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Recording and Reporting in MDR TBRecording and Reporting in MDR TBDominican Republic ExperienceDominican Republic Experience
Dra. MarDra. Maríía Rodra RodrííguezguezTechnical National Unit for MDR TBTechnical National Unit for MDR TB
6th Meeting of the Stop TB Working Group on MDR
Tbilisi, Georgia 20-22 September 2007
�� Area: 48,670.82 kmArea: 48,670.82 km22
�� Population Density: 175 habitants x KmPopulation Density: 175 habitants x Km22
�� Population: 9,100,183 (2006)Population: 9,100,183 (2006)
�� Annual Growing rate: 1,6%Annual Growing rate: 1,6%
�� 63% urban population.63% urban population.
�� 9 Health Regions with 30 DPS y 8 Areas in SD ( Total 38)9 Health Regions with 30 DPS y 8 Areas in SD ( Total 38)
�� 1200 health establishments (public system)1200 health establishments (public system)
Dominican RepublicDominican Republic
TB cases notified TB cases notified Dominican Rep. 2005Dominican Rep. 2005
29492949
53125312
NumberNumber
3333New SS+New SS+
5757All casesAll cases
RateRate
Source: WHO Global Report. 2007
SS(+): Sputum Smear Positive
DOTS Coverage and New SS(+) Case DOTS Coverage and New SS(+) Case Detection Rate, Dominican Rep.1999Detection Rate, Dominican Rep.1999--
20052005
0
10
20
30
40
50
60
70
80
90
1999 2000 2001 2002 2003 2004 2005
DOTS Coverage(%)
Detection Rate (%)
76%
Sources: WHO Global Report. 2007, National Tuberculosis Control Program – SESPAS – RD
0%
20%
40%
60%
80%
100%
Death 4.4 4.9 4.7 4.5 3 3.9
Failure 1.3 1.8 1 2 1.5 1.5
Transferred 3.7 3.2 4.2 3.3 2.7 2.5
Default 14.9 12.5 12.7 10.7 9.7 7.2
Completed TX 29.9 20.9 17.3 7.4 7.6 4.4
Cured 45.8 56.7 60.1 72.5 74.7 80.3
2000 2001 2002 2003 2004 2005
Total # 2617 2569 2474 2269 2593 2691
75.777.6 77.4
79.981.3
84.7
NewNew SmearSmear Positive Positive CohortCohort2RHZE/4R2RHZE/4R33HH33. . D.RD.R. . 20002000 –– 2005.2005.
SourceSource: : NationalNational Tuberculosis Control Tuberculosis Control ProgramProgram –– SESPAS SESPAS –– RDRD
USA 1.2%
CUBA 0,3%
PERU 3.0%
PR2.5%
NIC 1.2%
R.DOM 6.6%
ARG
1.8%
URU
0.01%
BRA 0.9%
(MDR-TB < 3%)
Initial MDR Resistance (Américas, 1994–2002)
CHI 0.6%
BOL 1.2%
CAN 1.2%
COL 1.47%
VEN 0.3%
ECU 5.0%
ELS0.3%
HON 1.8%
(MDR-TB =< 1%)
(MDR-TB >= 3%)
NO data
GUA 3.7%
Source: Situación Epidemiológica de la TB OPS/OMS 2004
MEX 3 estados 2.4%
Beginning of the programmatic Beginning of the programmatic management of MDR TB,2005management of MDR TB,2005--20062006
�� GLC approval for acquisition of second line drugsGLC approval for acquisition of second line drugs
�� Global Fund financial aidGlobal Fund financial aid
�� Designation of a National Technical MDR TB Unit Designation of a National Technical MDR TB Unit responsibleresponsible
�� Creation of the National Evaluation Committee (CONE TB Creation of the National Evaluation Committee (CONE TB MDR)MDR)
�� Actualization of the Category IV patientActualization of the Category IV patient’’s censuss census
�� Evaluation of all cases Evaluation of all cases
�� Elaboration and validation of the national guidelinesElaboration and validation of the national guidelines
�� Meetings of CONE TB MDRMeetings of CONE TB MDR
�� Training of health personalTraining of health personal
IndicationIndication ofof TB TB TreamentsTreamentsRegimentsRegiments, , DomincanDomincan RepRep. 2007. 2007
New patientsNew patients Category ICategory I
((2RHZE/4R3H3)2RHZE/4R3H3)
Category IICategory II
(2SRHZE/1RHZE/5R(2SRHZE/1RHZE/5R33HH33EE33))
Standardized Category IVStandardized Category IV
((KmZOfxEthCs/OfxEthCsKmZOfxEthCs/OfxEthCs))
Individualized Category IVIndividualized Category IV
Failures Category I in DOTFailures Category I in DOT
Failures Category IIFailures Category II
Treatment after default Treatment after default witnwitn DSTDST
Relapses with DSTRelapses with DST
Contacts of Standardized Category IV Contacts of Standardized Category IV
Treatment after defaultTreatment after default
RelapsesRelapses
Failures Cat. I no DOTFailures Cat. I no DOT
Failure to Standardized Category IV Failure to Standardized Category IV
Chronics who used Second Line drugsChronics who used Second Line drugs
Contacts of Individualized patientsContacts of Individualized patients
Information ManagementInformation Management
Category IV patientsCategory IV patients
�� Instruments recommended from WHO, Instruments recommended from WHO,
similar to those used for the sensitive similar to those used for the sensitive
patientspatients
�� Non computerized systemNon computerized system
�� Centralized informationCentralized information
Category IV PatientsCategory IV Patients
Registration instruments:
1. Initial evaluation form and Case Summary,Evolution form (Clinical records)
2. Assistance control card (Treatment card)
4. Registration “book” of Category IV
Case SummaryCase Summary
Drug history sheet, Case SummaryDrug history sheet, Case Summary
Author: Dr. José Caminero Luna
Assistance control card
ItIt containscontains::�� Demographic informationDemographic information
�� Summary of preview treatmentsSummary of preview treatments
�� Summary of CONE meeting and decisionsSummary of CONE meeting and decisions
�� HIV informationHIV information
�� Bacteriology resultsBacteriology results
�� Treatment regimentTreatment regiment
�� Number and dates of doses takenNumber and dates of doses taken
�� Treatment resultTreatment result
�� Contacts controlContacts control’’ss
�� AppointmentsAppointments
�� Follow up after treatmentFollow up after treatment
Two Excel files Two Excel files
1.1. One with all registered cases One with all registered cases MDR suspect, some later MDR suspect, some later excluded when DST shows no excluded when DST shows no MDRMDR
2.2. Another with cases starting Another with cases starting treatmenttreatment
Category IV Register
Category IV PatientsCategory IV PatientsReports:
1. Quarterly case report and
annual consolidate
2. Preliminary outcome report (9
months after last quarter day)
3. Annual report of treatment
outcome ( 24-36 after period)
Casereport, annual consolidate Dominican Rep,2006
Nombre de la Unidad de Salud PNCT-REP DOMINICANA Trimestre 01-02-03-04
Nombre del Distrito Año 2006
Número del Distrito
Nombre del Coordinador del Distrito Dra. María Rodríguez 181
Firma Fecha: 14/09/2007
Bloque 1: Pacientes registrados en la Categoría IV y pacientes que iniciaron tratamiento Categoría IV
TB MDR
confirmad
Sospecha
TB MDR
137 30
24 0
Bloque 2: Casos de TB MDR confirmados durante el Trimestre por historia de tratamiento anterior
Recaída
Despúes
de
Abandono
Después de
Fracaso al
1er.
Tratamient
Después de
Fracaso al
Retratamie
nto
2 13 7 46 55 0 14 137
Extrapul
monar
nuevo
Total Pacientes Cat IV
Informe trimestral de registro de casos de Categoría IV
Nuevo
Antes tratados
Pacientes
Registrados durante el Año como Categoría IV
Que iniciaron tratamiento Categoría IV durante el Año
Otros* Total
TB Pulmonar
Preliminary outcome reportYear 2006, Dominican Rep.
Nombre de la Unidad de Salud PNCT-REP DOMINICANA Trimestre 01-02-03-04
Nombre del Distrito Año 2006
Número del Distrito
Nombre del Coordinador del DistritoDra. María Rodríguez Total Pacientes Cat IV 181
Firma Fecha: 14/ 09 / 09
Cultivo
negativo
Cultivo
positivo
Cultivo
desconoci
do
Cultivo
negativo
Cultivo
positivo
Cultivo
desconoci
do
Cultivo
negativo
Cultivo
positivo
Cultivo
desconoci
do
FallecidoAbandon
o
Transfere
ncia sin
confirmarTB MDR
confirmada 2416 1 0 0 1 0 1 0 3 2 0 0
TB MDR
sospechosa 0 0 0 0 0 0 0 0 0 0 0 0 0
Total24 16 1 0 0 1 0 1 0 3 2 0 0
Evaluación preliminar de tratamiento de Categoría IV a los 6 meses
(llenado 9 meses después del inicio de tratamiento)
Egresados durante el trimestreBaciloscopia y cultivo a los 6 meses de tratamiento
Baciloscopia Negativa Baciloscopia Positiva Baciloscopia Desconocida
Número
de
pacientes
que
iniciaron
tratamient
ObservationsObservations
�� Instruments are simple and easy to completeInstruments are simple and easy to complete
�� Patients reported in one period that did not start Patients reported in one period that did not start treatment until next: 48 patients reported in treatment until next: 48 patients reported in 2006 have started treatment in 2007 2006 have started treatment in 2007
�� Follow up report of patients reported in one Follow up report of patients reported in one period that did not start treatment: 55 patients period that did not start treatment: 55 patients reported in 2006 have died in waiting list (48 reported in 2006 have died in waiting list (48 confirmed MDR).confirmed MDR).
�� More Intermediate results needed before final More Intermediate results needed before final reportreport
�� A computerized system would be very A computerized system would be very convenient.convenient.