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Programmatic Management of Multidrug Resistant TB (PMDT)

Programmatic Management of Multidrug Resistant TB (PMDT). 5 th Joint International Monitoring Mission of NTP, Thailand 23 August, 2013. Situation. 2006 Drug Resistance Survey : 1.7% new & 34.5% previously treated MDR -TB ( 2,190 cases in 2012) ; 2012 survey results awaited

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Programmatic Management of Multidrug Resistant TB (PMDT)

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  1. Programmatic Management of Multidrug Resistant TB (PMDT) 5th Joint International Monitoring Mission of NTP, Thailand 23 August, 2013

  2. Situation • 2006 Drug Resistance Survey: 1.7% new & 34.5% previously treated MDR-TB (2,190 cases in 2012); 2012 surveyresults awaited • MDR-TB management implemented by NTP in 2008/09; 2012-2016 PMDT plan & updated TB Guidelines drafted • MDR-TB risk groups defined (Re – On – Pre) • Culture & drug susceptibility testing (C/DST) for first line TB drugs available at Regional level and in Bangkok, and rapid molecular testing in various sites • 2012: 492 confirmed MDR-TBcases reported to WHO, number on treatment unclear, outcomes on first cohort not available yet • 100 MDR-TB treatmentcentres registered with NHSO • No reported stock outs of second line TB drugs (SLD), drugs for adverse drug reactions available and covered under NHSO

  3. Issues • MDR-TB plan and updated TB Guidelines not yet available • Diagnostic algorithms unclear (with doctors discretion), multiple (re-) confirmation of test results • Delay and/or under-reporting of cases, no MDR-TB module in TBCM, reporting to NTP only from late 2011 • Inconsistent treatment practices: Regimens not as per guidelines, low SLD dosages, daily DOT not always done • Limited experience in managing MDR-TB cases, no M/XDR treatment committee at Regional level • Multiple sourcing (GPO & GDF) & funding of SLDs (NHSO, GF & Hospital funds), different ordering cycles (GPO & GDF) • Unclear reimbursement / funding under NHSO, SSS and GF for C/DST, follow up cultures, treatment of migrants

  4. Recommendations • Finalise and publish 2012 DRS results • Finalise MDR-TBPlan and updated TB Guidelines, disseminate and monitor implementation • Establish an integrated comprehensive web-based case based information system (Summary recommendation 2) • Support clinical practice via clinical case meetings coordinated by ODPC, and link with National MDR-TB Expert group • As part of supportive patient-centered care approach, ensure availability of DOT observer for all cases throughout treatment • Ensure timely provision of support packages to patients and DOT observer • Reimbursement of full PMDT package, including all diagnostic and follow up tests, under the respective insurance schemes • Develop mechanism to ensure migrants with MDR-TB diagnosed early and treated based on experiences from GF SSF project

  5. THANK YOU

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