Transcript TB Projects Implementation: Does it impact to NTP?

TB Project Implementation:
Impact on NTP?
June 30, 2010
TB Program
Thailand MOPH – U.S. CDC Collaboration
Overview
Surveillance
Research
Training
Technical Assistance
Active Population-Based
Surveillance and Enhanced Control
of TB: The Thailand TB Active
Surveillance Network (TB-Net)
Partners and project sites
Ministry of Public Health
Bangkok Metropolitan
Administration (BMA)
Research Institute of
Tuberculosis (Japan)
Thailand MOPH – U.S.
CDC Collaboration
Non- and intergovernmental organizations
Funded: USAID, GDD,GAP
Chiang Rai
Tak
Ubon-ratchathani
Bangkok
Phuket
Difference between Active
Surveillance Network and Routine
TB Control in Thailand
Active, not passive, surveillance of diagnosed cases
Data from private, NGO, and non-MOPH government
facilities
Electronic recording of individual cases, not summary
Expanded data collection
Continuous data analysis
More than microscopy: culture (province), DST
(referred)
Integration of HIV counseling, testing, treatment
Goal of TB Net
Develop models for TB prevention and
control by
– Measuring incidence of diagnosed TB, HIV
co-infection, and MDR-TB
– monitoring epidemiologic and clinical features
of TB
– developing, studying, implementing, and
monitoring TB prevention and control
strategies in Thailand
Objectives of TB Net
Develop model program for measuring incidence,
mortality from TB, TB/HIV, and MDR-TB, and to
monitor changes over time;
Use surveillance data to assess impact of public
health interventions, detect outbreaks, allocate
resources, guide public health and clinical
practice;
Build human resources and technical capacity in
epidemiology, laboratory, and information
technology;
Develop platform for operational research on TB
and TB/HIV, and to assess the impact of public
health interventions.
Activities of TB-Net
Surveillance
Diagnosis
TB
Private
Sector
Healthcare
HIV
Drug-resistance
Research
Treatment
All persons diagnosed with
TB in public and private
health care facilities
Standard epidemiologic data
at beginning and end of
treatment
Culture, susceptibility testing
HIV counseling, testing
Monitor HIV care services for
TB patients
Electronic recording and
reporting
Have we met the objectives?
Model to assess incidence/mortality
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Assess interventions, guide practice
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Build epi, lab, IT capacity
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Platform for operational research
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>10 manuscripts published addressing
programmatic and surveillance questions
Many aspects of TB Net now routine
– TB/HIV initiatives (PITC, ART training)
– Access to liquid culture
– Electronic data collection
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Have we met
2nd Global Plan to Stop TB, 20062010?
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DOTS expansion and enhancement
Address TB/HIV and MDR-TB
Establish Public-private partnerships
Enable and promote research
Strengthen health-system
Empower patients and communities
Policy Change
Impact
TUC/TB Contribution
National policy adopted to
Built evidence base; tested
perform HIV counseling and strategy; financial support for
testing on TB patients
planning workshop in Viet Nam;
technical assistance on drafting
initial plan
National TB recording /
reporting system revised to
include HIV-related data
Built evidence base;; revised
national forms based largely on
forms developed for Ubon
project
Better Public Health Outcomes
Impact
Increased case finding in
Bangkok, Phuket
TUC/TB Contribution
Provided infrastructure and technical
guidance to enhanced public and
private collaboration, TB program
monitoring
Decreased death rate and
Provided infrastructure and technical
increased TB success rate among guidance
TB/HIV in Ubon, and Chiang Rai
Increased sputum conversion rate Provided infrastructure and technical
and treatment success rate in
guidance
Phuket and Bangkok
Increased proportion of patients
receiving HIV counseling and
testing in Bangkok, Chiang Rai,
Phuket, Tak, and Ubon
Provided infrastructure and technical
guidance
Enhanced Capacity (1)
Impact
TUC/TB Contribution
More rapid, sensitive diagnostic
methods for TB in Bangkok.
Chiang Rai, Phuket, Tak, Ubon
Provided infrastructure and technical
guidance
Access to routine drug
susceptibility testing for Bangkok,
Chiang Rai, Phuket, Tak, Ubon
Provided infrastructure and technical
guidance
Electronic recording and reporting
implemented in Bangkok, Chiang
Rai, Phuket, Tak, Ubon,
Bamrasnaradura Institute
Provided infrastructure and technical
guidance
Enhanced Capacity (2)
Impact
TUC/TB Contribution
Measuring outcomes of public
Provided infrastructure and technical
health interventions by
guidance; Observational study launched
conducting operational research to understand causes of high, early
mortality rate in TB/HIV patients
Training of public health staff in
TB, Laboratory and TB/HIV
management
Provided infrastructure and technical
guidance
Enhanced capacity for TB
outbreak response
Outbreaks investigated at Phuket
Vachira Hospital and Wat Tham Krabok
with laboratory, IT, epidemiologic,
statistical support from TUC
Exporting of Models
Impact
TUC/TB Contribution
Expanded TB/HIV partnerships in
Northeastern Thailand
Lessons learned in Ubon project
applied to other provinces by using
resources from GFATM
Expanded Public- PrivatePartnerships (PPP) in Bangkok
Lessons learned in 2 health centers
(HC) of Bangkok project applied to
7 HCs then 19 HCs
WHO TB/HIV training course for
SEARO countries
Curriculum development;
organization; Hosting of site visits at
project sites
Lab Capacity building to TB Active
Surveillance Network (1)
Improve lab capacity and ability including
infrastructure, equipments and reagents
Human resource: hiring full time staffs and
support staff to present in international
conference
Provide Technical support for new diagnostic tools
implementation (Liquid media culture, Capilia TB
and Hain test)
Lab Capacity building to TB Active
Surveillance Network (2)
Develop and implement Electronic data recording
Support Lab quality control
- Collaborate with NTRL for monitoring
and supervision
- Participation in External Quality Assurance
of College of American Pathologists
- Organize training on Standard Operating
Procedure of TB culture and Good
Laboratory Practices
Do we have Impact on TB Lab ?
Liquid culture Implementation
Implementation of Rapid
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identification by strip speciation
(Capilia TB and SD Bioline)
Expansion of Electronic recording 
for lab data
Lessons Learned
Active surveillance increases case finding
– Enables comparisons between public and
private sector TB treatment outcomes
Enhanced laboratory capacity, performance
MDR-TB rates ~1-4% consistent with national
estimates – no hidden epidemic
Increased TB/HIV collaboration for testing,
linkages to care
Rich database for operational research
Challenges
Have engaged private sector to share data for
monitoring and evaluation, but need strategy to
elevate private sector’s standard of care
System developed and integrated into MOPH, but
many competing reporting systems proposed in
MOPH – need unified national standard for TB
How to translate implementation models into
routine practice and scale up?
Research (1)
2004-2008
Observational study of HIV-infected TB patients
2005-2008
Improving diagnosis of TB in HIV-infected
persons
2008-2011
Public health impact of implementing the
GenoType® MTBDRplus assay for diagnosis
and management of drug-resistant TB in
Thailand
Research (2)
2009-2010
Evaluation of a program to enhance TB
laboratory services in Thailand: Did
providing TB drug-susceptibility results to
physicians change clinical practice?
2009-2010
Performance comparison of SD Bioline TB AG
MTP 64 Rapid with Capilia TB NEO for
mycobacterial species identification from brothbased culture at ODPC7, Ubon Ratchathani
Training
Operational research
Counseling –HIV Diagnosis counseling and
testing in TB patients
Increasing ART use in HIV-infected TB
patients
TB infection control, collaboration with
WHO
TB/HIV inter-country, collaborate with WHO
Laboratory: SOP, AFB, Culture, DST, EQA
Technical Assistance
NTP program
Outbreak response
Lab capacity building
Epidemiological & statistical consultation
Manuscript development for TB-Net
Future Directions
Continued focus on 3 key areas: research,
training, technical assistance
Focus on lab capacity building and
improving diagnosis in routine care
settings
Operational research in improving IC,
ICF/IPT in HIV
Increased focus on MDR TB
Thank you for your attention