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The 5 th Joint International Monitoring Mission to review NTP Thailand, 2013

The 5 th Joint International Monitoring Mission to review NTP Thailand, 2013. 14-19 August 2013 ODPC7 and Srisaket Province. Outline. Objectives Sites visited Overall impressions Key findings, recommendations by topic. OBjectives. Objectives of 5 th Joint Monitoring Mission of NTP.

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The 5 th Joint International Monitoring Mission to review NTP Thailand, 2013

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  1. The 5th Joint International Monitoring Mission to review NTP Thailand, 2013 14-19 August 2013 ODPC7 and Srisaket Province

  2. Outline • Objectives • Sites visited • Overall impressions • Key findings, recommendations by topic

  3. OBjectives

  4. Objectives of 5th Joint Monitoring Mission of NTP • Track progress of recommendations from 2007 and 2009 reviews • Review implementation within National TB Strategic Plan 2011-2016 • Analyse achievements and challenges • Identify actions and areas for improvements

  5. Approach • 5 field teams: ODPC 9, 11, 3, 7, 1, plus epidemiology review team • Site criteria • Not included in previous JMM’s And one or more of the following: • Examples of good practice • High TB burden • Requiring additional support • Opportunity to assess a specific technical issue

  6. Site Visits

  7. ODPC 7

  8. Sisaket Provincial Hospital

  9. Sisaket Provincial Health Office

  10. Khuk Khan District Hospital

  11. Huay Nuea Primary Care Unit

  12. Sriritana District Hospital

  13. Pingpuay Primary Care Unit

  14. Sisaket Prison

  15. Samrongtagen Primary Care Unit

  16. Overall Impressions • Extraordinarily warm welcome; open sharing of information • Impressively dedicated staff at all levels, including volunteers • Strong technical teams • Monitoring and accountability are strong and effective • Innovation is encouraged

  17. Overall Impressions (II) • Collaboration between institutions and at different levels is excellent • Multiple examples of best practice, opportunities for others to learn from staff teams here • Most key TB indicators better than national average; continuing high prevalence

  18. Overall Impressions (III) • Systemic challenges to efficient program implementation • A few specific technical recommendations • Key issue: how to translate local excellence to other areas?

  19. Technical Areas

  20. 1. Case Finding • At every level, both testing (AFB) and SS+ case finding was high 2008-10 then decreased • Active case finding efforts: case contacts, elderly, DM, TB/HIV, migrants, prisoners • Symptom screening, AFB/CXR

  21. Case Finding • Algorithms not always clear • Symptom questions, criteria for diagnostic assessment and which tests • Monitoring information often not enough to evaluate yield, effectiveness of screening • Yield appears low in most groups other than TB/HIV and DM • Sensitivity of algorithm? • Juice worth the squeeze?

  22. Case Finding: Recommendations • Define approach clearly and track data to evaluate yield • Asymptomatic primary screening vs. symptomatic care seekers; community vs. facility • Target population number, number symptom screened, number with diagnostics, SS+/SS-/EP cases

  23. TB screening in DM patients

  24. ODPC7 Case Finding

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