Transcript Abstract - WHO archives

Abstract
Problem Statement: Armenia received anti-TB drugs from the Global Drug Facility to treat patients
in the civil sector in January 2003, whereas the supply of anti-TB drugs for prisons is ensured by the
International Committee of the Red Cross (ICRC) as from 2002, allowing anti-TB drugs for all
patients. However, a high default rate in the civil sector results in a high transmission of TB
infection, and therefore increases treatment costs for society.
Objectives: To evaluate the efficacy of active follow-up of released prisoners under anti-TB
treatment to the civil sector and its impact on the general population and related treatment costs.
Design: Cross-sectional study.
Setting and Population: One central penitentiary hospital in Yerevan, Armenia, using TB transfer
forms and patient records analysed from January 2003 until November 2003.
Intervention: The study of TB cases released from prisons covered 2 periods: from January to July
2003, no active follow-up of patients was done. From July till November 2003, patients were assisted
by a doctor of the Ministry of Justice to ensure registration at TB facilities and completion of
treatment.
Outcome Measures: TB transfer forms and patients’ treatment cards were systematically reviewed
during the period of intervention, giving % of defaulters, % of drug intakes, and completion rates.
Results: In the group of patients without active follow-up, only 22% continued treatment, whereas in
the group actively followed-up, 62.5% completed treatment. This means that in the group without
follow-up, 78% of the patients will infect an average of 15 persons in the civil sector, resulting in
about 117 TB cases. In the group with active follow-up, only 56 TB cases will be produced. For
society, this represents an increased cost of USD 9360 per 100 patients compared to a cost of USD
4480 per 100 patients if active follow-up is in place together with availability of drugs in the civil
sectors and prisons.
Conclusions: Provision of anti-TB drugs in Armenia in the civil sector and in prisons combined with
active tracking of released prisoners under treatment doubled reductions in anti-TB treatment costs.
Therefore, we recommend continuing active follow-up of released prisoners under treatment since it
improves drug use and treatment completion.
Background and setting
• In Armenia, TB cases detected in the prison
system constitute a disproportionately large
fraction of disease burden. The prison TB
prevalence is estimated to be 50 times that of the
general population.
• As from 2002, the ICRC is supporting the
Ministry of Justice to detect promptly TB cases
and treat them in the Central Penitentiary Hospital
and the pre-trial detention centre through DOTS.
Introduction
• Anti-TB drugs are supplied from 2 sources:
the GDF for civilian and the ICRC for
prisons.
• Prisoners released while under treatment are
entitled to complete a free course of DOTS.
However, barriers to treatment access in TB
facilities result in a high defaulter rate for
patients including ex-prisoners.
Objectives
• The MOJ supported by the ICRC follows each
patient released from prisons to the TB facilities
and help in basic medical/administrative steps.
• To evaluate the efficacy of active follow-up of
released prisoners under anti-TB treatment to the
civil sector and its impact on the general
population and related treatment costs.
Method 1
• Active follow up consists on accompanying
the released prisoners while under DOTS to
civilian TB facilities. This is ensured by a
physician of the MOJ.
• Completion rates during six months without
active follow up were compared to five
months with active follow up.
Method 2: future perspectives
• An individualized automatized database is
under preparation for the civilian sector that
will record information of TB registers
(TB03, TB10, TB12).
• Such DB already exists in prisons.
• In the future, the two DB will be linked to
ensure information flow between prisons
and the civilian sector.
Results 1
• Completion of treatment is 22% without
active follow-up compared to 62.5% with
active follow-up.
• 117 additional TB cases are produced if no
active follow-up compared to 56 if active
follow-up.
Results 2
• For the society, this represents an increased
cost of USD 9360 per 100 patients
compared to USD 4480 per 100 patients if
active follow-up is carried out together with
availability of anti-TB drugs in both sectors
(civil & prisons) as is as from January 2003.
Discussion
• Informal payments are a major barrier to TB
treatment access and their reduction by
medical services is of utmost importance.
• In the future, provision of anti-TB drugs to
both sectors from one source (GDF in the
civil sector) may strengthen links in
between these sectors.
Summary
• Provision of anti-TB drugs in Armenia in
the civil sector through the GDF and in
prisons through the ICRC combined with
active tracking of released prisoners while
under DOTS doubled reduction in anti-TB
treatment costs.
Conclusion & recommendations
1
• Active follow-up of released prisoners
under DOTS should continue.
• Barriers to TB treatment access could be
diminished through reduction of informal
payments by medical services. This may be
done through fourfold measures.
Conclusion & recommendations
2
• Increase salaries of medical professionals.
• Link salaries to performance.
• Transparent accounting and reporting of
financial activities through clear governance
of TB facilities.
• Publicize patients rights in facilities and
through large media coverage.