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MDR-TB Globally and in the region 2013

MDR-TB Globally and in the region 2013. Dr Samiha Baghdadi Medical officer – STB WHO – EMRO Cairo March 2014. The structure of the presentation. MDR-TB burden globally and in the region MDR-TB notification MDR – TB treatment outcomes Regional challenges and strategic directions

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MDR-TB Globally and in the region 2013

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  1. MDR-TB Globally and in the region 2013 Dr Samiha Baghdadi Medical officer – STB WHO – EMRO Cairo March 2014

  2. The structure of the presentation • MDR-TB burden globally and in the region • MDR-TB notification • MDR – TB treatment outcomes • Regional challenges and strategic directions • Ambulatory care for MDR-TB

  3. Global coverage of data on DR-TB 1994-2013

  4. MDR-TB rate among New TB cases

  5. MDR-TB rate among previously treated TB cases

  6. Estimated MDR-TB among TB cases by WHO region

  7. Contribution of WHO regions to MDR-TB burden 2012

  8. Countries notified at least 1 XDR case

  9. MDR-TB cases 2012Estimated, notified and enrolled on treatment

  10. Estimated Number of MDR-TB cases among notified TB cases 2012

  11. Confirmed MDR-TB cases among notified TB cases 2012

  12. Contribution to MDR-TB notification by region 2012

  13. Treatment outcomes

  14. Treatment success rate by country 2011

  15. Regional challenges/risks foreseen • Unstable situation in many countries in the region, namely (Afghanistan, Egypt, Lebanon, Iraq, Pakistan, Somalia, Syria, Tunisia and Yemen). This situation resulted in several challenges as follows: • Huge population movement across the region • Huge staff turn over • Destruction of infrastructure • Limited movement in the field • Sever loss of drugs and equipment • Limited lab capacity • Culture and DST are not available in Somalia and South Sudan. DST is not available in Afghanistan. • Most of the countries in the region did not widely apply the new diagnostics. • DR survey and surveillance: • Updated survey is ongoing in Iraq, Iran, Pakistan, Sudan, and needed in Syria. • There is a need to document/report results of DR surveillance that is ongoing in GCC countries, and expand the continuous surveillance in the remaining 15 countries. • Libya is still the only country in the region without proper management of MDR-TB management.

  16. Regional challenges/risks foreseen • Expected financial gap to support scaling up MDR-TB activities in most countries, mainly (Djibouti, Egypt, Lebanon, Jordan, Iran, Pakistan and Syria). • Limited human resources at country level (MDR local support on continuous basis is needed in Afghanistan, Iraq, Pakistan and Sudan mainly). • Limited consultancy capacity in the region in general ( a team of 5 consultants was established last year to support countries)

  17. The strategic directions of the work of EMR_GLC • Improve planning for PMDT (update the regional plan and support planning at country level), • Develop regional high standard ambulatory based model • Develop Regional framework and guidance about the utilization of New diagnostics and lab support, • Scale up R&R for MDR, infection control at all levels, HR capacity, • Promote prequalified regional companies; develop mechanisms for joint proposals, drugs grants. • Operational research

  18. Promote using ambulatory model in MDR-TB care Justification: • Limited country capacity (infrastructure: hospitals, infection control) and financial. • New diagnostics increase case detection (X-Pert). • Long waiting list of detected cases. • Global experience is encouraging However : Ambulatory care does not exclude hospitalization

  19. What do we need for ambulatory model • Networking: • Diagnosis, • Treatment, • Treatment follow up, • Side effect management, • Daily observation and care, • Social support

  20. Some basic items for provincial profile • Population • Admin areas • Geographical description • Notified cases/notification rate ( TB type, Age and gender) • Treatment outcomes ( TB type, Age and gender) • Estimated MDR-TB cases among new and previously treated • Infection control • Lab coverage • EQA for DSM • C/DST coverage • PPM coverage • PHC coverage • Hospitals available • Referral system • Community support • Provincial map (PHC facilities, hospitals, laboratories, TB facilities, PPM facilities, patient distribution, MDR cases distribution) and community support points. • Security issues • MDR focal person

  21. RO support to countries for AT • Briefing about ambulatory model 2012 • Training on planning 2013 • Follow up planning process 2013 Future plans 2014 • Monitoring missions and evaluation • Lesson learnt

  22. SWOT analysis

  23. Stakeholder analysis/matrix

  24. Provincial profile

  25. Provincial map

  26. Strategic frame work

  27. OP plans

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