Transcript Poster presentation

Introducing fixed dose
combination tablets into DR
CONGO using the Global TB
Drug Facility
20 provincial agencies
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Country profile: DR Congo
 DR Congo is one of the world’s 22
high burden TB countries
 Size: 2 345 000 Km²
 Population: 54 141 875
 Health organization:
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20 TB provincial agencies
515 health districts
738 health centers
DOTS coverage: 70%
Country profile: DR Congo(2)
 Notification:
 New case smear positive: 44 518
 All cases: 70 625
 Notification rate (new case): 82 / 100 000 Pop
 Treatment outcome 2001(new case SS+):
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Treatment success rate: 78%
Dead rate: 6%
Defaulted rate: 10 %
Failed: 1%
Transferred: 4%
 Various donors are providing financial supports
(USAID, EU, NGOs,etc). GFATM has provided
DRC with additional funding to fight TB
Why did DR Congo apply to
GDF?
 DR Congo applied for assistance from
the GDF because the National
Programme (NTP) did not have
enough drugs to treat TB patients.
 In fact, the country had lacked buffer
stocks for 10 years, some regions had
no drugs, and the programme’s
funding partners were unable to
increase their budgets for drugs.
Why did DR congo apply to
GDF?
 As result of periodic shortages, DOTS could
not be maintained or extended throughout
the country even though DR Congo’s TB
control programme was generally good.
 The National Programme in DR Congo
decided to shift to the 4FDC because of a
need for simplified drug management and
the compatibility of the existing TB drug
treatment regimens in DR Congo.
How did the GDF assist DR
Congo ?
 Grant of TB drugs for 63,000 patients
in Year 1 and 63,000 in Year 2
 Total approx value = $1.5 million
 Quality assured FDCs
 Technical support from GDF
secretariat in Geneva and three incountry technical missions
Introducing of 4 fixed dose
Combination with GDF grant
 TB regimen in DRC NTP:
 Category 1: 2RHZE/6HE
 Category 2: 2SRHZE/1RHZE/5R3H3E3
 The DR Congo is a current recipient of GDF
support, having been approved for a 3-year
grant of TB drugs, including the 4 FDC, in
november 2001.
 Before this period, the National TB
Programme (NTP) was using 3 FDCs
(RHZ) and Ethambutol separately.
4FDC improve the use of drug
by TB patients in NTP of DR
Congo
 Shifting from 3FDC to 4 FDC reduce
the number of daily tablets to be taken
by TB patients.
 A TB patient weighting 50 Kg had 8
tablets with 3 FDCs and have now
only 4 tablets.
 4FDC improved the treatment
compliance of TB patients
4FDC improve TB drug
management in NTP of DR
Congo
 Improve case finding because TB
drugs are available
 Simplified drug ordering
 Simplified stocking and distribution
 Reduced complex prescription
 Minimised the potential error
Case notification (all cases)
50 000
44 518
45 000
42 054
case number
40 000
36 112
35 000
33 442
30 000
25 000
20 000
34 923
24 609
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15 000
10 000
5 000
0
87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02
Years
New cases SS+
Relapse
SSneg
Extrapulmonary
4FDC improve TB drug
management in NTP of DR
Congo(2)
Sponsored by WHO DRC
office, NTP organised a
workshop in aim to get a guide
for drug management.
 A management committee,
including NTP responsible,
Health Minister representative
and NGOs, was set up.

4FDC improve TB drug
management in NTP of DRC(3)
 As the NTP will manage TB
drug for the first time, it was
necessary to hire a pharmacist.
 A guideline on the TB drugs
management, named
“PATIMED” is written. It
describes TB drug recording
and reporting system and how
to use the 4 FDCs.
4FDC improve TB drug
management in NTP of DRC(4)
 Some of provincial TB manager
were trained to use the guide.
 The district health managers are
not trained yet.
 The supervision on the field work
needs to be reinforced to make
sure that drugs are used as
recommended
4FDC improve DOTS strategy
 In 2002 and 2003, 2 more provincial
agencies expanded DOTS strategy.
 In 2004, 2 other provincial agencies
will expand DOTS strategy.
 DR Congo plans to achieve 90%
DOTS coverage by the end of 2004.
 NTP is improving case finding
Conclusion
 The provision of 4FDC drugs from GDF has made
it possible to improve the drug management skills
of TB control Programme personnel and primary
health care workers who are responsible for the
diagnosis and treatment of TB.
 With available and consistent drug supply, the TB
programme plans to extend DOTS in whole the
country .
 4FDC improve the use of drug for TB patients
 GDF ensured that there were drugs and buffer
available for all TB patients