MDR-TB and TB Update: Rayong Province

CAP-TB Strategic Planning MeetingAugust 1, 2013

Bangkok, Thailand

Chittima Thibbadee, M.D.

Presentation Outline

• Latest MDR-TB and TB prevalence

• At-risk populations

• Current effort

– Prevention

– Care and treatment

Presentation Outline

• Available resources/fundings

– Available resources e.g. equipment, human

resources, number of health facilities with the

diagnosis and treatment capacity, etc.

– Funding sources, period and focuses

• Challenges and Gaps

Rayong

Pattaya

Latest MDR-TB and TB Prevalence

TB Prevalence Rate in Rayong Province Between 2008 - 30 June 2013*

Year

*2013 data is between 1 October 2012 – 30 June 2013

TB incidence (per 100,000) by WHO region,

and in Thailand, 2011

source: WHO, Global Tuberculosis Report 2012

TB incidence in Thailand is 2.5 – 4 times higher than Europe & America regions

Number of case between 2008-June 2013

645 case 683 case 65 1 case 690 case 640 case

606 case ที่��มา : TB 07

MDR-TB Prevalence Rate in Rayong Province Between 2008 - 30 June 2013

*2013 data is between 1 October 2012 – 30 June 2013

พ.ศ.

Number of MDR-TB Patients by District

Districts

Number of MDR-TB Patients

2007(n=10)

2008 (n=19)

2009(n=25)

2010(n=8 )

2011(n=11)

2012(n=29)

2013(October12-

June13)(n=19)

Muang 5 6 14 4 5 17 8

Klaeng 3 6 5 2 3 2 2

Ban Khai 2 1 2 1 3 1 2

Ban Chang - 1 1 - - 3 2

Pluak Daeng - 3 1 - - - 2

Wang Chan - - 1 - - 1 1

Nikom Pattana - 1 1 - - - -Khao Cha-mao - - - - - - -Rayong Central Prison

- - - - - 2 1

Other provinces - 1 (Chonburi

)

- 1(Songkla)

- 3 (Chonburi)

1

(Chonburi)

At-risk Populations

Population group Number of Population

1. Elderly 67987,

2. Diabetics 17779,

3. Migrants 14770,

4. HIV infected persons

12,560

5. Inmates 6 ,211

Current Effort

Prevention

1. Early (MDR-TB) case detection, contact

investigation

2. Quality DOT in drug-sensitive TB (DS TB)

3. Proper management of MDR-TB

4. Increase public awareness

5. World TB Day campaign

Care and Treatment

1. TB clinics staffed with trained health personnel

2. Active /intensified case finding in different at-risk population groups

3. Sputum smear tests/culture to diagnose pulmonary TB by the National TB Program

4. Quality DOT

Care and Treatment (cont)

5. Uninterrupted supply of quality TB drugs6. Infection control in hospital/household le

vels7. Integrated HIV/AIDS and TB program8. Patient’s registration and reporting

completeness9. MDR-TB patient register implemented

Available Resources

Health Facilities and Diagnosis Capacity

1. 65 culture and identification laboratories (Solid media culture is performed at Rayong Hospital)

2. 35 DST laboratories (DST for FLDs/SLDs is also available at Siriraj Medical School/BTB)

3. 24 Molecular Assay laboratories (14 GeneXpert machines in Thailand, one at Rayong hospital with support from USAID|Asia through CAP-TB Project)

Public and Private Health Facilities in Rayong Province

DistrictPublic Health Facilities Private

Health Facilities

regional(n)

community(n)

sub-district

(n)

Health center

(n)

Private hospital

(n)

Mueang 1 1 19 10 3

Klaeng 0 1 23 1 0

Ban Khai 0 1 15 0 0

Pluak Daeng 0 1 10 0 0

Ban Chang 0 1 9 0 0

Wang Chan 0 1 7 0 0

Khao Chamao 0 1 6 0 0

Nikhom Phatthana

0 1 5 0 0

Total 1 8 94 11 3

Human Resources

Health personnel who care for MDR-TB patients at Rayong Hospital

•2 Medical physicians (pulmonologist)

•1 Paediatrician

•1 Pharmacist

•1 Register Nurse (& counselor)

Human Resources(cont)

Health personnel who care for MDR-TB patients at Rayong Hospital

•4 Medical Technologist (lab staff)

•1 Counselor

• Health worker (home visit)

- Full time 2

- Part time 3

Current Funding Sources

• National Health Security Office (NHSO) –

ongoing

Objectives:

1. Active case findings/screening amongst at-risk

populations and close contacts of TB/MDR-TB

patients

2. Directly-observed therapy (DOT) by trained

personnel for TB/MDR-TB patients

Current Funding Sources

• Global Fund – to be ended in September 2014

Objectives:

1. Support the implementation of DOTS in all

communities in three districts in Rayong Province

2.Facilitate TB/HIV activities

3.Empower community in TB prevention and control

4.Provide living support to patients

Current Funding Sources

• USAID | Asia through CAP-TB Project – to be

ended in September 2016 Objectives:

1. Strengthen MDR-TB prevention and management among at-risk population groups

2. Support active case findings/screening among HIV infected persons, diabetics, elderly persons and migrant population in four communities in three districts in Rayong Province.

3. Provide package of service to patients to support treatment adherence.

Current Funding Sources

Local administration organization –

ongoing

Objectives:

–To support project implementation according

to the need and priority of the areas

Current Funding Sources

Local administration organization –

ongoing

Objectives:

–To support project implementation according

to the need and priority of the areas

Challenges and Gaps

Prevention

Challenges Way forward

1. Prevention of acquired MDR-TB

- Strengthen quality DOT for TB patients

- Improve infection control practice in household

2. Prevention the continuing spread of MDR-TB strain

- Strengthen early MDR-TB case detection in community

3. Stop chain of transmission

- Strengthen MDR-TB management

Diagnosis

Challenges Way forward

1. Culture and DST test reimbursement

- Number of tests (throughout the treatment course) to be reimbursed is in discussion

2. Use of GeneXpert to diagnose MDR-TB beyond at-risk populations

Care and Treatment

Challenges Way forward

1. Promote treatment adherence and success

- Side effect management

- Provide socio-economic support to patients

2. Stigmatization - Public/community education

3. Information sharing - Improve communication and record tracking and keeping system

4. Quality DOT provision for MDR-TB patients

- Community engagement

Thank you

For your attention