NATIONAL TB 2012 INDICATOR ANALYSIS REPORT

Presented by: Sandile GinindzaLugogo Sun Hotel05th-7th June 2013

Ministry of Health NTCP

TB Notifications Trends

1991 1993 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

2000

4000

6000

8000

10000

12000

1531 14582058

23643022

36534167

5877 61186748

77498375

86649145

9636 9656

11032 11057

9180

7741

TB case Notifications

Systematic TB Screening

2010 2011 20120

50000

100000

150000

200000

250000

300000

350000

TB Screenings Conducted since 2010 to 2012

Hhohho Lubombo Manzini Shiselweni Swaziland

TB Screening cont’d

2010 2011 2012

Hhohho 0.160535481062255 0.0812347043498855 0.0574479310028443

Lubombo 0.0796460176991151 0.133630418426992 0.0533398053016207

Manzini 0.0731208341582525 0.0709965548041343 0.069671089420975

Shiselweni 0.160258620689655 0.0512408498482414 0.0177786274134965

Swaziland 0.307147195788621 0.0789535062319739 0.0547841051420348

3%

8%

13%

18%

23%

28%

33%

Total Presumptive cases after screening

TB Screening Cont’d

Hhohho Lubombo Manzini Shiselweni Swaziland0

200

400

600

800

1000

1200

1400

1600

1800

429

101147 134

811

424

156

334

103

1017

499

191

862

119

1671

Total cases Diagnosed with TB after Screening

201020112012

TB Screening Cont’d

2010 2011 20120%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage of Actively Diagnosed cases Started on Treatment

Hhohho Lubombo Manzini Shiselweni Swaziland

TB Notifications

New SS+ New SS- ETB New SND Other Total

Hhohho 543 473 281 404 285 1986

Lubombo 416 154 333 262 179 1344

Manzini 1209 506 509 619 308 3151

Shiselweni 389 407 213 153 98 1260

TOTAL 2557 1540 1336 1438 870 7741

500

1500

2500

3500

4500

5500

6500

7500

TB Notifications by Type, 2012

Declining TB Burden

2008 2009 2010 2011 20120

2000

4000

6000

8000

10000

12000

Trends in TB Notifications 2008-2012

Hhohho Lubombo Manzini Shiselweni TOTAL

Trends in Distribution of TB cases by Sex

Hhohho F

Hhohho M

Lubom F

Lubom M

Manzini F

Manzini M

Shiselw F

Shiselw M

Nation F Nation M

2010 0.49 0.51 0.48 0.52 0.5 0.5 0.5 0.5 0.49 0.51

2011 0.5 0.5 0.45 0.55 0.49 0.51 0.48 0.52 0.47 0.53

2012 0.48 0.52 0.45 0.55 0.47 0.53 0.47 0.53 0.47 0.53

10%

30%

50%

70%

90%

TB Burden By Sex

2010 2011 2012

CHILDHOOD TB NOTIFICATIONS

Estimated number of deaths

490,000(range: 470,000–510,000)

327,000 Estimated TB Notifications

The Global Childhood TB Burden -2011Estimated TB incidence rates, by country, 2010

TB cases per 100 000

0–24

25–49

50–99

100–299

>=300

No estimate

Estimated Incident TB cases

64,000(range: 58,000–71,000)

Swaziland Childhood TB Situation

2009 2010 2011 2012

Males 848 1656 15148 30099

Females 1032 2176 18582 34331

2500

7500

12500

17500

22500

27500

32500

TB Screenings Conducted Among Children aged <15 yrs

MalesFemales

TB Screening cont’d

2009 2010 2011 2012

Males 0.261792452830189 0.147946859903382 0.0433060470029047

0.0205986909864115

Females 0.842054263565892 0.126838235294118 0.0396082230115165

0.0253706562581923

5%15%25%35%45%55%65%75%85%95%

Presumptive TB Cases from Screenings among Children

TB Screening Cont’d

2009 2010 2011 20120

5

10

15

20

25

30

35

40

45

5

13

41

1815 16

35

23

Confirmed Childhood TB Cases from Presumptive cases

Males Females

Notification of Childhood TB Cases

0-4 years 5-14 years

0-4 years 5-14 years

0-4 years 5-14 years

0-4 years 5-14 years

0-4 years 5-14 years

New SS+ New SS- ETB SND Other TOTAL

0

100

200

300

400

500

600

700

800

900

Childhood TB Cases by Type

# with TB # Tested for HIV # HIV + # on CPT # on ART

TB/HIV Services Among Childhood TB Patients

% with TB % Tested for HIV % HIV + % on CPT % on ART0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

11%

89%

58%

95%

45%

HTC, CPT & ART Provision to Childhood TB patients

MDR-TB Among Children

2012 Males MDR-TB

2012 Males Rif 2012 Females MDR-TB

2012 Females Rif

Hlathikhulu 0 1 0 1

Nhlangano 0 0 0 1

Matsanjeni 0 0 0 0

Mankayane 1 0 0 0

Matsapha MSF

0 0 1 0

Piggs Peak 0 0 0 1

Hospital 0 0 0 2

Total 1 1 1 5

Childhood MDR-TB Cases Enrolled on Second Line Treatment, 2012

TB/HIV Services (All Forms)

Male Female Total Male Female Total Male Female Total Male Female Total% HIV Tested % Testing HIV + % on CPT % on ART

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%88%

96%92%

79% 80% 80%

99% 97% 98%

64%69%

66%

TB/HIV Services provided to TB Patients by Sex

Sputum Conversions…

0%10%20%30%40%50%60%

19%

49%

14% 11%5% 2%

19%

34%

15% 20%9%

3%

Sputum Conversion rates

# of New Smear Positive Cases # of Re-treatment Smear Positive Cases Total

Regional Conversions…2012

Sputum ConversionRegion

OverallHhohho Lubombo Manzini Shiselweni

Converted New cases 73% 57% 59% 69% 65%

New SND 10% 21% 24% 14% 17%

New Failure to convert cases

9% 16% 10% 12% 12%

Died New cases 6% 4% 4% 5% 5%

Converted Retreatment Cases

54% 34% 50% 56% 49%

SND retreatment cases 12% 28% 19% 20% 20%

Retreatment Failure to convert cases

22% 22% 20% 5% 17%

Died Retreatment cases 10% 8% 11% 5% 9%

Treatment Outcomes

2008 2009 2010 2011 2012

New SS+ve cases 0.36 0.5 0.52 0.49 0.48

Retreatment cases 0.21 0.26 0.3 0.3 0.34

New & Retreatment SS+ve cases 0.33 0.45 0.49 0.46 0.46

10%

30%

50%

70%

90%

Trends in Cure Rates 2008-2012

Treatment Success…

2008 2009 2010 2011 2012

New SS+ve cases

0.581621997911591

0.676626206037971

0.686176470588235

0.709856396866841

0.731892757102841

Retreat-ment cases

0.383107088989442

0.434725848563969

0.511363636363636

0.472370766488414

0.508905852417303

New & Retreat-ment SS+ve cases

0.544400452488688

0.630057803468208

0.656189083820663

0.673103448275862

0.701590594744122

10%30%50%70%90%

TB Treatment Success rate trends

Unfavourable Treatment OutcomesTB Outcomes 2008 2009 2010 2011 2012

# % # % # % # % # %

Died New SS+188 7% 313 10% 349 10% 317 10% 206 8%

Defaulted New SS+329 11% 250 8% 245 7% 166 5% 130 5%

Transferred out New SS+300 10% 81 3% 70 2% 65 2% 75 3%

Treatment failures New SS+ 174 6% 236 7% 240 7% 259 8% 203 8%

Died Retreatment cases156 12% 212 15% 256 17% 267 18% 198

17%

Defaulted Retreatment cases 151 12% 127 9% 149 10% 102 7% 81 7%

Failure Retreatment cases97 7% 150 11% 133 9% 160 11% 115

10%

Transferred Out Retreatment 133 10% 53 4% 57 4% 77 5% 35 3%

ASSESSMENT OF PROGRESS TOWARDS 2014 STRATEGIC PLAN ASPIRATIONS

TB CORE INDICATORS AS OUTLINED IN M&E PLAN

IMPACT INDICATORSIndicator Name Target by 2014 Actual by Dec

2012Comment on likelihood of achievement

Program Impact

TB Incidence 1365/100 000 1320/100 000

Very likely however, given the declining notifications the relevancy of the incidence rate is weakened.

TB Prevalence 746/100 000 854/100 000 Less likely though the variance is within margin

TB Mortality 29/100 000 53/100 000 Less likely though the variance is within margin

OUTCOME INDICATORSIndicator Name Target by 2014 Actual by Dec

2012Comment on likelihood of achievement

Program Outcome

TB Treatment Success 82% 73%likely to be achieved if current gains are sustained and strengthened

TB Case Detection (All) 100% 53%Will not be met.

TB Case Notification Rate 1149/100 000 717/100 000

Will not be met however, the notifications declined when least expected hence the variance

OUTPUT INDICATORS

Retreatment TB cases 12% 11%New Pulmonary TB SND 15% 20%New Pulmonary TB SS+ 40% 33%

Sputum Conversion Rate (New) 75% 63%

Sputum Conversion Rate (Retreatment) 60% 50%

Cure Rate of New TB cases 60% 48%Cure Rate of Re-treatments 35% 34%Treatment Completion rate 22% 25%Treatment Failure rate 5% 8%Default rate 7% 5%Smear Positivity rate 40% 37%Retreatment Failure rate (Chronic TB) 15% 10%

OUTPUT INDICATORS

% HCFs initiating TB Treatment 67/139 (48%) 73/139 (53%)

% Health Staff trained in TB 70% No reliable data

TB Control is among Stated Priorities 10% increase for TB Budget Data still being validated

Availability of TB Program Manual No target Manual available & Partly distributed

Availability of TB Program Strategic Plan & Budget No target Yes

OUTPUT INDICATORSDiagnosis & Lab

TB Microscopy coverage (Ratio) No target 1/50 000

TB Culture services coverage ratio No target 1/1 000 000

% Laboratories performing regular EQA 90% 100%

Private Public Mix

% Private HCFs submitting TB Notifications 15% 11%

% Patients detected in the private sector 11% 4%

Drug ManagementExistence of Buffer Stock at Central & Peripheral levels No target No reliable data

Accuracy of Stock Records for anti-TB drugs 80% No reliable data

% HCFs reporting no stock-out of anti-TB drugs 100% 100%

OUTPUT INDICATORSTB/HIV

% PLWHA Screened for TB 100% No reliable Denominator

% Registered TB patients who received HIV testing 90% 92%

HIV Ser0-prevalence among TB patients 75% 80%

% registered TB/HIV Patients started on ART 50% 66%

Supervision & Patient Support% of facilities receiving periodic supportive supervision from NTCP 80% 22/73 (30%)

% Registered TB Patients receiving direct observation of treatment (D.O.T.) 85% 4025/7741 (52%)

% MDR-TB Patients receiving DOT 97% 113/220 (51%)

% Laboratory Confirmed MDR-TB cases 33% 220/2437 (9%)

% Laboratory Confirmed MDR-TB cases enrolled on second line treatment 86% 185/220 (84%)

Quick Reflections…

WHERE TO FROM HERE….- What policy directions & strategies are relevant?