The Regional Centre of Excellence (CoE) on Programmatic Management of Drug Resistant Tuberculosis (PMDT)

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1 The Regional Centre of Excellence (CoE) on Programmatic Management of Drug Resistant Tuberculosis (PMDT) General Information The Centre of Excellence (CoE) on Programmatic Management of Drug Resistant Tuberculosis (PMDT) for East Africa was established in Kigali, Rwanda in mid 2010 with support of USAID East Africa. This support was channelled through KNCV, as the lead TB CAP partner for the project. Although this is a training centre on PMDT for the Eastern African countries, other countries on the African continent also access the trainings. Up until the CoE was established all PMDT trainings were held at the WHO Collaborative Centre, in Riga Latvia. The Riga training is expensive and logistically difficult for the regional countries because of the high cost of air travel and challenges in obtaining visas. Given the increased demand for training with increasing cases of drug resistant TB, the establishment of the CoE was an answer to a critical regional need. The need for a training center was substantiated from results of an analysis of WHO MDR/XDR TB data by global and regional stakeholders who concluded that National TB programs from the East African Region lacked capacity to diagnose and treat MDR-TB and therefore urgently needed to start building capacity (institutional, organizational and individual program officers) to implement PMDT programs. Subsequently in 2010 three countries (Ethiopia, Kenya and Rwanda) were evaluated by a team composed of KNCV and RCQHC. The Rwanda NTP (IHDPC) together with the School of Public Health and the National Reference Laboratory were chosen to establish the Regional CoE. The current setup of the Regional PMDT CoE in Rwanda brings together functions of three institutions (cited above), also referred to as pillars under the IHDPC/TB division directorate since his creation until last year. But from October 2011, the leader has been given to NUR/SPH. These institutions signed a Memorandum of Understanding (MoU) in August 2010 describing the functions, roles and responsibilities of all the three CoE pillars Vision The East African Regional Centre of Excellence for Program Management of Multi and Extremely Drug Resistant Tuberculosis supports the elimination of Multi Drug Resistance and Extreme Resistance Tuberculosis in the East African region

2 Mission The East African Regional PMDT CoE provides opportunities to the involved countries to learn, share and exchange experiences on evidence based program management including quality assured laboratory practices and operational research. Goals The overall goal is to have quality PMDT programs implemented in the involved East African Regional countries. Other Goals are: Ensure availability of high quality, evidence based curricula, addressing the needs of the countries trainees Provide high quality evidence-based PMDT trainings based on international standards adapted to the regional context for all cadres To ensure experience exchange on all PMDT related issues Ensure adequate and high quality human resources for trainings, consultancies and research Have physical infrastructure for the training in clinical, laboratory, programmatic, and research aspects of PMDT Ensure a sustainable Centre of Excellence within 5 years Specific Objectives To provide adapted curricula on the programmatic management of drug resistant TB (PMDT) in an HIV prevalent and resource limited setting in conformity with WHO guidelines To organize attendance, certified and accredited courses on PMDT and related issues: Clinical, lab diagnostics, Infection Control and Research. To have a coordinated mechanism in place for exchange of best practices and lessons learnt on PMDT and related issues To establish National and Regional team of facilitators and subject specialists, to support up-to-date PMDT implementation in regional countries To upgrade and maintain the existing infrastructure to the level they will provide a conducive environment for the implementation of the CoE activities To establish revenue based financial system to ensure continuation of planned activities

3 Achievements 1. So far 2 workshops: The 1 st Workshop: Held in October 2010 in Kigali and brought together twenty two (22) national and regional Stakeholders on PMDT, including TB program managers. Stakeholders present included: RBC/HIV Division, TB (NTP) and HIV/AIDS Units, Rwanda, School of Public Health Rwanda, National Reference Lab, WHO, CDC, Partners in Health, USAID, KNCV, ICAP/Columbia University, Damien Foundation and Interact. The main purpose was to update all stakeholders on the establishment of the regional PMDT Center of Excellence and develop PMDT agenda. One of the outputs from this first workshop was an overwhelming desire for training of health care staff within the region on PMDT and Infection control by the participants. The 2nd Workshop: Held in December 2010 in Kigali as training of trainers and an occasion to discuss and develop the training curriculum for PMDT country focal points due in January The workshop was attended by 17 experts from Kenya, Uganda, Ethiopia, Netherlands and USA. The Training of the Trainers of the PMDT/ TB Infection Control course objectives were ;To provide an overview on adult training methodology; To develop/adapt case studies on patient management; To develop/adapt case studies on M & E; To pilot assessment tools for TBIC and To develop/pilot patient interview questionnaire. The main output was the developing of the training agenda and curriculum and assigned the faculty in December 2010 for the first international training course on PMDT and TB Infection Control in January Three international courses: 1st International course on PMDT: This training was held from 17th to 21st January 2011 in Kigali Rwanda. Two participants were invited (and all attended) from each of the following countries: Ethiopia, Kenya, Tanzania, Burundi, Uganda, Zambia, Rwanda, DRC Congo, Malawi and Liberia. A total of 34 (facilitators and focal points) attended the course 1st International course on basic TB Infection Control: This training was held from 20th to 24th June 2011 in Kigali Rwanda. One participant was invited (and all attended) from each of the following countries: Ethiopia, Kenya, Tanzania, Burundi,

4 Uganda, Zambia, Rwanda, Malawi and Nigeria. A total of 24(facilitators and focal points) attended the course. 1st International course on laboratory course: This training was held from 26th to 30th September 2011 in Kigali Rwanda. Participants were invited (and all attended) from each of the following countries: Zimbabwe, Kenya, Somalia, Burundi, Uganda, Zambia, Rwanda, Ethiopia, Swaziland, South Sudan and Malawi. A total of 28 (facilitators and focal points) attended the course 2 nd International PMDT Course was attended by 11 international participants (Ethiopia (2); Kenya (2), Malawi (1); Tanzania (1); Uganda (2); Zimbabwe (2); Burundi (1); and 8 national participants from Rwanda NTP. In total 19 participants (5 females and 14 males). The 2nd International Basic TB Infection control course: Twenty two (22) participants from TB programs and clinical specialists from Ethiopia, South Sudan, Tanzania, Uganda and Rwanda attended the training course. One of the participants was female. Sixteen (16) participants were Rwandese doctors. All participants were doctors. 3. Field visits: Some field visits have been carried out to share experience on the ground with TB teams from East African countries (Uganda, Kenya, Tanzania and Burundi). 4. About Infrastructure: Class room has been renovated and furnished at the School of Public Health. Library has been equipped with books and Journals on TB, TB/HIV and MDT TB. Challenges Sustainability of Centre of Excellence PMDT: Until the Centre has been supporting by USAID fund via KNCV. But for the next years they are not source of fund for his sustainability. Lack of national trainers: Until they are not enough local trainers to support CoE PMDT. Accreditation of the courses on PMDT and related issues (Clinical, lab diagnostics, Infection Control and Research) Publication on the best practices done in Rwanda and regional countries.

5 Future plans: Maintain the three existing training courses Establish: a. TB/VIH co Infection course (English and French sessions) b. TB-IC,PMDT and Lab French courses. Some pictures: (See below)

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