Upload
laura-lopez-gonzalez
View
222
Download
0
Embed Size (px)
Citation preview
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
1/24
MDR XDR TB in Tugela Ferry/KZN
overview and response 2010
Claudio Marra
Philanjalo/TFCARES
Laboratory strengthening in high TB-burden African countries
Seminarjointly organized by the Ministry of Health Lesotho and FIND under the auspices of WHO
Maseru, 24 February 2010
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
2/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
Msinga Sub District
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
3/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
4/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
5/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
6/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
7/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
8/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
9/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
Msinga Sub district
Population 172 000
TB incidence 1054/100 000
DRTB incidence 141/100 000
30% HIV+ pregnant women
75% of TB patients co infected HIV
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
10/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
SINCE 2005 A TOTAL NUMBER OF 852 DRTB REPORTED
364 MDR TB
488 XDR TB
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
11/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
0
5
10
15
20
25
30
35
JAN
MAR M
AY JUL
SEP
NOV
2005
0
5
10
15
20
25
30
35
JAN
MAR M
AY JUL
SEP
NOV
2005
2006
0
5
10
15
20
25
30
35
JAN
MAR M
AY JUL
SEP
NOV
2005
2006
2007
0
5
10
15
20
25
30
35
JAN
MAR M
AY JUL
SEP
NOV
2005
2006
2007
2008
0
5
10
15
20
25
30
35
JAN
MAR M
AY JUL
SEP
NOV
2005
2006
2007
2008
2009
MDR + XDR cases diagnosed between
January 2005 and December 2009
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
12/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
MDR XDR TB
2008
MDR 46
XDR 75
TOTAL 121
2009
MDR 78
XDR 59
TOTAL 137
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
13/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
HIV-Associated MDR & XDR TB in S AfricaGandhi et al, AJRCCM 2010
0. 00
0. 25
0. 50
0. 75
1. 00
SURV1YR
0 50 100 150 200 250 300 350 400
STRATA: TYPE=MDR Censored TYPE=MDR
TYPE=XDR Censored TYPE=XDR
XDR TB (n = 382)
MDR TB (n = 272)
Survival in days
mortality 67%
mortality 82%
29 days
60 days
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
14/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
0
100
200
300
400
500
600
DC21 PMB(D22 )
D C23 Cosh DC25 DC26 DC27 DC28 DC29 DC43 DURBAN
200020012002200320042005200620072008
Distribution of MDR by district
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
15/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
01020304050607080
DC21 DC22 DC23 Cosh DC25 DC26 DC27 DC28 DC29 dc43 durban
2001 20022003 20042005 20062007 2008
Distribution of XDR by district
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
16/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
TB cases diagnosed annually
2004: all TB 4.572 mortality: 15.2%
Defaulters, transferred, not evaluated:19.7% 2005: all TB 4.741 mortality:13.2%
Defaulters, transferred, not evaluated:14.8%
2006: all TB 5.537 mortality:12.1%
Defaulters, transferred, not evaluated:12.4%
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
17/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
Transmission of MDR & XDR TB
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
18/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
Evidence for Nosocomial Transmission
No prior treatment in 55% 2/3 patients hospitalized in past 2 years
Initial community contact tracing-fewadditional cases
Health care workers died with XDR TB
Genotyping showed similar strain in83%
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
19/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
Response
Coordinated response under theleadership of the Provincial- District
Managers was planned
More Human and Economic resourcesmade available
Support by International Partners available
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
20/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
Sustained Response
Improvement of the program for TB More nurses and tracing team available
Training and supervision strengthened
Cure rate at 83% default rate ~1%
Since 2006 Household investigation started
Contacts screened 4492
Adults contacts diagnosed with MDR: 29
Adults contacts diagnosed with XDR: 40 Total 69 transmission 3.7
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
21/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
Sustained Response
Decentralized MDR TB hospital opened (32beds) in the district Home base care for MDR TB started ~100 are followed
Policy changes toward HIV/TB integration Increased VCT among TB patients
Increased ARV initiation among TB patients
TB screening among HIV patients
Infection control COSH TB ward with negative pressure extractor installed in 2006
Open window policy implemented
Administrative rules introduced like triage for patients with cough
Use of mask N95 introduced for all health workers operating in TB wardsand other areas
Intensive case find started in the hospital and the community
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
22/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
Response challenges
Laboratory service at COSH with one microscopist processing anaverage of 75 sample a day
TAT 48 h 78%
5.5% smear+ on TB suspects
Cultures and DST sent to Durban (200KM) - ?cost?
In 2009 COSH requested 5020 cultures and DST
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
23/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
Conclusion
MDR XDR TB remains a major and growing challenge in KZN
Weve made progress with treatment (first 6 patients cured for MDR
TB in the decentralized MDR TB centre in the district)
More than 100 patients with MDR TB on home base care in the district
Infection control is being addressed (still challenges linked to the old
hospital infrastructures)
Laboratory is the remaining challenge: needs strengthening at the
district level
8/2/2019 Laboratory Strengthening in High TB-Burden African Countries
24/24
Laboratory strengthening in high TB-burden African countriesMaseru, 24 February 2010
Acknowledgement
DOH District and Province
COSH
Philanjalo
TFCARES (Yale University, Albert Einstein College of Medicine)
Italian Cooperation Italian National Health institute
University of KwaZulu Natal