NATIONAL TB 2012 INDICATOR ANALYSIS REPORT Presented by: Sandile Ginindza Lugogo Sun Hotel 05 th -7 th June 2013 Ministry of Health NTCP

TB Notifications Trends

Systematic TB Screening

TB Screening cont’d

TB Screening Cont’d

TB Notifications

Declining TB Burden

Trends in Distribution of TB cases by Sex

CHILDHOOD TB NOTIFICATIONS

Estimated number of deaths 490,000 (range: 470,000–510,000) 327,000 Estimated TB Notifications The Global Childhood TB Burden Estimated Incident TB cases 64,000 (range: 58,000–71,000)

Swaziland Childhood TB Situation

TB Screening cont’d

TB Screening Cont’d

Notification of Childhood TB Cases

TB/HIV Services Among Childhood TB Patients

MDR-TB Among Children

TB/HIV Services (All Forms)

Sputum Conversions…

Regional Conversions…2012 Sputum Conversion Region Overall HhohhoLubomboManziniShiselweni Converted New cases 73%57%59%69% 65% New SND 10% 21%24% 14% 17% New Failure to convert cases 9% 16% 10% 12% Died New cases6% 4% 5% Converted Retreatment Cases 54%34%50%56% 49% SND retreatment cases 12% 28%19%20% Retreatment Failure to convert cases 22% 20% 5% 17% Died Retreatment cases10%8%11%5%9%

Treatment Outcomes

Treatment Success…

Unfavourable Treatment Outcomes TB Outcomes #%#%#%#%#% Died New SS % % % % 206 8% Defaulted New SS % 250 8% 245 7% 166 5% 130 5% Transferred out New SS % 81 3% 70 2% 65 2% 75 3% Treatment failures New SS % 236 7% 240 7% 259 8% 203 8% Died Retreatment cases % % % % % Defaulted Retreatment cases % 127 9% % 102 7% 81 7% Failure Retreatment cases 97 7% % 133 9% % % Transferred Out Retreatment % 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 INDICATORS Indicator NameTarget by 2014Actual by Dec 2012 Comment on likelihood of achievement Program Impact TB Incidence1365/ / Very likely however, given the declining notifications the relevancy of the incidence rate is weakened. TB Prevalence746/ / Less likely though the variance is within margin TB Mortality29/ / Less likely though the variance is within margin

OUTCOME INDICATORS Indicator NameTarget by 2014Actual by Dec 2012 Comment on likelihood of achievement Program Outcome TB Treatment Success82%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/ / Will not be met however, the notifications declined when least expected hence the variance

OUTPUT INDICATORS Retreatment TB cases12%11% New Pulmonary TB SND15%20% New Pulmonary TB SS+40%33% Sputum Conversion Rate (New)75%63% Sputum Conversion Rate (Retreatment) 60%50% Cure Rate of New TB cases60%48% Cure Rate of Re-treatments35%34% Treatment Completion rate22%25% Treatment Failure rate5%8% Default rate7%5% Smear Positivity rate40%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 targetYes

OUTPUT INDICATORS Diagnosis & Lab TB Microscopy coverage (Ratio)No target1/ TB Culture services coverage ratioNo target1/ % Laboratories performing regular EQA90%100% Private Public Mix % Private HCFs submitting TB Notifications15%11% % Patients detected in the private sector11%4% Drug Management Existence of Buffer Stock at Central & Peripheral levels No targetNo reliable data Accuracy of Stock Records for anti-TB drugs80%No reliable data % HCFs reporting no stock-out of anti-TB drugs 100%

OUTPUT INDICATORS TB/HIV % PLWHA Screened for TB100%No reliable Denominator % Registered TB patients who received HIV testing 90%92% HIV Ser0-prevalence among TB patients75%80% % registered TB/HIV Patients started on ART50%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 DOT97%113/220 (51%) % Laboratory Confirmed MDR-TB cases33%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?