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Dr Hind Satti Partners In Health Lesotho

Standard of Care for MDR-TB. Dr Hind Satti Partners In Health Lesotho. Landlocked country located within South Africa (bordering Free State and KwaZulu-Natal) Population 1.8 million 12,275 TB new cases notified in 2009 Over 2000 re treatment cases HIV prevalence rate: 23.2% in 2005

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Dr Hind Satti Partners In Health Lesotho

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  1. Standard of Care for MDR-TB Dr Hind Satti Partners In Health Lesotho

  2. Landlocked country located within South Africa (bordering Free State and KwaZulu-Natal) Population 1.8 million 12,275 TB new cases notified in 2009 Over 2000 re treatment cases HIV prevalence rate: 23.2% in 2005 80% of TB cases are HIV positive (NTP 2008) Lesotho: Basic Facts

  3. Lesotho MDR-TB Programme • A comprehensive response to MDR-/XDR-TB in Lesotho, established by the MOHSW. • International partners include PIH, WHO, FIND, OSI • Community-based treatment and care model that includes all 10 districts • First patients enrolled in August 2007; 500 patients enrolled to date

  4. National TB Reference Laboratory

  5. Case Detection • All HCWs including NTP staff • TB/HIV coordinators/Officers at district hospitals • Health centre nurses providing HIV/TB care • Routine HIV screening of MDR-TB patients, partners, family members • Protocol for “medium-risk” and “high-risk” • Sputum sent to national TB laboratory • Screening of household contacts

  6. Botsabelo MDR-/XDR-TB Hospital

  7. Patient Characteristics • Approximately 78% HIV-positive with advanced AIDS-defining conditions • Severe malnutrition • Multiple failed TB treatment regimens • Extensive TB disease • Mostly 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 2004. 8(11):1382–1384

  9. Infection Control • Outpatient • TB clinics and general outpatient clinics • Treatment supporters • Family members • Inpatient • Cross-infection of patients • Protection of health workers (TB and HIV)

  10. Social assistance

  11. MDR-TB/HIV • 100% 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 doses • Report side effects • Provide injections. • Accompany patient for clinical evaluations • Screen 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. 2009 Sep 25;4(9):e7186.

  14. Conclusion • Diagnosis and management of MDR-TB in high HIV-prevalence settings is challenging but possible • Empiric treatment of MDR-TB is needed to decrease early mortality • Side effects are more common and earlier • Infection control at all levels: hospital, clinic, community is critical. • Community-based MDR-TB/HIV allows for rapid enrollment and closer monitoring of side effects

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