Systematic TB Screening: Philippine Experience The 9th Technical Advisory Group and National TB Program Mangers meeting for TB control in the Western Pacific Region Manila. Philippines 9-12 December 2014

TB Screening Policies NTP Manual of Procedures (2013) DOH Policy: Guidelines for the scaling up and use of Xpert MTB/RIF as rapid diagnostic tool under the NTP

TB Screening Policies 1.Both passive and intensified casefinding activities are implemented in all DOTS facilities. Intensified casefinding: a. close contact b. high-risk clinical groups (HIV/AIDS, diabetes, etc.) c. high-risk populations (inmates, elderly, IPs, urban and rural poor, etc.)

Intensified Casefinding Close contact – all household contacts of index case are screened for signs and symptoms and chest xray within 7 days Jails and prisons - screening activities among inmates are implemented: – upon entry to the jail or prison – during detention through cough surveillance – prior to transfer of inmates to another jail or prison – prior to release of inmates back to the community.

Intensified Casefinding TB in urban and rural poor areas – Community Health Teams and Barangay Health Workers identify presumptive TB during their routine activities in the communities and households – referred to the local health center for evaluation

Intensified Casefinding TB in PLHIV – All PLHIV at the Social Hygiene Clinic or Treatment Hub undergo TB screening: symptomatic screening (e.g., cough of any duration, fever, night sweats, loss of weight) and CXR. – If symptomatic, sputum is collected for Xpert MTB/RIF. – TB screening is done upon HIV diagnosis and during monthly and annual follow-up visits.

TB Screening Policies 2.Microscopy, whether by light or fluorescence microscopy, is the primary diagnostic tool in NTP case finding. 3.Xpert MTB/RIF is used for TB diagnosis among:  presumptive DR-TB  PLHIV with signs and symptoms of TB  Children  EPTB  smear negative patients with chest xray findings

TB Screening Policies Presumptive TB case: – any person whether adult or child with signs and/or symptoms suggestive of TB whether pulmonary or extra-pulmonary, or those with chest x-ray findings suggestive of active TB. – A person with cough of any duration: close contact, high risk clinical group, high risk population

TB Screening Policies 4.All household contacts of bacteriologically confirmed TB cases, DRTB patients and index childhood TB cases are screened for TB. 5.All Persons living with HIV (PLHIV) are screened for TB co-infection.

TB Screening Activities Training of regional NTP coordinators and HCW on new MOP Dissemination of policy on Xpert implementation Intensified case finding in jails and prisons PLHIV screened for TB in HIV treatment hubs Increased engagement of public and private hospitals Engagement of pharmacies for referring patients Establishment of remote smearing stations Expansion of xpert sites

TB Screening Activities Total no. of presumptive TB examined - 2,481,418 (45%) of 5.5 million Total no. of children given treatment or given INH preventive therapy - 102,747 (14%) of 730,000 Total MDR-TB cases detected and registered 7,883 (40%) of 19,500 54% of inmates with access to DOTS services engagement of public (35%) and private hospitals (18%) Xpert sites expanded to 73

THANK YOU