• DOTS expansion in DOTS lagging countries
• Improve quality case management
• Improve comprehensiveness health sector
  involvement
• Revisit E
• Revisit estimates

7
Pakistan DOTS expansion

• Start showing changes
• Competent NTP strong political leader
• Increased GOP budget
• IACC strategic plan
• More partners
• WB, DFID, JICA, USAID..
• Continued expansion is challenge

Improve N DOTS expansion
8
Improve quality case management

• Laboratory network
• Nominate SNRL start QA introduction
• TB surveillance
• Improve the use of quarterly reports HB, IB
• Introduce nominal, computerized system LB, IB
• High risk group management
• Contact case management
• Adult lung health initiative
• Pilot project in Morocco

Improve N Quality
9
Improve comprehensiveness

• Intersectoral collaboration
• Private public mix
• Implementation of generic tools
• Documentation (KIT, Egypt)
• Medical schools
• Collaboration guidelines published
• Operational research
• 25 Operational research with SGS support
• 7-country study on delay analysis with CIH
  RIT (02)
• OR workshop with IUATLD/USAID (Oct 02)

Improve N Comprehensiveness
10
Revisit estimates

• Hot countries
• Egypt, Iran, Iraq, Jordan, Syria, Sudan
• Improve N (notifications) first
• Epidemiological surveys etc later.
• PPD survey in Sudan (2003)
• Disease prevalence survey (later in Egypt?)
• Others

Revisit E Estimation
11
Regional Targets

• Detect 70 of all cases in the Region and
  successfully treat 85 of them by 2005
• Enroll all detected cases in the Region in DOTS
  activities by 2005
• Reduce prevalence and deaths of tuberculosis by
  50 by 2010

47th EM Regional Committee, October 2000
12
How do we go there?

• Multi-year strategic plan
• Goal expected impact (26.1)
• Objectives and expected outcomes (27)
• Broad activities related to each specific
  objective and expected output (27.1)
• Budget information (30)
• Scale-up of DOTS activities
• 5 main components plus others(Expanded DOTS
  framework)

13
Goal Expected Impact (26.1)

• Goal
• Reduce mortality, morbidity and transmission of
  TB and prevent multi-drug resistant TB, so that
  TB would no longer pose a threat to public health
  
• Impact indicators
• Mortality/prevalence 50 reduction by 2010
• Incidence 50 reduction by 2010

14
Objectives expected outcomes (27)

• Objectives
• Achieve high quality and comprehensive DOTS
  activities
• Outcome indicators
• DOTS population coverage 100
• Case detection rate 70
• Treatment success rate 85

15
Broad activities expected output (27.1)
16
Budget Information (30)