1. Country Progress Report LAO PDR
The ninth Technical Advisory Group and National TB Programme Managers meeting for TB control in the Western Pacific Region
Manila, Philippines
9 -12 December 2014

2. TB Epidemiology
WHO Global Tuberculosis Report 2014

3. Major successes
DOTS started in 1995 with WHO and Damien Foundation Belgium
In 5 central, 17 provincial, 142 districts hospitals and 903 health centres (95%) and 175 private clinics and pharmacies (PSI)
4124 notified TB cases (2013) and treatment success rate 90% (2012)
First TB prevalence survey in 2010 and first external TB review in 2013
Culture started in 2010 and DST in 2014
GeneXpert in 2 central hospitals and 1 provincial hospital (Savannakhet)
76% TB patients have HIV test result (Q3 2014)
PMDT started in 2011: 25 MDR-TB patients on 9 month regimen (July 2013-Nov 2014)
The NSP is based on prevalence survey and TB review findings and recommendation to increase TB case detection

4. TB prevalence survey 1. Census 2. Interview 3. Specimen collection
3. Chest X-Ray

5. Major challenges Stagnation in TB detection (31% CDR all forms, 2013)
Low identification and referral of presumptive TB in some provinces/districts
Low referral by OPD, IPD, MCH etc.
Child TB is under diagnosed
TB HIV collaboration is still limited
MDR is under diagnosed and often late
Low sensitivity of direct microscopy
Lack of information of the population on TB
Insufficient involvement of community
Managerial constraints (funding, infrastructure, procurement, administrative procedures)

6. Case detection stagnation
Notification rates of tuberculosis in Lao PDR,
stagnation
Source: NTC

7. National TB Strategic Plan 2015-2019
Aligned with National Health Sector Plan
Budgeted
Funded mostly by Global Fund (NFM request for ) and other partners (WHO, DFB, USAID):
LAO PDR NTP will be member of the Mekong Basin Disease Surveillance
Vision: zero deaths, disease and suffering due to TB
Goal: To reduce TB burden and to reach the targets of WHO Post-2015 Global Tuberculosis Strategy (adopted by 67th World Health Assembly 2014 on 19 May 2014)
Specific target: Increase TB case detection rate (CDR) from 31% in 2013 to 70% in 2019
Objectives:
Integrated patient centred TB care and prevention
Strengthening TB-HIV collaborative activities
Managing drug resistant tuberculosis (PMDT)
Improved management

8. TB detection in Lao PDR, forecast 2015-2019

9. Laboratory strengthening
LED: not significant advantage compared to ZN in Lao context of low work load
Xpert MTB/RIF: 30% yield compared to microscopy (as a first test, NRL April-Nov 2014)
GeneXpert scaling-up: cumulative 10 in 2014 (being procured), 15 in 2015, 20 in 2016
EQA microscopy since 2004,
QA Culture and DST with KIT as SRL
Laboratory information management system
TA partners: WHO, Stop TB partnership, KIT, Merieux Foundation

10. Scaling-up Xpert MTB/RIF testing in Lao PDR

11. Reach the unreached: intensive case finding
Engaging all health providers in public (OPDs, IPDs, MCH, ANC etc. and private sector) at all levels of the PHC
ICF among house hold TB contacts including children, PLWH, prisoners, mine workers, mobile population, factories, patient with diabetes and other co-morbidities,
ACF mobile camps in high prevalence areas (with CXR and GeneXpert)
Diagnosis and treatment of child-TB
Identify and refer all presumptive TB patients to the TB unit or to the TB laboratory
Support health centres (training, supervision, budget for transportation of specimens)
Advocate to local authority, chiefs of villages, village health committees to involve in TB control activities
Use NGOs/CBOs (LYU, LOPHA, MAAP, PEDA, PSI)

12. Patient centred care: involvement of patients and civil society
All stakeholders, public sector, donors, partners, NGOs/CBOs, key affected population and patients representatives provided their input in situation analysis, NSP elaboration and country dialogue (workshops)
TB technical working group (TWG) includes NGOs/CBOs and partners
NGOs/CBOs conduct joint need assessment surveys with local authorities to identify at risk population and explore gaps and barriers in accessing TB services
NGOs/CBOs mobilize village health committees, chiefs of villages and villagers for TB case detection and sending patients/specimens in relation with the health centres and to participate in ACF campaigns
NTP supports specimen transportation from health centres to TB laboratory

13. TB/VIH Collaboration with CHAS (planning, training and supervision)
Rapid HIV testing for all TB patients (77% in 2014, target 100%)
Coordination with CHAS for CPT and early ART among all TB-HIV patients
«3 Is » among the PLWH: Intensive case finding, infection control and IPT
*2014: projection of 3Q, NTC data

14. PMDT
Achieved
Target
Presumptive MDR-TB patients examined by Xpert MTB/RIF or culture/DST (retreatment)
60%
100%
RR/MDR-TB patients enrolled
90%
9 months MDR treatment: 25 MDR-TB patients under treatment in Dec 2014 25
35 in 2014, 40 in 2015, 45 in 2016, 50 in 2017
Surveillance (DRS in 2015)
In preparation with KIT
2015
MDR-TB patients support for transportation, food, examinations
Follow-up and care of adverse drugs events (report to FDD)
Report severe ADE to FDD
Cohort event monitoring (2015)
Training of all physicians on PMDT (including diagnosis, treatment and infection control)
Central level
Train all provinces by 2015
Infection Control (administrative, environment, personal protection)
Training of limited number of staff
Train health staff at all levels on IC
Data management
E-RR under development
Electronic R/R in 2015

15. Surveillance
Quality of surveillance system: EQA microscopy established since 2004
QA culture and DST with KIT
DRS to be conducted in 2015
New case definition rolled out in new national TB guidelines 3 rd edition (2014)
e-R&R: under development for MDR-TB
Analysis and usage of data at national and sub-national levels: briefing and debriefing meeting of NTP supervisors
LAO PDR NTP will become member of the Mekong Basin Disease Surveillance (cross-border information and collaboration on TB control)

16. Policies and supportive systems
TB care financing and social protection:
social protection is limited to only 10-15% of the population
Strengthening notification mechanism:
Training all physicians and nurses in TB wards, OPD, IPD in public and private hospitals, in health centres, village health volunteers (VHV) and village health workers (VHW), private clinics and pharmacists
paper based RR system to be upgraded to electronic RR
Drug regulations:
No change since drug regulation meeting in March 2014

17. Management
Supervising all levels (central, province, district hospitals and health centre) and visit TB patients
Improving communication, reporting and feed back (web based R/R)
Train staff of all levels on administration, finances and reporting
Ensure procurement, maintenance, logistic and storage

18. Partners

19. Thank you