mdr-tb globally and in the region 2013
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MDR-TB Globally and in the region 2013. Dr Samiha Baghdadi Medical officer – STB WHO – EMRO Cairo March 2014. The structure of the presentation. MDR-TB burden globally and in the region MDR-TB notification MDR – TB treatment outcomes Regional challenges and strategic directions - PowerPoint PPT PresentationTRANSCRIPT
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MDR-TB GLOBALLY AND IN THE REGION 2013Dr Samiha Baghdadi Medical officer – STBWHO – EMROCairo March 2014
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The structure of the presentation• MDR-TB burden globally and in the region• MDR-TB notification• MDR – TB treatment outcomes• Regional challenges and strategic directions• Ambulatory care for MDR-TB
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Global coverage of data on DR-TB 1994-2013
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MDR-TB rate among New TB cases
JOR SYR SOM IRN AFG IRQ LIB PAK EGY BAH KWT UAE OMN KSA YEM QTR LEB DJI SUD TUN MOR PAL EMR
6.36.2
5.25
2.9 2.9 2.9 2.9
2.32.2 2.2 2.2 2.2
1.81.7
1.21.1
0.9 0.9 0.82
0.5
3.5
Graph 2: MDR rate among new
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MDR-TB rate among previously treated TB cases
LEB IRN SOM AFG IRQ LIB PAK SYR JOR EGY KSA YEM DJI SUD MOR TUN BAH KWT QTR UAE OMN PAL EMR
67
48.2
41
35.4 35.4 35.4 35.4
3129
25
16 15 14.4 14.412.2 12
10.8 10.8 10.8 10.88.3
32
Graph3: MDR rate among previously treated
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Estimated MDR-TB among TB cases by WHO region
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Contribution of WHO regions to MDR-TB burden 2012
AFR13%
AMR2%
EMR6%
EUR25%
SEAR30%
WPR25%
Graph 1: Contribution of WHO regions to MDR-TB burden 2012
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Countries notified at least 1 XDR case
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MDR-TB cases 2012Estimated, notified and enrolled on treatment
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Estimated Number of MDR-TB cases among notified TB cases 2012
PAK AFG SOM IRN SUD IRQ EGY MOR SSUD YEM SYR SAA DJI LIB TUN JOR LEB OMN QAT BAH UAE W&G KWT
11000
1100770 750 580 420 330 300 250 150 97 84 81 36 19 15 10 6 6 3 2 1 0
Graph 3: Estimated number of MDR-TB cases among notified TB cases
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Confirmed MDR-TB cases among notified TB cases 2012
PAK IRQ EGY SUD DJI MOR IRN AFG SAA TUN JOR SYR YEM LEB OMN BAH SSUD QAT UAE KWT SOM W&G LIB
1602
420
116 116 96 8050 31 20 15 13 13 8 6 6 4 3 2 2 0 0 0
Graph 5: Confirmed MDR-TB cases 2012
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Contribution to MDR-TB notification by region 2012
AFR22%
AMR4%
EMR3%
EUR44%
SEAR23%
WPR5%
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Treatment outcomes
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Treatment success rate by country 2011
Afghanistan Egypt Iraq Lebanon Morocco Pakistan Sudan Syria Tunisia Total
86
6772
100
27
70
5358
6966
Treatment success rate of MDR_TB cases 2011
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Regional challenges/risks foreseen • Unstable situation in many countries in the region, namely (Afghanistan, Egypt,
Lebanon, Iraq, Pakistan, Somalia, Syria, Tunisia and Yemen). This situation resulted in several challenges as follows:
• Huge population movement across the region• Huge staff turn over • Destruction of infrastructure• Limited movement in the field• Sever loss of drugs and equipment
• Limited lab capacity • Culture and DST are not available in Somalia and South Sudan. DST is not available in Afghanistan. • Most of the countries in the region did not widely apply the new diagnostics. • DR survey and surveillance:
• Updated survey is ongoing in Iraq, Iran, Pakistan, Sudan, and needed in Syria.• There is a need to document/report results of DR surveillance that is ongoing in GCC countries, and expand
the continuous surveillance in the remaining 15 countries.• Libya is still the only country in the region without proper management of MDR-TB management.
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Regional challenges/risks foreseen
• Expected financial gap to support scaling up MDR-TB activities in most countries, mainly (Djibouti, Egypt, Lebanon, Jordan, Iran, Pakistan and Syria).
• Limited human resources at country level (MDR local support on continuous basis is needed in Afghanistan, Iraq, Pakistan and Sudan mainly).
• Limited consultancy capacity in the region in general ( a team of 5 consultants was established last year to support countries)
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The strategic directions of the work of EMR_GLC• Improve planning for PMDT (update the regional plan
and support planning at country level),• Develop regional high standard ambulatory based
model • Develop Regional framework and guidance about the
utilization of New diagnostics and lab support,• Scale up R&R for MDR, infection control at all levels, HR
capacity,• Promote prequalified regional companies; develop
mechanisms for joint proposals, drugs grants.• Operational research
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Promote using ambulatory model in MDR-TB care
Justification:• Limited country capacity (infrastructure: hospitals,
infection control) and financial.• New diagnostics increase case detection (X-Pert).• Long waiting list of detected cases.• Global experience is encouragingHowever : Ambulatory care does not exclude hospitalization
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What do we need for ambulatory model
• Networking:• Diagnosis, • Treatment, • Treatment follow up, • Side effect management, • Daily observation and care, • Social support
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Some basic items for provincial profile1. Population2. Admin areas3. Geographical description4. Notified cases/notification rate ( TB type, Age and gender)5. Treatment outcomes ( TB type, Age and gender)6. Estimated MDR-TB cases among new and previously treated7. Infection control8. Lab coverage9. EQA for DSM10. C/DST coverage11. PPM coverage 12. PHC coverage13. Hospitals available14. Referral system15. Community support
16. Provincial map (PHC facilities, hospitals, laboratories, TB facilities, PPM facilities, patient distribution, MDR cases distribution) and community support points.
17. Security issues18. MDR focal person
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RO support to countries for AT• Briefing about ambulatory model 2012• Training on planning 2013• Follow up planning process 2013
Future plans 2014• Monitoring missions and evaluation• Lesson learnt
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SWOT analysis
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Stakeholder analysis/matrix
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Provincial profile
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Provincial map
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Strategic frame work
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OP plans