1. TB Management: A Medical Aid Perspective presented by Dr Noluthando Nematswerani

2. Agenda 1.Background 2.TB as a PMB 3.Current challenges 4.Proposed solutions

3. Background WHO Global TB Report 2009 TB is a major public health problem 9.27 million new cases per year 2 million deaths per year HIV epidemic in Sub-Saharan Africa

4. TB and HIV Leading causes of mortality and morbidity 70 % of all TB patients in SA are HIV positive

5. MDR TB This is a growing clinical and public concern 489 000 cases worldwide in 2006 Defined as resistance to at least INH and Rifa Treatment is expensive and complex Greatest risk factor is history of prior treatment for TB

6. Orenstein et al Lancet Infect Dis 2009 33 studies were included Better outcomes when treatment was longer than 18 months combined with DOT throughout the treatment (12 studies)

7. XDR - TB Defined as resistance to INH, Rifa, any fluoroquinolone and at least one of three of the second line injectable drugs (kanamycin, amikacin or capreomycin) As of June 2008 – XDR found in 49 countries

8. Rapid diagnosis Initiation of treatment Respiratory isolation Strategy for prevention and control of XDR TB

9. TB as a PMB Diagnosis and acute medical management; successful transfer to maintenance therapy in accordance to DOH guidelines

10. Current Challenges TB is a notifiable disease Availability of forms to private treating doctors Lack of follow-up in the private sector Limited access to TB medication in the private sector Retail pharmacy Medical aid funding

11. Proposed solutions Establishment of private sector TB clinics for treatment and follow-up

12. . Thank you