Transcript Document

Country Progress Report
9 th Technical Advisory Group and National TB
Programme Managers meeting for TB control in
the Western Pacific Region
Manila, Philippines
9 -12 December 2014
TB Epidemiology
• Population: 15 million
• Highest prevalence(764/100,000),incidence ( 411/100,000)
and death(63/100,000) among 22 HBC TB (2012)
• Prevalence (all forms) declined at an average of 5 % per year
(from 2000 to 2012)
• incidence( all forms ) declined at an average of 3 % per year
(from 2000 to 2012)
• Death rate declined at an average of 4.6 % per year(20002012)
• Prevalence far higher in population over 55 (about 3 times)
• HIV prevalence among TB patients: 6.3 in 2006
• HIV prevalence among aldult pop: 0.7 % in 2013
• MDR-TB: 1.4% in new and 10.5% in retreatment cases (2006)
Major successes
• Good DOTS coverage:100% at HC level
1314 health facilities are providing TB services( including 1090
Identifying more than 2/3 of incident cases
Big decline in prevalence,incidence and death
Achieving MDG
Two prevalence surveys conducted
Clear policy, plan and guidelines
Major challenges
• Still high prevalence, incidence and death
• Resources to maintain huge services(1314
health DOTS facilities),and expanding specific
services and new tools( childhood TB, PPM-DOTS,
TB-IC, Xpert…)
• Big reliance on external aid ( >75 % on donors)
• More ambitious targets, 2016-2020 and years
National TB Strategy/Policies
•Timeframe: 2014-2020
•Targets: annual average reduction of 6.5 % prevalence,
5.5% death and 4% incidence
•Alignment with WHO End TB strategy?
•Alignment with National Health Sector Plan
•Budgeted: 25-30 USD million per year
•Funding sources :
- 2015-2017 :GF: ~27%,Govt: 20%,USAID: amount ?
- 2018-2020: GF?,Govt: 25%,USAID: amount ?
Laboratory strengthening
• LED:Total Microscopy centers in 2014 = 215
(LED Microscope= 29 and Conventional Microscope = 186)
• Xpert: 20 in routine services and 8 inn ACF
•Quality assurance: SOP for EQA exists
- Participation rate = 97% , Agreement rate = 98.6% (2013)
- False positive rate = 2.8% , False negative rate = 1.2%( 2013)
- Acceptable performance = 89% in 2013
•Laboratory information management system:
Paper based report and quarterly basis
•TA partners-,GLI , RIT, US-CDC (Atlanta, USA), WHO, MSF (Antwerp,
Reach the unreached
•Intensive case finding: among elderly, diabetics,
prison inmates
•TB screening policy and practice:
- revising policy,
-ACF and childhood TB
•Contact investigation: improve diagnosis and
•TB-HIV: improve referral and diagnosis procedures( more
Xpert MTB/RIF,…)
•Child-TB: improve diagnosis and coverage
• Quality of surveillance system: sufficient &
acceptable( JPR 2012)
•New case definition roll out: introduced nation
wide since early 2014
•e-R&R: planned to start in 2016/2017
•Analysis and usage of data at national and subnational levels
- national level: good
- suib-national level: limited
•Current situation:
-11 treatment sites with 57 isolated rooms
- 20 Xpert machines
- MDR-TB cases increased from 31 in 2010 to 121 in 2013
•Plan vs universal coverage
-Treatment sites:11/18 ( 18 by 2020)
-Xpet: 20/82 (82 by 2018)
-Target cases: increase around 10% per year from 2014 to 2020
•Barriers: missing suspects during diagnosis process for DS TB
and referral system of samples of MDR-TB suspects
•Priority actions: improve diagnostic procedures and
referral system
Bold policies and supportive systems
•TB care financing and social protection
- big financial gap 2015-2020 (govt~ 25-30%)
- social protection is under discussion between NTP and
partners including MoH (TB NSP2014-2020)
•Strengthening notification mechanism:
- improve paper-based and planned for ereporting
•Drug regulations
- re-enforcing circular on banning on sale and import of
anti-TB drugs and sero-logical test for TB
Patient centred care: involvement of
patients and civil society
•Community mobilization activities
community DOTS: 577 HCs out of total 1090 HCs
•CBO involvement and their role :
•Involvement of patient groups in TB control
So far not much, mainly in country consultation and little in
•Forms of social support to TB patients
- transportation costs for DS and DR TB and food enablers for all