End TB Strategy top 10 indicators: current status in participant countries

Transcription

1 End TB Strategy top 10 indicators: current status in participant countries Dennis FALZON Global TB Programme, WHO/HQ Geneva Regional WHO / Global Fund meeting Kenya 20 September 2016

2 Objectives of the presentation 1. Summarize the main findings of the country survey of 5 of the top 10 indicators 2. Identify the main challenges in the generation of the indicators 3. Propose a framework to prioritize countryand indicator-specific solutions for investment

3 End TB Strategy top 10 indicators 1. TREATMENT COVERAGE 2. TREATMENT SUCCESS RATE 3. HOUSEHOLDS WITH CATASTROPHIC COSTS DUE TO TB 4. TB PATIENTS TESTED WITH A WRD AT DIAGNOSIS 5. LTBI TREATMENT COVERAGE 6. CONTACT INVESTIGATION COVERAGE 7. DST COVERAGE FOR TB PATIENTS 8. TREATMENT COVERAGE, NEW TB DRUGS 9. DOCUMENTATION OF HIV STATUS AMONG TB PATIENTS 10. CASE FATALITY RATIO

4 1. TREATMENT COVERAGE All TB MDR/RR-TB Source:

5 2. TREATMENT SUCCESS RATIO All TB (new & relapse, 2014) MDR/RR-TB, 2013 Source:

6 9. DOCUMENTATION OF HIV STATUS AMONG TB PATIENTS Source: WHO Global tuberculosis report 2015 (WHO/HTM/TB/ )

7 10. CASE FATALITY RATIO Source: WHO Global tuberculosis report 2015 (WHO/HTM/TB/ )

8 SUMMARY OF SURVEY REPLIES FOR NEW INDICATORS

9 4. TB PATIENTS TESTED WITH A WRD AT DIAGNOSIS % new & relapse cases diagnosed with a WRD Country BMU register compatible? Registers provide: Numerator Denominator Benin YES???? Ethiopia YES YES YES?? Kenya YES YES YES YES Malawi YES YES YES?? Mozambique YES YES YES?? Nigeria YES???? South Africa YES YES YES?? Swaziland YES YES YES?? Uganda YES YES YES?? Indicator generated? UR Tanzania YES NO NO Relapses reported under retreatment ; need to go to Rx card and lab register Zimbabwe YES YES YES??

10 5. LTBI TREATMENT COVERAGE % eligible household contacts <5 years started on LTBI treatment Country Data sources Numerator Denominator Aggregated data at national level? Benin Rx card of index c. & IPT register YES YES Yes (indicator generated quarterly ) Ethiopia TB register YES YES No Kenya TB register, others YES NO Yes Malawi TB register, others YES YES Yes Mozambique Contact register YES YES Yes Nigeria Special register YES YES Yes (<6y contact of bact+) South Africa Rx card of index c. YES NO No Swaziland Uganda Soon new contact & IPT registers TB, IPT & contact registers, er&r - - No YES YES Yes & No (? Developing) UR Tanzania Not captured - - No Zimbabwe contact & IPT registers; DHIS2 YES YES Yes

11 6. CONTACT INVESTIGATION COVERAGE % eligible contacts of bact.-confirmed TB evaluated for TB Country Data sources Registers provide: Indicator generated? Numerator Denominator Benin Not captured - - NO; no national guidance Ethiopia TB register YES YES NO Kenya TB register (low completeness) - -?more data from partners Malawi TB & contact registers YES YES YES; use special DCF Mozambique Contact register YES YES YES Nigeria New register & report YES YES NO (to start soon) South Africa Rx card of index SOME NO NO Swaziland Not captured - - New registers soon Uganda Not captured - - UR Tanzania Not captured - - NO Zimbabwe TB register YES YES NO

12 7. DST COVERAGE FOR TB PATIENTS % TB cases with DST results for at least rifampicin Country BMU register compatible? Registers provide: Numerator Denominator Benin YES?YES?YES?? Ethiopia???????? Kenya YES YES YES?? Indicator being generated? Malawi YES YES YES YES; use special logbook Mozambique YES YES YES? possibly Nigeria YES YES YES? South Africa YES YES YES?? Swaziland YES YES YES?? Uganda YES YES YES YES UR Tanzania YES?YES?YES?? Zimbabwe YES YES YES YES; DHIS2 at facility level

13 Country 8. TREATMENT COVERAGE, NEW TB DRUGS % eligible TB cases on bedaquiline or delamanid New TB drugs available? Data on R&R system? Data sources Eligibility recorded? Benin YES YES List of RR-TB/pre-/XDR cases? Ethiopia YES NO - - Kenya YES YES Rx logbook; facility and electronic register s Malawi NO - Will be updated if new drugs introduced Mozambique NO - - NO Nigeria NO - Expected in 2017? South Africa YES YES Electronic register YES Swaziland YES YES DR-TB register; new tools YES Uganda YES YES DR TB unit Register and NTRL DST reports UR Tanzania YES NO RR-TB list; SLD Rx card YES Zimbabwe NO NO To be updated as new drugs? YES - YES

14 INDICATORS BEING DERIVED ALREADY? Country 4 WRD 5 LTBI Rx 6 Contact 7 DST 8 New Rx Benin?????? Ethiopia???? Kenya???? Malawi?? No Bdq Mozambique???? No Bdq Nigeria???? No Bdq South Africa?????? Swaziland?????? Uganda???? UR Tanzania?? Zimbabwe?? No Bdq

15 Conceptual framework to focus on the main challenges Score the relative challenges to derive each indicator in your country (least 1-> most 6) Data source (e.g. accessing data from laboratories or from inexistent vital registration systems) Disaggregation (e.g. data available but not collected in a manner which permits certain aggregations/summarization) Data management (e.g. inefficiencies of paper-based registers; no automated dashboards to summarize the indicators) Definitional (e.g. user understanding of what is a contact, how to define a cure or validity of drug resistance results data) Indicators Resources (e.g. lack of staff devoted to M & E; no investment in electronic surveillance) 2 3 Other (please specify ) - - example

16 -> Roadmap Critical actions and technical assistance needs to implement the Top 10 indicators of the End TB strategy - Revising national M&E plan - Human resources including manpower, training - Supervision/data audit and feedback - Revise recording and reporting system (e.g. er&r) - Integrate indicators into national health information system