Transcript Objectives_ExpectedOutcomes_20110513

Goal
To discuss and refine current definitions of cases and
treatment outcomes for non MDR-TB and MDR-TB,
especially in anticipation of widespread use of Xpert MTB/RIF
Objectives
1. To review and propose refinements to current case
definitions for non MDR-TB and MDR-TB (Day 1)
2. To review and propose refinements to current definitions of
treatment outcomes for non MDR-TB and MDR-TB (Day 2)
Expected Outcomes
Agreement on a proposed set of case and treatment outcome
definitions, and steps required to adopt these definitions, for
consideration by WHO's Strategic and Technical Advisory
Group for TB (STAG-TB) in June 2011
Key points, Day 1
1. We are not defining how cases will be classified on patient cards (etc.)
BUT rather how they will be categorized for the purposes of paperbased (quarterly?) reports and hence surveillance at national and
global level (with ERR can aggregate/disaggregate as necessary)

Need to keep things simple (no more than current 36 categories)
2. Dropped "possible" and "probable categories", "probable" (sm+)
merged into "confirmed" and "possible" becomes "not confirmed

Language translates more easily (also simpler)
3. Support for "treatment change" category
4. Implicitly (explicitly?) dropping the sm+ category and the distinction
between pulmonary and extrapulmonary cases but HIV status and
data on children among "non-confirmed cases" must be captured
5. Questions:

how to capture C+ given delays in culture results, link to drug orders
6. Group not in favour of dropping "completed treatment" outcome
category – need to look again at categories (and associated
definitions) as neither Option 1 nor Option 2 retained this category
New and recurrent cases:
(incident cases)
16 sub-categories
("boxes" in paper-based
quarterly report)
New or
Recurrent
Includes C+,
Sm+, WRD+
Confirmed
Age and Sex
(2x5 subcategories)
<15, 15-24, 25-44,
45-64, >65
Not confirmed
MDR-TB status
(3 categories,
MDR Yes/No/
not known)
Age
(2 categories,
0-4, 5-14)
HIV status
(3 categories)
Treatment change:
(prevalent cases)
8 sub-categories
("boxes" in paperbased quarterly
report)
Treatment change
Interrupted
Confirmed
Not confirmed
MDR-TB (yes/no/
not known)
Defaulted
Confirmed
Not confirmed