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MDR-TB and TB Update: Rayong Province. CAP-TB Strategic Planning Meeting August 1, 2013 Bangkok, Thailand. Chittima Thibbadee , M.D. Presentation Outline. Latest MDR-TB and TB prevalence At-risk populations Current effort Prevention Care and treatment. Presentation Outline. - PowerPoint PPT Presentation
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MDR-TB and TB Update: Rayong Province
CAP-TB Strategic Planning MeetingAugust 1, 2013
Bangkok, Thailand
Chittima Thibbadee, M.D.
Presentation Outline
• Latest MDR-TB and TB prevalence
• At-risk populations
• Current effort
– Prevention
– Care and treatment
Presentation Outline
• Available resources/fundings
– Available resources e.g. equipment, human
resources, number of health facilities with the
diagnosis and treatment capacity, etc.
– Funding sources, period and focuses
• Challenges and Gaps
Rayong
Pattaya
Latest MDR-TB and TB Prevalence
TB Prevalence Rate in Rayong Province Between 2008 - 30 June 2013*
Year
*2013 data is between 1 October 2012 – 30 June 2013
TB incidence (per 100,000) by WHO region,
and in Thailand, 2011
source: WHO, Global Tuberculosis Report 2012
TB incidence in Thailand is 2.5 – 4 times higher than Europe & America regions
Number of case between 2008-June 2013
645 case 683 case 65 1 case 690 case 640 case
606 case ที่��มา : TB 07
MDR-TB Prevalence Rate in Rayong Province Between 2008 - 30 June 2013
*2013 data is between 1 October 2012 – 30 June 2013
พ.ศ.
Number of MDR-TB Patients by District
Districts
Number of MDR-TB Patients
2007(n=10)
2008 (n=19)
2009(n=25)
2010(n=8 )
2011(n=11)
2012(n=29)
2013(October12-
June13)(n=19)
Muang 5 6 14 4 5 17 8
Klaeng 3 6 5 2 3 2 2
Ban Khai 2 1 2 1 3 1 2
Ban Chang - 1 1 - - 3 2
Pluak Daeng - 3 1 - - - 2
Wang Chan - - 1 - - 1 1
Nikom Pattana - 1 1 - - - -Khao Cha-mao - - - - - - -Rayong Central Prison
- - - - - 2 1
Other provinces - 1 (Chonburi
)
- 1(Songkla)
- 3 (Chonburi)
1
(Chonburi)
At-risk Populations
Population group Number of Population
1. Elderly 67987,
2. Diabetics 17779,
3. Migrants 14770,
4. HIV infected persons
12,560
5. Inmates 6 ,211
Current Effort
Prevention
1. Early (MDR-TB) case detection, contact
investigation
2. Quality DOT in drug-sensitive TB (DS TB)
3. Proper management of MDR-TB
4. Increase public awareness
5. World TB Day campaign
Care and Treatment
1. TB clinics staffed with trained health personnel
2. Active /intensified case finding in different at-risk population groups
3. Sputum smear tests/culture to diagnose pulmonary TB by the National TB Program
4. Quality DOT
Care and Treatment (cont)
5. Uninterrupted supply of quality TB drugs6. Infection control in hospital/household le
vels7. Integrated HIV/AIDS and TB program8. Patient’s registration and reporting
completeness9. MDR-TB patient register implemented
Available Resources
Health Facilities and Diagnosis Capacity
1. 65 culture and identification laboratories (Solid media culture is performed at Rayong Hospital)
2. 35 DST laboratories (DST for FLDs/SLDs is also available at Siriraj Medical School/BTB)
3. 24 Molecular Assay laboratories (14 GeneXpert machines in Thailand, one at Rayong hospital with support from USAID|Asia through CAP-TB Project)
Public and Private Health Facilities in Rayong Province
DistrictPublic Health Facilities Private
Health Facilities
regional(n)
community(n)
sub-district
(n)
Health center
(n)
Private hospital
(n)
Mueang 1 1 19 10 3
Klaeng 0 1 23 1 0
Ban Khai 0 1 15 0 0
Pluak Daeng 0 1 10 0 0
Ban Chang 0 1 9 0 0
Wang Chan 0 1 7 0 0
Khao Chamao 0 1 6 0 0
Nikhom Phatthana
0 1 5 0 0
Total 1 8 94 11 3
Human Resources
Health personnel who care for MDR-TB patients at Rayong Hospital
•2 Medical physicians (pulmonologist)
•1 Paediatrician
•1 Pharmacist
•1 Register Nurse (& counselor)
Human Resources(cont)
Health personnel who care for MDR-TB patients at Rayong Hospital
•4 Medical Technologist (lab staff)
•1 Counselor
• Health worker (home visit)
- Full time 2
- Part time 3
Current Funding Sources
• National Health Security Office (NHSO) –
ongoing
Objectives:
1. Active case findings/screening amongst at-risk
populations and close contacts of TB/MDR-TB
patients
2. Directly-observed therapy (DOT) by trained
personnel for TB/MDR-TB patients
Current Funding Sources
• Global Fund – to be ended in September 2014
Objectives:
1. Support the implementation of DOTS in all
communities in three districts in Rayong Province
2.Facilitate TB/HIV activities
3.Empower community in TB prevention and control
4.Provide living support to patients
Current Funding Sources
• USAID | Asia through CAP-TB Project – to be
ended in September 2016 Objectives:
1. Strengthen MDR-TB prevention and management among at-risk population groups
2. Support active case findings/screening among HIV infected persons, diabetics, elderly persons and migrant population in four communities in three districts in Rayong Province.
3. Provide package of service to patients to support treatment adherence.
Current Funding Sources
Local administration organization –
ongoing
Objectives:
–To support project implementation according
to the need and priority of the areas
Current Funding Sources
Local administration organization –
ongoing
Objectives:
–To support project implementation according
to the need and priority of the areas
Challenges and Gaps
Prevention
Challenges Way forward
1. Prevention of acquired MDR-TB
- Strengthen quality DOT for TB patients
- Improve infection control practice in household
2. Prevention the continuing spread of MDR-TB strain
- Strengthen early MDR-TB case detection in community
3. Stop chain of transmission
- Strengthen MDR-TB management
Diagnosis
Challenges Way forward
1. Culture and DST test reimbursement
- Number of tests (throughout the treatment course) to be reimbursed is in discussion
2. Use of GeneXpert to diagnose MDR-TB beyond at-risk populations
Care and Treatment
Challenges Way forward
1. Promote treatment adherence and success
- Side effect management
- Provide socio-economic support to patients
2. Stigmatization - Public/community education
3. Information sharing - Improve communication and record tracking and keeping system
4. Quality DOT provision for MDR-TB patients
- Community engagement
Thank you
For your attention