Transcript Tuberculosis Facts - Open Society Foundations (OSF)

experience from Lesotho
Dr Hind Satti
Director Partners In Health
Lesotho
Lesotho: Basic Facts
• Landlocked country located within South Africa
(bordering Free State and KwaZulu-Natal)
• Population 1.8 million
• 12,275 TB new cases notified in 2009
• Over 2000 re treatment cases
• Estimated annual TB incidence for all cases is
691 per 100 000 population
• HIV prevalence rate: 23.2% in 2005
• 80% of TB cases are HIV positive (NTP 2008)
Courtesy of Tara Loyd
Lesotho MDR-TB Programme
• A comprehensive response to MDR-/XDRTB in Lesotho, established by the
MOHSW.
• International partners include PIH,OSI,
WHO, FIND.
• Community-based treatment and care
model that includes all 10 districts
• First patients enrolled in August 2007;
over 500 patients enrolled to date
Case Detection
• All HCWs including NTP staff
– TB/HIV coordinators/Officers at district hospitals
– Health centre nurses providing HIV/TB care
• Routine HIV screening of MDR-TB patients,
partners, family members
• Protocol for “medium-risk” and “high-risk”
• Sputum sent to national TB laboratory
• Screening of household contacts
Highlands
Lowlands
Selection of CHWs and Supervisors
• Selection is done at the community level in
the presence of the chief during a public
gathering.
• The selected member must be trusted and
respected by the community.
• The community health worker must be
literate and must be less than 60 years old.
Training of Treatment Supporters
 Knowledge






TB
OIs
HIV
Drug resistance
Drugs/side effects
Screening for
malnutrition and chronic
conditions
 Skills
 DOT, defaulter tracking
 Psychosocial support
 Infection control in the
home
 Screening family for TB
and HIV
 Screening for DM, HTN
and malnutrition
 Accompany pregnant
women to the clinic for
ANC and delivery
Selection of Treatment Supporters
• Lives close to the patient
• Accepted by patient and
family
• Willing to support patient
• Willing to accompany
patient to all clinical visits
• Attend monthly trainings
• Willing to provide
psychosocial support
Role of Treatment Supporter
•
•
•
•
Observe all doses
Report side effects
Provide injections.
Accompany patient for
clinical evaluations
• Screen for TB and HIV
in household contacts.
• Offer psychosocial
support to the patient
and the family.
National TB Reference Laboratory
Whatever it takes
Botsabelo MDR-/XDR-TB Hospital
care for very sick ones
Patient Characteristics
• Approximately 78%
HIV-positive with
advanced AIDSdefining conditions
• Severe malnutrition
• Multiple failed TB
treatment regimens
• Extensive TB disease
• Mostly smear-positive
The Perfect Storm
• Disease
– HIV
– TB
– Malnutrition
• Poverty
– 1-room shelter
– Poor hygiene
– Inadequate
clothing
Social assistance
shelter, transportation and food
MDR-TB/HIV
• 100% HIV testing during the first visit.
• Early initiation of HARRT for MDRTB/HIV
(10-21 days), regardless of CD4 count.
• Aggressive management of side effects.
• Home assessment visit before initiation.
• Household contact screening and testing
for TB and HIV.
2008 cohort analysis
• 150 patients were enrolled during 2008:
– 65% treatment success
– 34% death
– 0% default
– 0.7% (1) failure
– 0.7% (1) transfer out
Building capacity
• International training/ attachment for
HCW and TB managers.
• 2010- 5 countries - 68 HCWs
• Training materials with WHO.
• Technical assistance to other countries.
Conclusion
• Management of MDR-TB in high HIV-prevalence
settings is challenging but possible
• M&E
• Empiric treatment of MDR-TB is needed to
decrease early mortality
• Community engagement is critical.
• Community-based MDR-TB/HIV allows for rapid
enrollment and closer monitoring of side effects