1. MDR-TB GLOBALLY AND IN THE REGION 2013 Dr Samiha Baghdadi Medical officer – STB WHO – EMRO Cairo March 2014

2. The structure of the presentation • MDR-TB burden globally and in the region • MDR-TB notification • MDR – TB treatment outcomes • Regional challenges and strategic directions • Ambulatory care for MDR-TB

3. Global coverage of data on DR-TB 1994-2013

4. MDR-TB rate among New TB cases

5. MDR-TB rate among previously treated TB cases

6. Estimated MDR-TB among TB cases by WHO region

7. Contribution of WHO regions to MDR-TB burden 2012

8. Countries notified at least 1 XDR case

9. MDR-TB cases 2012 Estimated, notified and enrolled on treatment

10. Estimated Number of MDR-TB cases among notified TB cases 2012

11. Confirmed MDR-TB cases among notified TB cases 2012

12. Contribution to MDR-TB notification by region 2012

13. Treatment outcomes

14. Treatment success rate by country 2011

15. Regional challenges/risks foreseen • Unstable situation in many countries in the region, namely (Afghanistan, Egypt, Lebanon, Iraq, Pakistan, Somalia, Syria, Tunisia and Yemen). This situation resulted in several challenges as follows: • Huge population movement across the region • Huge staff turn over • Destruction of infrastructure • Limited movement in the field • Sever loss of drugs and equipment • Limited lab capacity • Culture and DST are not available in Somalia and South Sudan. DST is not available in Afghanistan. • Most of the countries in the region did not widely apply the new diagnostics. • DR survey and surveillance: • Updated survey is ongoing in Iraq, Iran, Pakistan, Sudan, and needed in Syria. • There is a need to document/report results of DR surveillance that is ongoing in GCC countries, and expand the continuous surveillance in the remaining 15 countries. • Libya is still the only country in the region without proper management of MDR-TB management.

16. Regional challenges/risks foreseen • Expected financial gap to support scaling up MDR-TB activities in most countries, mainly (Djibouti, Egypt, Lebanon, Jordan, Iran, Pakistan and Syria). • Limited human resources at country level (MDR local support on continuous basis is needed in Afghanistan, Iraq, Pakistan and Sudan mainly). • Limited consultancy capacity in the region in general ( a team of 5 consultants was established last year to support countries)

17. The strategic directions of the work of EMR_GLC • Improve planning for PMDT (update the regional plan and support planning at country level), • Develop regional high standard ambulatory based model • Develop Regional framework and guidance about the utilization of New diagnostics and lab support, • Scale up R&R for MDR, infection control at all levels, HR capacity, • Promote prequalified regional companies; develop mechanisms for joint proposals, drugs grants. • Operational research

18. Promote using ambulatory model in MDR- TB care Justification: • Limited country capacity (infrastructure: hospitals, infection control) and financial. • New diagnostics increase case detection (X-Pert). • Long waiting list of detected cases. • Global experience is encouraging However : Ambulatory care does not exclude hospitalization

19. What do we need for ambulatory model • Networking: • Diagnosis, • Treatment, • Treatment follow up, • Side effect management, • Daily observation and care, • Social support

20. Some basic items for provincial profile 1. Population 2. Admin areas 3. Geographical description 4. Notified cases/notification rate ( TB type, Age and gender) 5. Treatment outcomes ( TB type, Age and gender) 6. Estimated MDR-TB cases among new and previously treated 7. Infection control 8. Lab coverage 9. EQA for DSM 10. C/DST coverage 11. PPM coverage 12. PHC coverage 13. Hospitals available 14. Referral system 15. Community support 16. Provincial map (PHC facilities, hospitals, laboratories, TB facilities, PPM facilities, patient distribution, MDR cases distribution) and community support points. 17. Security issues 18. MDR focal person

21. RO support to countries for AT • Briefing about ambulatory model 2012 • Training on planning 2013 • Follow up planning process 2013 Future plans 2014 • Monitoring missions and evaluation • Lesson learnt

22. SWOT analysis

23. Stakeholder analysis/matrix

24. Provincial profile

25. Provincial map

26. Strategic frame work

27. OP plans