management of mdr-tb transition from hospital …...• development of sop’s, training materials,...

1

Management of MDR-TB – Transition from hospital based management to community based management in

Bangladesh

Refiloe Matji

TB CARE II Director

October, 2016

USAID TB CARE II PROJECT - BANGLADESH

BACKGROUND

• TB CARE II was a USAID funded project from 2011-2015

• The aim was to support the National TB Program to reduce

morbidity and mortality due to TB

• One of the objectives of the project was to strengthen the

management of MDR TB through early detection, quality

diagnosis and treatment


Epidemiology

• High burden of both drug

susceptible and drug resistant

TB

• TB Prevalence: 411/100 000

• TB Incidence: 225/100 000

• 4,700 cases of MDR TB in

2014

• MDR TB prevalence:

1.4% of new cases

28.5% of retreatment cases


Key Partners

• Government Counterparts from the National TB Control Program

• TB CARE II team

• Partners in Health

• World Health Organization

• Damien Foundation

• Local NGO’s


MDR TB Status

• Long Waiting periods before treatment initiation

• Long hospitalization > 6 months

• Limited initiation sites

• Limited diagnostic sites

• Poor infection control


Introduction of Community based MDR TB Management

• Implementation started in 3 sites

• Introduction of Xpert MTB/Rif

• Formation of National PMDT Committees at different levels

• Development of SOP’s, training materials, R&R tools and other

supportive tools

• Increase the number of MDR TB beds

• Psycho-social and nutrition support to patients

• Introduction of m-Health for monitoring and supervision

of treatment


TB m-Health

• m-Health was introduced

in November 2013.

• By July 2015, 34 districts

were covered by m-Health.

• Total of 723 health workers

trained

• 1,054 MDR cases

monitored by 418 DR TB

DOT providers monitored

electronically.


MDR TB Cases diagnosed and treated

Ca

rry o

ve

r

from

20

08

TB CAR II Start to work with NTP


Key Results

Key Results

• Rapid transfer of patients to community

increased yearly treatment enrollment

from 390 in 2011 to approximately 1,200

in 2014.

• 2,620 patients enrolled into MDR-TB

treatment between 2012 and June 2015.

• Treatment initiation delay after

diagnosis reduced from > than two

months to < than a week.

• Analysis of project data showed a

treatment completion of 84%

• 2,956 household contacts screened; 91

TB and 26 RIF cases identified


Analysis on treatment initiation time in selected

sites

158

15 15 12

2011 2012 2013 2014

NIDCH

Median # of Days

84

33

7 3

2011 2012 2013 2014

Chittagong CDH

Median # of Days

69

1511

6

2011 2012 2013 2014

National

Median # of Days


Key componentsTraining

Quality

clinical care

Counseling

Daily Rx supervision

at home level

Regular Monitoring

& SupervisionCash

transfer


Conclusion

• The community based management of MDR-TB

showed a great potential for Bangladesh to increase

access to and quality of MDR-TB services. The

results suggests that a high cure rate with minimal

treatment interruption and failure is achievable.


Acknowledgments

• National TB Control Program (Bangladesh)

• Partners in Health team (Michael Rich et al)

• WHO team

• Local NGO’s

• Patients


THANK YOU


TB CARE II, is funded by United States Agency for

International Development (USAID) under Cooperative

Agreement Number AID-OAA-A-10-00021. The project team

includes prime recipient, University Research Co., LLC (URC),

and sub-recipient organizations Jhpiego, Partners in Health,

Project HOPE along with the Canadian Lung Association;

Clinical and Laboratory Standards Institute; Dartmouth

Medical School: The Section of Infectious Disease and

International Health; Euro Health Group; and The New Jersey

Medical School Global Tuberculosis Institute

management of mdr-tb transition from hospital …...• development of sop’s, training materials,...

Documents