Scale up of MDR TB Management in the Philippines: Lessons Learned

Transcription

1 Scale up of MDR TB Management in the Philippines: Lessons Learned Tropical Disease Foundation in collaboration with the NTP, Department of Health Ma. Imelda D. Quelapio, MD

2 Philippines: Magnitude of the TB problem 83M population; 17 regions 9 th of 22 high-burden countries 3 rd in WPRO 16 th of 25 priority countries for MDRTB 4.4% MDR in new and 21% in previously treated (2004, DRS) 4,469 estimated MDR cases every year (Global MDR/XDR Response, )

3 DOTS and MDR TB management DOTS coverage: nationwide in 2003 Case detection rate: 75%, 2005; Success rate: 87%, 2004 MDR TB management: 2000: Green Light Committee (GLC) PILOT project for 200 patients 2003: 500 patients through Global Fund (GFATM) Round : DECENTRALIZATION of MDR services to public health centers 2006: MAINSTREAMING of MDR TB management into the NTP through GFATM Round 5 (2,500 patients)

4 Mainstreaming Integrating MDR TB Management into the routine activities in the National TB Program Careful and stepwise process of shifting procedures one by one from project mode to program Moving from centralized to decentralized services; from specialized treatment centers to DOTS facilities in the community (public health centers or private-public mix DOTS/PPMD units)

5 MDRTB Patient accrual (Apr 99- Aug 07) Current = 808 Total target Y2011 = 3200 GFATM = New patients Cumulative Pilot Mainstreaming Decentralization (14 GF) TDF, PCSO, DOH GFATM)

6 GFATM support in the expansion MDRTB N=13,330 till pre GF/GF2 GF 5 RCC (14 GF) Yearly no. to treat Cumulative no. to treat

7 Political Commitment: setting the policy environment Mainstreaming into the NTP Memorandum of agreement with key partners: NTP: central, regional, local Laboratory Implementing sites: private, public Consultations with partners Implementing Guidelines for MDR TB MDR TB Training Modules

8 Political Commitment: setting the policy environment: Memorandum of Understanding Department of Health Lung Center of the Philippines Tropical Disease Foundation Department of Health Regional Health Office National TB Reference Lab Lung Center Philippines Local government Units - MM Tropical Disease Foundation

9 Consultative meetings with partners National TB Control Program Regional Health Offices City Health Offices Local health units

10 DOTS Facility/ Public/PPMD Unit REFERRAL SYSTEM MDR TB Treatment Center Microscopy DOT Uninterrupted supply of drugs Recording and reporting MDRTB Symptomatic/Suspect Microscopy, culture and DST DOT: with support mechanisms Uninterrupted supply of SLDs Recording and reporting MDR TB

11 MDR TB Treatment Center In house facility Out-patient facility Comprehensive services for MDR TB SM, link to culture and DST centers Infection control measures Management of severe adverse reactions Supportive care: Psychosocial sessions Patient general assemblies Livelihood activities Drug management Recording and reporting

12 DECENTRALIZATION DOTS Facility/ Public/PPMD Unit MDR TB Treatment Center DOT of SLDs Management of mild adverse drug reactions Simple drug management Recording and reporting Sputum-negative MDRTB patient Microscopy, culture and DST DOT: SLDs; Uninterrupted SLDs Recording & reporting MDR TB Sputum-positive MDR patient

13 Metro Manila Region 10M population Treatment Center METRO MANILA 6 Specialized MDR TB Treatment Centers 89 Treatment Sites (DOTS facilities) 76/452 (16%) local health centers (Treatment Sites) 13 FBO/NGO/PPMD Units (Treatment Sites) 15 of the 17 (88%) cities in Metro Manila DOTS facilities trained in MDRTB management Treatment Site

14 Metro Manila Region 17 Regions in the Philippines Nationwide coverage ALL regions by (6%) 10 (2%) Region I Region II 6 (1%) 13 (2%) 122 (22%) 19 (3%) CAR Region III 162 (29%) 30 (5%) 20 (4%) 69 (12%) 15 (3%) 6 (1%) 25 (4%) 11 (2%) Metro Manila Region IVB Region VI Region VII Region IVA Region V 6 (1%) 8 (1%) Treatment Center Places of residence Treatment Site 99- July 07 Region VIII Region X Region XIII Region IX Region XI ARMM

15 Establishing the Laboratory Network: Metro Manila Supranational laboratory RIT/KIT NTRL TDF, CTRL TDF, RITM/NTRL LCP, PTSI Level III/central Level II/intermediate DST Centers Culture Centers Microscopy centers in Treatment Centers Level I/peripheral Microscopy Centers

16 Metro Manila Region 2 DST Centers 6 Culture Centers Nationwide coverage ALL regions by 2009 Culture Center DST Center Laboratory Network

17 Drug Management Selection Forecasting Procurement Distribution Use Inventory Department of Health Materials Management Division Regional Health Offices Centers for Health Dev t Warehouses MDR TB Treatment Centers City health offices DOTS Treatment Sites

18 Recording and Reporting TB Register Department of Health Recording and Reporting Regional Health Offices Centers for Health Dev t City health offices MDR TB Treatment Centers Recording DOTS Treatment Sites

19 Lessons learned Consult with partners Engage as many partners as possible Build on existing system(s) Simplify Pilot sites and procedures Take advantage of available financial support Continue to strengthen DOTS

20 Challenges Absorptive capacity HR and physical structures Laboratory strengthening Sustainability Shifting focus from project mode to program Infection control