laboratory strengthening in high tb-burden african countries

8/2/2019 Laboratory Strengthening in High TB-Burden African Countries

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MDR XDR TB in Tugela Ferry/KZN

overview and response 2010

Claudio Marra

Philanjalo/TFCARES

Laboratory strengthening in high TB-burden African countries

Seminarjointly organized by the Ministry of Health Lesotho and FIND under the auspices of WHO

Maseru, 24 February 2010


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Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010

Msinga Sub District


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Msinga Sub district

Population 172 000

TB incidence 1054/100 000

DRTB incidence 141/100 000

30% HIV+ pregnant women

75% of TB patients co infected HIV


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SINCE 2005 A TOTAL NUMBER OF 852 DRTB REPORTED

364 MDR TB

488 XDR TB


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MDR + XDR cases diagnosed between

January 2005 and December 2009


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MDR XDR TB

2008

MDR 46

XDR 75

TOTAL 121

2009

MDR 78

XDR 59

TOTAL 137


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HIV-Associated MDR & XDR TB in S AfricaGandhi et al, AJRCCM 2010

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0. 25

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SURV1YR

0 50 100 150 200 250 300 350 400

STRATA: TYPE=MDR Censored TYPE=MDR

TYPE=XDR Censored TYPE=XDR

XDR TB (n = 382)

MDR TB (n = 272)

Survival in days

mortality 67%

mortality 82%

29 days

60 days


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DC21 PMB(D22 )

D C23 Cosh DC25 DC26 DC27 DC28 DC29 DC43 DURBAN

200020012002200320042005200620072008

Distribution of MDR by district


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01020304050607080

DC21 DC22 DC23 Cosh DC25 DC26 DC27 DC28 DC29 dc43 durban

2001 20022003 20042005 20062007 2008

Distribution of XDR by district


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TB cases diagnosed annually

2004: all TB 4.572 mortality: 15.2%

Defaulters, transferred, not evaluated:19.7% 2005: all TB 4.741 mortality:13.2%

Defaulters, transferred, not evaluated:14.8%

2006: all TB 5.537 mortality:12.1%

Defaulters, transferred, not evaluated:12.4%


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Transmission of MDR & XDR TB


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Evidence for Nosocomial Transmission

No prior treatment in 55% 2/3 patients hospitalized in past 2 years

Initial community contact tracing-fewadditional cases

Health care workers died with XDR TB

Genotyping showed similar strain in83%


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Response

Coordinated response under theleadership of the Provincial- District

Managers was planned

More Human and Economic resourcesmade available

Support by International Partners available


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Sustained Response

Improvement of the program for TB More nurses and tracing team available

Training and supervision strengthened

Cure rate at 83% default rate ~1%

Since 2006 Household investigation started

Contacts screened 4492

Adults contacts diagnosed with MDR: 29

Adults contacts diagnosed with XDR: 40 Total 69 transmission 3.7


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Sustained Response

Decentralized MDR TB hospital opened (32beds) in the district Home base care for MDR TB started ~100 are followed

Policy changes toward HIV/TB integration Increased VCT among TB patients

Increased ARV initiation among TB patients

TB screening among HIV patients

Infection control COSH TB ward with negative pressure extractor installed in 2006

Open window policy implemented

Administrative rules introduced like triage for patients with cough

Use of mask N95 introduced for all health workers operating in TB wardsand other areas

Intensive case find started in the hospital and the community


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Response challenges

Laboratory service at COSH with one microscopist processing anaverage of 75 sample a day

TAT 48 h 78%

5.5% smear+ on TB suspects

Cultures and DST sent to Durban (200KM) - ?cost?

In 2009 COSH requested 5020 cultures and DST


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Conclusion

MDR XDR TB remains a major and growing challenge in KZN

Weve made progress with treatment (first 6 patients cured for MDR

TB in the decentralized MDR TB centre in the district)

More than 100 patients with MDR TB on home base care in the district

Infection control is being addressed (still challenges linked to the old

hospital infrastructures)

Laboratory is the remaining challenge: needs strengthening at the

district level


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Acknowledgement

DOH District and Province

COSH

Philanjalo

TFCARES (Yale University, Albert Einstein College of Medicine)

Italian Cooperation Italian National Health institute

University of KwaZulu Natal

laboratory strengthening in high tb-burden african countries

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