Presentation on theme: "Standard of Care for MDR-TB"— Presentation transcript:
1 Standard of Care for MDR-TB Dr Hind SattiPartners In HealthLesotho
2 Lesotho: Basic FactsLandlocked country located within South Africa (bordering Free State and KwaZulu-Natal)Population 1.8 million12,275 TB new cases notified in 2009Over 2000 re treatment casesHIV prevalence rate: 23.2% in 200580% of TB cases are HIV positive (NTP 2008)
3 Lesotho MDR-TB Programme A comprehensive response to MDR-/XDR-TB in Lesotho, established by the MOHSW.International partners include PIH, WHO, FIND, OSICommunity-based treatment and care model that includes all 10 districtsFirst patients enrolled in August 2007; 500 patients enrolled to date
5 Case Detection All HCWs including NTP staff TB/HIV coordinators/Officers at district hospitalsHealth centre nurses providing HIV/TB careRoutine HIV screening of MDR-TB patients, partners, family membersProtocol for “medium-risk” and “high-risk”Sputum sent to national TB laboratoryScreening of household contacts
7 Patient Characteristics Approximately 78% HIV-positive with advanced AIDS-defining conditionsSevere malnutritionMultiple failed TB treatment regimensExtensive TB diseaseMostly smear-positive
8 Lesotho vs. rest of the world† *Tomsk, Latvia, Estonia, Peru, Philippines† Nathanson et al. Adverse events in the treatment of multidrug-resistant tuberculosis: results from the DOTS-Plus initiative. Int J Tuberc Lung Dis (11):1382–1384
9 Infection Control Outpatient Inpatient TB clinics and general outpatient clinicsTreatment supportersFamily membersInpatientCross-infection of patientsProtection of health workers (TB and HIV)
11 MDR-TB/HIV100% HIV testing during the first visit.Early initiation of HARRT for MDRTB/HIV (10-21 days), regardless of CD4 count.Aggressive management of side effects.Home assessment visit before initiation.Household contact screening and testing for TB and HIV.
12 Role of Treatment Supporter Observe all dosesReport side effectsProvide injections.Accompany patient for clinical evaluationsScreen for TB and HIV in household contacts.Offer psychosocial support to the patient and the family.
13 Effect of HIV on MDR-TB mortality Seung KJ, Omatayo DB, Keshavjee S, Furin JJ, Farmer PE, Satti H. Early outcomes of MDR-TB treatment in a high HIV-prevalence setting in Southern Africa. PLoS One Sep 25;4(9):e7186.
14 ConclusionDiagnosis and management of MDR-TB in high HIV-prevalence settings is challenging but possibleEmpiric treatment of MDR-TB is needed to decrease early mortalitySide effects are more common and earlierInfection control at all levels: hospital, clinic, community is critical.Community-based MDR-TB/HIV allows for rapid enrollment and closer monitoring of side effects