7 TB in MongoliaMongolia is one of the 7th high burden TB country in West Pacific region of WHO.3985 cases last year per 2.7 population ( cases per 270 mln USA population)185 MDR casesTotal 19 XDR cases400 paediatric casesTB incidence 219 perTB prevalence 280 perTB Mortality 21 per2011 statistics is promising
8 Last ten years incidence, treatment success and mortality
10 Timeline 1968: The TB laboratory was established 1992: The TB laboratory network was developed1994: NTP was established and DOTS launched1994: Organization of the National Reference Laboratory1997: Quality assurance system was introduced, Supranational Reference Laboratory (SRL) Japan1997: First Drug Resistance Survey (DRS) conducted1999: 100% DOTS coverage2001:Reogranization of the TB Department under the National Center for Communicable Disease (NCCD)2001: GFATM Round1 launched, later on RCC12002: National Programme of Communicable Diseases (NPCD) approved, TB program is a sub-programme of the NPCD2005: GFATM Round 4 launched, Later on RCC 42006: launching of GLC approved project for management of 375 patients with drug-resistant TB (DR-TB)2007: Second DRS conducted2008: The review of the NTP2009: Testing of drug resistance to second-line anti-TB drugs (SLD) started2010: second National Programme of Communicable Diseases (NPCD) approved for the years , TB program is a sub-programme of the NPCD2010: National strategic plan to stop TB in Mongolia, (Objective 3-expand programmatic management of MDR-TB)2010: Updated the guidelines on tuberculosis care and service (appendix 3- guidelines on drug resistant TB services and care) approved by MOH, 20102010: National TB Infection control (IC) guidelines developed and approved2010: GLC approved second cohort for 790 patients2011: GFATM Round 10 approved and the consolidated grant will be launched in July 20112012 ; ACSM strategy is in development process
11 Current TB situation Political and financial commitment National strategic plan to stop TB in Mongolia (Objective 3-expand programmatic management of MDR-TB), MoH, 2009National guidelines on tuberculosis care and service updated and approved by MoH, 2009 (appendix 3- guidelines on drug resistant TB services and care)Successful resource mobilization from the GFATM (since 2006 –present, single stream funding)
12 MDR-TB patients enrolled (2003- 2011) MDR-TB estimates burden by WHO: 106 new MDR-TB cases every yearBUT BY END OF 2011 – WE DIAGNOSED 180First three month of 2012 – 22 new casesDRS survey 2007:among new cases: 1.4%Among retreatment cases 27.5%893 MDR-TB cases were diagnosed, out of them:58.1% (519) have been enrolled to treatment, 26.5% (237) died, and 1.3% (12) refused treatment, 1.1% (10) were treated abroad or private hospital, 0.8% (7) were not able to be enrolled in treatment due co-morbidities, 12.1% (108) were on the waiting list.
13 National TB reference laboratory with 37 branches and sputum transportaion scheme
14 Current MDR-TB situation Available infrastructure:NTRL (DST, culture, liquid culture, LPA on FLDs)Treatment is available through GFATM supportInfection control:Administrative measuresGeneral infection control order, approved by MoH, 2010TB infection control guidelines, 2010
16 PartnersWorld Vision International Mongolia (WVIM) started the implementation of the GF TB grants since It has been collaborating with the “Enerel” charity and Prison Hospital on provision of TB care services for vulnerable population as homeless and prisoners, conducting active case finding and ACSM activitiesMongolian Anti-Tuberculosis Association (MATA) worked as sub-recipient (SR) for GF supported project since 2003 on the implementation of home-based and lunch-DOT for TB patients through trained health volunteers nationwide. Also they led ACSM activities for general population as well as for patients and their family to reduce stigma and discrimination against TB.Mongolian Association of Family Clinics (MAFC) implemented the PPMD since April 2009 within the Round 1 RCC. The MAFC has been carrying out the following interventions: training TOT among family physicians on early detection and treatment, referral of TB suspects to a secondary and tertiary level of TB services, transportation of sputum samples from primary health care services to TB dispensaries, and developing clinical guidelines for family doctors
17 Partners Mongolian Antituberculosis Union newly formed in 2011 Health Science University of Mongolia (HSUM) collaborates closely with the NTP on the revision of the curriculum of relevant health sciences courses including medical course, nursing and pharmacy. The HSUM is instrumental in on formalizing of policy documents in collaboration with the Ministry of Education.The GFATM provides financial supportWorld Health Organization (WHO) provides technical assistance through its Country and Regional Offices.
18 Strength and Weakness Strengths of T B Control Program Good and detailed National Strategic Plan to Stop TB in Mongolia ( )KAP survey for health providers completed and publishedKAP survey with general population in final stagesPartnerships in place and community mobilizationCommitment of staff and available technical supportChallenges in TB Control ProgramHuman resources (all)Limited knowledge of TB (all)Stigma and discrimination (all)CoordinationSignificant amount of data but not used appropriately, TB prevalence survey not contactedEngaging all providers/community groupsPolitical commitment
19 Challenges and some factors Various vulnerable groups (homeless, alcoholics, poor) difficult to reachSeeking diagnosis lateTreatment defaultInfection Control practices/guidelines not implementedNo diversified funding for TB control activitiesLimited knowledge on TB (all) and availability of services among populationLimited knowledge on Interpersonal Communication and Counseling skills (providers)Lack of target specific messaging on TBNo coordination or/and consistency of TB messages among partnersCoordination, planning, partnerships, networksNo standardized training curriculum and tools for providers and community volunteersHealth providers have no interest to work in TB sectorCurrently limited efforts to gain political support for TB
22 TB day HRD strategy ACSM strategy TB patient social care and isolation KAP surveyTB incidence among HCWMoU with high burden districtsTB registration webMedia and webActivity among TB patientsAXA among school childrenDebjee- amongTB Voluntary WorkersTV education program