Monitoring PPM contributions – from operational research to regular reporting Knut Lönnroth Stop TB Department 5 th PPM Subgroup Meeting Cairo, 4 June 2008

Evidence on contribution Case detection increase: 10-50% locally Treatment quality: 85% treatment success rate Cost-effective (cost per additional cure is low) Cost reduction for poor patients (~100 $ less) But, on from small to medium scale projects

HBCs with PPM DOTS initiatives, 2004 High burden countries with PPM initiatives High burden countries without PPM pilots High burden countries scaling up PPM

HBCs with PPM DOTS initiatives, 2006 High burden countries with PPM initiatives High burden countries without PPM pilots High burden countries scaling up PPM

HBCs with PPM DOTS initiatives, 2007 High burden countries with PPM initiatives High burden countries without PPM pilots High burden countries scaling up PPM

Open circles mark the number of new smear-positive cases notified under DOTS 1995–2006, expressed as a percentage of estimated new cases in each year. The solid line through these points indicates the average annual increment from 1995 to 2000 of about new cases, compared to the average increment from 2000 to 2006 of about cases. Closed circles show the total number of smear-positive cases notified (DOTS and non- DOTS) as a percentage of estimated cases. Progress towards the case detection target 40% (4 million cases) missing! PPM Subgroup created

Smear-positive TB cases undetected by DOTS programmes in eight high-burden countries,

What we want to know on national level 1.How many (%) providers are involved through PPM, by type of provider, and type of activity 2.Number (%) of cases detected through referral and/or diagnosis, by provider type 3.Number (%) of patients treated under PPM, by provider type 4.(Cohort analysis, by provider type – though not equally important)

Intensified urban PPM districts; India (14): Summary of contribution by different health sectors – 3 rd qtr 2006 to 2 nd qtr 2007)

Source: Ambe et al 2005

How? – Tools are ready! New recording and reporting system – revised forms and guidelines Conventional laboratory and district TB registers can be used to get most of the information Complement with PPM situational analysis data to enumerate providers and their involvement

LT enter name of referring provider based on: A. Lab request/referral form B.Oral info about who sent patient

Provider (code)

Name (code) of DOT provider

Reporting? Not part of quarterly reports!! – too cumbersome, and not required 1.Record for sake of district level management 2.Extract information as and when required for monitoring and evaluation 3.Report yearly, based on sample of district or sentinel sites 4.Report to Global TB Report and to PPM Subgroup meeting:

Pakistan Provider groupInvolvement (Please mention yes or no or level of involvement) Contribution (Please provide available data on contribution of different PPM providers ) Professional associations Yes: What percentage?What percentage? Corporate SectorNot yet HospitalsYes: What percentage?What percentage? Informal providersYes: What percentage?What percentage? Private laboratoriesNot yet Private clinicsYes: What percentage?What percentage?

PPM notification, EMRO 2008

Questions What are the practical steps that countries need to take to start pilot and fully implement a system to record and report on PPM? What advocacy is needed to promote PPM monitoring on national level? Policy for data management on country and global level?