Indicators for MDR-TB detection and outcomes

Transcription

1 Indicators for MDR-TB detection and outcomes Dennis FALZON TB surveillance and surveys: A training workshop for consultants Geneva, Switzerland - 26 May 2011

2 Reference 2

3 Aggregated forms pages &

4 Revised R&R for MDR (1) - Discussion from 22 February 2010with group from GLC, KNCV, MSF, MSH, PIH, UNION, WHO. - Objective: minimumindicators for national or project level monitoringand - suitable for different partners (WHO, GLC, GF) - easily extracted manually or electronically - conform to what was used in past and DOTS system - Focus on indicators rather than forms 4

5 Revised R&R for MDR (2) Indicator Group Cohort Computed Stratification Detection (4) 6 months 3 months after end of semester Risk categories Enrolment (4) 6 months 1 month after end of semester Children, females, HIV-positive on ARV Interim results (5) 3 months 9 months after end of quarter None Final outcomes (6) 12 months 24 months after end of year HIV positive; XDR (success and death)* * Recommended stratification as per conditions specified in instructions 5

6 Detection TB patients with result for isoniazid and rifampicin DST Confirmed MDR-TB cases detected among TB patients tested for isoniazid and rifampicin DST Confirmed MDR-TB cases tested for susceptibility to fluoroquinolone and second line injectable Delay in diagnosis of MDR-TB months COHORT READ 6

7 Enrolment MDR-TB cases (suspected or confirmed) enrolled on MDR-TB treatment Confirmed MDR-TB cases enrolled on MDR-TB treatment Confirmed XDR-TB cases enrolled on XDR-TB treatment Delay in start of MDR-TB treatment months COHORT READ 7

8 Interim results MDR-TB cases on MDR-TB treatment regimen with negative culture by 6 months MDR-TB cases on MDR-TB treatment regimen who died by 6 months MDR-TB cases on MDR-TB treatment regimen who defaulted by 6 months Patients on MDR-TB treatment regimen found not to have MDR Patients on XDR-TB treatment regimen found not to have XDR months COHORT READ

9 Final outcomes MDR-TB cases with an outcome cured MDR-TB cases with an outcome completed MDR-TB cases with an outcome died MDR-TB cases with an outcome failed MDR-TB cases with an outcome defaulted MDR-TB cases with no outcome assigned (transferred, still on treatment or unknown) months COHORT READ 9

10 Overall timeline Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Detection, Enrolment: Interim results : Final outcomes: 2 yearly 4 yearly 1 yearly 10

11 Changes (1) Separate stratifications for Risk categories Children Females HIV-positive individuals (+/- ART) Coverage of DST and results in risk groups No stratification of outcome by prior treatment history Separate outcomes for XDR and HIV positive where indicated Intervals (delays) in diagnosis and in start of treatment 11

12 Changes (2) Detection & enrolment: 6-monthly instead of 3-monthly Ratio of "enrolled to identified" MDR 6-month conversion of culture (no longer includes 5- month bacteriology) Outcomes : transferred out merged with unevaluated; information on unwarranted MDR/XDR treatment No changes in the definitions, registers or treatment card 12

13 Acknowledgements - Working group: Dennis Falzon, Philippe Glaziou, Nico Kalisvaart, Joël Keravec, Carole Mitnick, Pierre-Yves Norval, Edine Tiemersma, Arnaud Trébucq, Francis Varaine - Substantive comments: Amal Bassili, Jaime Bayona, Salem G Barghout, Léopold Blanc, Haileyesus Getahun, Agnes Gebhard, Christian Gunneberg, Peter Metzger, Nani Nair, Norbert Ndjeka, Wilfred Nkhoma, Mamel Quelapio, Vija Riekstina, Sarah Royce, Patricia Shirey, Fraser Wares, Matteo Zignol 13

14 Templates (1) Detection Risk category (list as many as exist) Total With results for H & R Number of TB cases Resistant to both H & R (MDR) With MDR and tested for FQN & 2 nd line inj. Risk category 1 (specify) Risk category 2 (specify) Total No. of MDR-TB cases with information on interval Interval between suspicion and DST results (days) Mean Minimum Maximum 14

15 Templates (2) Enrolment 15

16 Templates (3) Interim results Number of patients started on MDR-TB treatment found not to have MDR Number of patients started on treatment for XDR-TB found not to have XDR 16

17 Templates (4) Final outcomes TB patient type Number of cases started on treatment Cured N % Completed N % Died N % Failed N % Defaulted N % No outcome assigned N % All confirmed MDR-TB cases All confirmed XDR-TB cases * MDR-TB HIV+ve * * Recommended stratification as per conditions specified in instructions 17

18 Exercise 18

19 Exercise (1) Detection : what is your next question? Number of MDR- TB cases with information on interval Interval between MDR suspicion and DST results (in days) Mean Minimum Maximum

20 Exercise (2) Enrolment : what would you ask? TB patient type Confirmed MDR Confirmed MDR, HIV+ on ART Identified during assessment period Started on M(X)DR-TB treatment

21 Exercise (3) Interim results : where are the rest? Number of confirmed MDR- TB cases started on MDR-TB treatment 50 Culture negative at 6 months N % 25 50% Died by 6 months N 5 % 10% Defaulted by 6 months N % 5 10% 21