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Magnitude and management globally and nationally

Magnitude and management globally and nationally. Global Magnitude of DR-TB Problem. The WHO, Stop TB Department, estimates the number of incident cases (including new and re-treatment cases) occurring worldwide in 2003 alone to be 458 000.

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Magnitude and management globally and nationally

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  1. Magnitude and management globally and nationally

  2. Global Magnitude of DR-TB Problem • The WHO, Stop TB Department, estimates the number of incident cases (including new and re-treatment cases) occurring worldwide in 2003 alone to be 458 000. • Prevalent cases worldwide could be two or three times higher than the number of incident cases.

  3. The third global report on anti-tuberculosis drug resistance surveillance has documented that: • Many areas of the world face endemic and epidemic DR-TB. • One third of DR-TB cases had resistance to all four of the first-line drugs tested in the global survey. • Moreover, DR-TB patients often live for several years before die of the disease and transmit resistant bacilli. • Prevalence of DR-TB may therefore be three times greater than its incidence, suggesting that the true number of DR-TB cases in the world today may approach or exceed one million.

  4. In patients never previously treated: • The median prevalence of MDR-TB was 1.2% (range 0–14.2%); 11 sites exceeded the 6.5% threshold for extreme values, including 7 in the former Soviet Union.

  5. In previously patients treated: • The median prevalence of MDR-TB, 7.7% (range 0–58.3%). • The probability of MDR-TB was over 10-fold higher in previously treated patients, than for untreated patients.

  6. Magnitude of the DR-TB Problem in Egypt

  7. According to the tuberculosis drug resistance survey done in Egypt, 2002, in which a total number of 849 patients enrolled, 632 never previously treated and 217 retreatment patients, results were as follows: -

  8. Effort to address DR-TB problem • DOTS was, and remains, the most cost-effective approach to detecting and curing cases and to preventing the onset and spread of drug resistance. • In 1997, WHO and the International Union Against Tuberculosis and Lung Disease (IUATLD) reported for the first time standardized information on drug resistance from surveys or surveillance systems conducted since 1994 in some 35 countries. • In April 1998, during which the term “DOTS-Plus” was coined and the DOTS-PLUS working group was established to assist countries and support efforts to assess the feasibility of DOTS-Plus and to produce sound policy recommendations.

  9. Effort to address DR-TB problem, (cont.) The Green Light Committee (GLC) was thus born in June 2000: hosted by WHO as a partnership among five categories of participants: • Governments of resource-limited countries, • Academic institutions, • Civil society organizations, • Bilateral donors, • WHO

  10. The Green Light Committee (GLC): • Negotiates prices of drugs with producers; • Assures creation of, and adoption of, sound policies for proper management of drug-resistant TB in applying countries; • Developed strict criteria to review proposals for DOTS-Plus projects; • Assists countries in developing such proposals • Ensures their proper implementation; and finally, • Provides access to quality assured second-line drugs at concessionary prices to those projects considered technically and scientifically sound and not at risk of producing additional drug resistance.

  11. first set of guidelines – Guidelines for establishing DOTS-Plus pilot projects for the management of multi-drug-resistant tuberculosis was produced in 2000 and the latest updated version issued in 2006, • By September 2005: 35 GLC-approved projects had been implemented in some 29 countries around the world, providing treatment to more than 10 000 cases of MDR-TB in resource-limited settings.

  12. Effort to address DR-TB problem in Egypt: • Egypt successfully applied to the Green Light Committee (GLC) to implement DOTS plus program in 2003. • The plan for establishing 4 centers, covering the whole country, to treat the drug-resistant TB cases using the second line anti-tuberculosis drugs was approved.

  13. A team was trained in Latvia under the supervision of WHO and treating policy and treatment regimens were prepared in collaboration with the GLC expertise. • The first center is already established in Abbassia chest hospital, and the first group of patients has started receiving treatment since the first of July 2006..

  14. Descriptive analysis for the cohort registered from1July to December 2006 • Number of patients was 28 pts, 8 females & 20 males • Females age ranges from 24 to 50 years old with mean = 32.1, median = 27 & SD = 9.72 • Males age ranges from 18 to 85 years old with mean = 42.2, median =42& SD = 16.1

  15. History of previous treatment • Two male patients (7%) have no history of previous treatment but were contact to their MDR-TB mother. • 93% of the cohort received CAT I and CAT II treatment regimens with different treatment outcomes: failure to defaulting.

  16. Presenting complaints & percentage

  17. Side Effects appeared

  18. Sputum conversion • By Now, all patient are smear negative culture negative for AFB except for a single patient who is still smear negative and culture positive.

  19. Deaths • Three cases (10.7%) died of respiratory failure after being admitted to ICU and mechanically ventilated.

  20. THANK YOU

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