Presentation on theme: "Accelerating PMDT scale up in Ethiopia"— Presentation transcript:
1 Accelerating PMDT scale up in Ethiopia Ezra Shimeles (MD, MPH)TBCARE/KNCV, Ethiopia
2 Outline Introduction and background National TB and MDR TB situation National Performance on TBMDR TB Scale upChallenges in PMDT Scale upWay forward
3 Introduction and Background: Ethiopia 11 administrative units90 million population83.6 % in ruralEconomy(IMF)Agriculture 46.6%Industry 14.5%Services 38.9%GNI Per Capita:410(World Bank 2012)Life expectancy at birth :59(World Bank 2011)Land mass not needed, located in the Horn of Africa not needed11 admin units, subdivision in ? Subunits and municipalities ?GNI 410 – (LIC)
5 Health Profile Health Service No. of health facilities Human capital PHS coverage = 92%No. of health facilitiesHospital = 132Health centers = 3000Health posts = 15,700Human capitalPhysicians = 2,115Health officers = 1606Nurses = 20, 109Health extension workers = 34, 382
6 National TB Situation and NTP overview Among the 22 HBC16th among the 27 MDR-TB high priority countriesIncidence:258/100,000 populationPrevalence :TB 237/100,000 populationThe TB related mortality rate : 18/100,000WHO 2012 TB Report
7 MDR-TB burden DRS survey 2003-2005 1.6% New 11.8% Previously treated WHO estimate2500 MDR TB Cases are expected from notified cases annuallyDST requirement per annum:6000 new and 6000 retreatment cases (2013)Current survey is under way but result not ready.(unofficial among Retreatment 15%; among New 1.3%)
8 Tuberculosis Case finding ( All forms of TB (New and retreatment) New patients
9 Treatment outcome for new PTB+ New PTB + patients
12 National PMDT implementation plan Phase I: pilot phase ( )Target: treat 45 patentsEstablish MDR treatment at one TB Hospital in 2009Scale Up phases: Five years expansion plan ( ):Target : treat 8,018 MDR-TB patientsPhase II: Roll out phase using ( )MDR TB referral centersEstablishment of regional culture and DST centersPilots Ambulatory modelPhase III: Scale up phase( )Rapid diagnostic techniquesAmbulatory centers up to Zonal hospitals levelDifference phase 2 and 3 ? What does up to zones mean ?Scale-up plan in numbers of patients to be put on treatment ?
13 Preparatory phase for initiation National technical working group on MDR-TB established.Guidelines: PMDT; TB infection controlTraining material for health care workersTraining of health care workersRenovation of MDR-TB wardsRegistration of second line anti-TB drugs conductedProcurement of SLDsInfection control items such N-95 respirators, were made availableRecording and reporting formats developed and printedIEC materials including posters and stickers developed and printedDo you have pictures that illustrate these points ?
15 Achievement of pilot phase Treatment started at St Peter TB hospitalTreatment follow up sites establishedCapacity built:infrastructure, staff, IC, M&E,Enrollment : 100% of target45 patients put on treatmentTreatment outcomeSatisfactory= phase 1 ?
16 Shifting the gear: Preparation for accelerated scale up Implementation protocol for ambulatory care for DR-TBCustomization of training material for middle levelSelection of TIC and TFC1 TIC linked to 8-10 TFCUpdate case finding and diagnostic approachesEstablishment of Sputum sample transport systemEfficient PSM for SLDs, ancillary drugsSocio-economic support for patientsRenovations of TICs, TFCsImprove Human capital and leadershipMDRTB specific ACSM
24 Major ChallengesMDR TB Suspect identification and Sputum sample transportation challengesGeneXpert rollout is very slowHR Capacity needs not metPoor Lab support for patient monitoringAncillary drugs shortage - What, when, wherePatient socioeconomic support system not standardizedInfection control settings in most health facilities not satisfactorySLD Supply to TICs and TFCs not fully integrated to the national DSMLong turn around time for follow up Culture resultsSuggest to remove the 1stRewording – pictures ?
25 Targets for in PMDTTo decentralize the MDRTB treatment service to PHC level by 2015:TIC at Zone level (40, 70, 96 zones in 2006, 7 and 8 respectively) and at least one TFC at Woreda level (814 Woredas).DST screening for10% of New PTB smear positives and100% of previously treated TBTo enroll 100% notified confirmed MDR TB cases for treatmentTo achieve 95% interim result of culture conversionTo achieve TSR rate of 80% and reduce the death rate from 15% to 10%To improve cases finding in pediatric age groupto reach 7% of all casesTo provide integrated MDR TB and HIV service in all MDRTB service points
26 Major partners of MOH for PMDT Roll out Global FundWHO, FIND, EXPAND TB ProjectUSAID:TB CARE I(KNCV), HEAL TB (MSH), PHSP (Abt.)Global Health CommitteeCDC : JHU, I-TECH, ICAP, UCSDMSF BelgiumInternational Organization for Migration