Transcript TB situation 2000-2005 (Name of the country)

Republic of the Fiji Islands
National TB Programme
Dr Sakiusa Mainawalala
TB Coordinator Western
Fourth Pacific Stop TB Meeting
11-14 March 2008, Brisbane
Country Information (2007)
Population
827,900
DOTS coverage (%)
100%
MDR-TB in new TB cases
0
MDR-TB in previously treated TB cases
0
HIV prevalence
<1%
HIV+ among new adult TB cases
1
Trend of notification rates: 2000-2006
(all forms of TB and new sputum smear positive)
TB INCIDENCE 1946 - 2006
800
700
600
500
400
300
200
100
0
06
20 5
0
20 4
0
20 3
0
20 2
0
20 1
0
20 0
0
20 9
9
19 8
9
19 7
9
19 6
9
19 5
9
19 4
9
19 3
9
19 2
9
19 1
9
19 0
9
19 9
8
19 8
8
19 7
8
19 6
8
19 5
8
19 0
8
19 9
7
19 8
7
19 7
7
19 6
7
19 5
7
19 4
7
19 3
7
19 2
7
19 1
7
19 0
7
19 9
6
19 8
6
19 7
6
19 6
6
19 5
6
19 4
6
19 3
6
19 2
6
19 1
6
19 0
6
19 9
5
19 8
5
19 7
5
19 6
5
19 5
5
19 4
5
19 3
5
19 2
5
19 1
5
19 0
5
19 9
4
19 8
4
19
Year 2007 PTB / EPTB INCIDENCE
18
17
16
14
13
12
10
10
9
8
8
6
5
4
3
4
3
3
2
4
2
2
2
3
2
3
2
1
2
1
0
(PTB)
(EPTB)
DEC
NOV
SEP
AUG
JUL
JUN
MAY
APR
MAR
FEB
JAN
0
OCT
6
9
Trend of Treatment Success/Case
Detection Rate: 2000-2007
Year
2000
2001
2002
2003 2004
2005 2006
Cure Rate 85
85
78
89
92
96
86
Case
61
Detection
Rate
73
77
84
69
72
89
SUCCESS RATE-2000-2006
100
90
80
70
60
Rates 50
40
30
20
10
0
Cure Rate
Case Detection
Rate
2000
2001
2002
2003
Year
2004
2005
2006
Anti-TB drug supply
Drug supply comes from Gov’t pharmacy
Payment for TB drugs comes from Gov’t
The Programme suffered from Expired
drugs and drug shortage for some months
on the 3rd quarter of 2007.
Current Stock Level
DRUG
STRENGTH
QUANT/Quat
Ethambutol
400mg
3,500
INH
100mg
3000
Pyrazinamide
500mg
500
Rifampicin
150mg
4000
Rifampicin
300mg
3000
Rifam/INH
300/150mg
1600
Rifam/INH
150/100mg
5000
Streptomycin
1g
250
Laboratory Workload Reports
Q1-2007 Q2-2007
Q3-2007
Patients
tested +ve tested +ve
tested
+ve tested +ve
Diagnosis
100 16 107 17
110 23 140 52
16 1 18 2
87
156
15
14 40 10
49 130 48
1 0
0
145 46 267 47
131 27 151 53
33 1 42 3
216
163
30
37 85
51 13
2 0
Follow-up
Not stated
Q4-2007
Specimens
Diagnosis
Follow-up
Not stated
27
48
0
Laboratory Quality Assurance
Proportion of specimens scored as saliva
287
Are ZN staining reagents prepared in the local TB laboratory?
Yes/No
Are control slides used to check performance of ZN stain?
Yes
Was there any shortage of laboratory supplies during the past
year ? (Yes/No)
Proportion of AFB microscopy results available within 24 hrs (%
of total)
Did your lab(s) participate in a panel test during the past year ?
(Yes/No)
Did your lab(s) participate in blinded rechecking during the past
year ? (Yes/No)
Were on-site evaluations carried out of laboratory services since
Aug 2006? (Yes/No)
No
Yes
100
Yes
Yes
No
Indicators of QA implementation
[1] Total number of TB microscopy
4
units:
[2] having had at least one round of
3
blinded-rechecking (EQA) in 2007:
[3] with poor performance (major errors)
Nil
determined during the last round of EQA
[4] where corrective action was taken if
Nil
poor performance found during last EQA
%
%
%
Plan of Activities 2006 Review
Outcome
areas
Specific Activities
Year 1
1.
Policy/progra
m
management
MDR-TB Policy
TB/HIV Policy
Infection Control
Policy
DOTs Centre-Northern
Q2 2007
Q4 2006
Q1 2007
2.Diagnosis/
Laboratory
Lab Manual
Refurbishment of Lab
Dept.
Q1 2007
3. Case
Management
(including
DOT)
Develop policy &
strengthen notification
of TB in private sectors
Ensure availability of
transport for DOTs in
all level
Q4 2007
Year 2
External
support
Progress
WHO
support
None
TB/HIV
co-infection
surveillance
None
Yet to be
completed
WHO
Support
Reviewed
& Printed
Towards
completion
Q2 2007
Q2
2008
WHO &
PLF
Q2
2008
4.Drug
Management
Convene regular meeting
between Pharmacy section
and TB unit (6monthly)
Q4 2006
5. Advocacy,
Communicatio
n, Social
mobilization
Advocacy to political
leaders for more
commitment to TB control
(e.g infrastructure/HR
Q1 2007
TB-HIV/MDRTB/PPM DOTS
Formalize integration of
Q4 2006
HIV&TB programs
Formalize integration of TB Q2 2007
programme with Private
sectors
Staffing/
Training
Refresher course for
health care providers
(Doctors, nurses, lab techs)
Global Fund
Not Applicable
Q2 2007
Monthly
meeting
Q1 2008
WHO
None (due to
Gov. takeover)
WHO
JICA
LTK
workshop
Q4 2007
Funding for TB control
Source(s)
Duration
Amount
MOH (Human Resource
Costs).
annual
300,000-00
WHO Biennium Budget
2008-2009
2008
31,300-00
MoH Travel and Program
Logistics Costs.
2008
30,000-00
Total available
361,300-00
Estimated financial gap for--- (2008)
200,000-00
Achievements and weaknesses
Achievements – able to raise the Case
Detection Rate from around 70% to 88-89%
Weakness
1) Poor reporting of treatment outcomes
2) Unreliable drug supply:Fiji relies on bulk procurements
scheme so that the cheapest tender provides the drugs for Fiji and the supply
system can be discontinous leading to interruption in drug supplies to TB
units.(*Since more patients are being detected and screened now, drug quota
for the previous year was inadequate which lead to drug shortage).
3) Questionable drug quality:Fiji relies on bulk
procurements scheme so that the cheapest tender provides the drugs for Fiji
and the supply system can be from different suppliers for which no quality
assurance control is excised internally or externally. There were also inpatient
cases that took a longer time to become sputum negative and also had
increasing smear counts despite being on Rx.
Vinaka Vakalevu and thank you.