Components of a TB program

1. Components of a TB program Capacity Building for Tuberculosis control, with a specific focus on TB/HIV in CAREC Member Countries Montego Bay, Jamaica

2. Many questions arise when we speak about TB control Montego Bay, Jamaica

3. Aims of this presentation • To set the main components for TB control • To describe the classic principles of the DOTS strategy and its achievements Montego Bay, Jamaica Stop TB Department

4. The TB Program …is a join effort of the goverment and the community, acting to reduce, and in the long term to eliminate, the epidemiological, social and economic problems, and the human suffering caused by tuberculosis, by means of the rational use of technical knowledge and available resources. WHO, Standard Procedures Manual, Scientific Publication, No 418 Montego Bay, Jamaica

5. Components of a TB program • ? • ? • ? • ? Montego Bay, Jamaica

6. Components of a TB program • Structure, human resources and integration in the health services • Strategic Plan • Budget • Technical guidelines, norms and protocols • Activities: • Case Detection • Laboratory Services • Treatment (including cohort analysis) • Drug supply • Information system – Epidemiological surveillance • Supervision • Training • Research • Health promotion Montego Bay, Jamaica

7. Components of a TB program Coordination Strategies & Policies • Drug supply • Human Resources • Laboratory • Information System Montego Bay, Jamaica

8. Areas of NTP activities • Organizational and budgetary decisions • Technical policies • Information systems 4. Laboratory services • Supplies and logistics • Training, communication and advocacy Montego Bay, Jamaica

9. TB Care for All: Evolution of the DOTS Strategy Montego Bay, Jamaica

10. History of DOTS 80s : Styblo defines IUATLD model to control TB in Tanz. 1991: WHA establishes the 70/85 targets for 2000 1993: WHO declares TB as a global emergency 1994: New TB control framework 1995: DOTS launched as a WHO strategy 1998: London committee,StopTB Partnership launched 2000: Amsterdam declaration; targets in 2005 2001: 6 Working Groups and GDF launched 2001: GFATM, MDGand Washington Commitment 2002: Expanded Framework DOTS Brand Name Montego Bay, Jamaica

11. The DOTS Strategy is a comprehensive strategy which ensures cure to majority of tuberculosis patients presenting to primary health care services. Source: Stop TB at the source, WHO/TB/95.183 Use DOTS more widely, WHO/TB/97.224 Montego Bay, Jamaica

12. DOTS Components • Government commitment to ensuring sustained, comprehensive TB control activities • Case detection by sputum smear microscopy among symptomatic patients self-reporting to health services • Standardized short-course chemotherapy using regimens of six to eight months, for at least all confirmed smear positive cases. Good case management includes directly observed therapy (DOT) during the intensive phase for all new sputum positive cases, the continuation phase of rifampicin-containing regimens and the whole re-treatment regimen. • A regular, uninterrupted supply of all essential anti-TB drugs • A standardized recording and reporting system that allows assessment of case-finding and treatment results for each patient and of the TB control program performance overall Int J Tuberc Lung Dis 2001; 5(3):213-215 Montego Bay, Jamaica

13. Aspects of DOTS • Technical • Logistical • Operational • Political Montego Bay, Jamaica

14. Aspects of DOTS: Technical • Case detection and diagnosis • Standardized short-course chemotherapy • Direct observation during the initial phase of treatment (DOT) • Recording and reporting of progress and cure Montego Bay, Jamaica

15. DOT Approximately one third of patients do not take medications regularly as prescribed, and perhaps one third of patients who do take medications make errors in self-administration. Sbarbaro JA. Ann. Allergy 1990 Montego Bay, Jamaica

16. Aspects of DOTS: Logistical • Dependable drug and diagnostic supply • Laboratories for microscopy • Supervision and training of health workers Montego Bay, Jamaica

17. Aspects of DOTS: operational • Five basic core elements • Flexibility in implementation Montego Bay, Jamaica

18. Aspects of DOTS: political • Government commitment • Policy formulation • Resource mobilization Montego Bay, Jamaica

19. Three phases to gradual DOTS implementation 1. A pilot project phase (emphasis in technical and operational aspects) 2. An expansion phase (emphasis in logistical and training aspects) 3. A maintenance phase Montego Bay, Jamaica

20. An efficient system of TB control should be an integral part of Primary Health Care Montego Bay, Jamaica

21. DOTS is more than: • DOT • Only 5 components (but: planning, budgeting, financing, training, supervision, mapping, staff management, data analysis, assessment) • Strictly 5 components (but: flexible DOT in low incidence, culture, X-ray, DOTS Plus) Montego Bay, Jamaica

22. DOTS Expansion 1990-2002:Rapid and Impressive 180 155 DOTS launched 147 126 122 104 98 New Framework 73 19 15 10 Montego Bay, Jamaica Global Tuberculosis Control. WHO Report 2003. WHO/HTM/TB/2004.331

23. Montego Bay, Jamaica

24. Montego Bay, Jamaica

25. Montego Bay, Jamaica

26. Montego Bay, Jamaica

27. Treatment Outcomes by WHO Region: DOTS vs. non-DOTS2001 Cohort DOTS Non-DOTS Not treated successfully Treated successfully Not evaluated Montego Bay, Jamaica Global Tuberculosis Control. WHO Report 2003. WHO/HTM/TB/2004.331

28. Where are we going with DOTS? Montego Bay, Jamaica

29. Global TB Control Targets • WHA (year 2005): - To detect 70% of infectious TB cases - To treat successfully 85% of detected cases • MDGs (2015) – Goal 6: Combat HIV/AIDS, malaria and other diseases Target 8: to have halted by 2015 and begun to reverse the incidence of malaria and other infectious diseases - Indicator 23: reduction in prevalence and deaths - Indicator 24: proportion of cases detected and cured under DOTS In practice: 50% reduction in TB prevalence and deaths by 2015 Montego Bay, Jamaica Stop TB Department

30. Progress towards Global Targets70/85 by 2005 • Case detection rate: 43% • Treatment success rate: 82% Best forecast: treatment success achieved case detection close, but not achieved Montego Bay, Jamaica Stop TB Department

31. Montego Bay, Jamaica

32. Progress towards the 70/85 targets, selected Caribbean Countries, 2003 Montego Bay, Jamaica

33. Quality TB care for all: Ensure a high standard • Patient care to cure and prevent TB is the ultimate goal of DOTS • The foundation of DOTS is effective patient care which alleviates suffering, as well as controls and prevents TB in a community • A standard of care for TB exists already, and is evidence-based, but needs further promotion among all care providers • Simply, each care provider, public or private, should: 1- Diagnose TB quickly (i.e., bacteriological confirmation) 2- Treat TB properly (i.e., SCC and treatment support) 3- Report TB cases and treatment outcomes • If all providers did the right thing, we would control TB Montego Bay, Jamaica Stop TB Department

34. Conclusion If all providers did the right thing, we would control TB If all the NTP could ensure the DOTS components in place, we would control TB Montego Bay, Jamaica