Transcript UPHOLD TB STRATEGY 2006/07

UPHOLD Strategy for Tuberculosis
Control 2006/2007
Status Report May 2007
Presentation to Ministry of Health
Officials
Overview of the Presentation
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Introduction/background
Strategy for TB control
TB control Activities
Results/Achievements
Challenges
Lessons learned
Way forward
Introduction and background (1)
• UPHOLD -Uganda Program for Human and Holistic Development
• UPHOLD is a USAID funded project
• Overall project aim- increase access and utilization of sustainable
and quality social services
• Education, Health and HIV/AIDS in support of USAID’s Strategic
Objective 8(aims to improve human capacity)
• Assist Ugandans to achieve Improved health, longer and more
productive lives
• USAID resources for TB have increased each year and now total
over $408 million making it the largest donor in this area
Introduction and background (2)
• Currently operates in 34
districts (up from 20),
covering 42%
• Uganda’s population ~
11.8m people, Has six
Regional Offices and one
satellite office
• geographical situated in all
regions of the country
Introduction and background (3)
• UPHOLD implements activities with a focus on ‘4
Rs’:
Results at people level
Responsible speed in implementation
Regional leadership and accountability
Reaching out to and working principally with
Ugandan institutions and systems
Introduction and background (2)
• UPHOLD’s core technical areas of implementation include:
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HIV/AIDS
Primary School Education
Child Health
Integrated Reproductive Health
Adolescent Health
Communicable Disease Control- Malaria and
Tuberculosis
TB High Burden countries
2004/2005
100
China
Cambodia
Bangladesh
90
Afghanistan
Indonesia
Treatment success (%)
India
UR Tanzania
Pakistan
80
Viet Nam
Philippines
DR Congo
Myanmar
Brazil
Kenya
Nigeria
Target zone
Mozambique
Thailand
Ethiopia
70
Uganda
South Africa
60
Russian Federation
Zimbabwe
50
40
0
20
40
60
80
DOTS case detection rate (new smear-positive, %)
100
120
Tuberculosis Situation in Uganda
• Est. ARI of 3%. Annual prevalence of 300-330/100,000
incidence of M + of 150-165/100,000
• HIV: it is estimated that 60% of TB patients are
dually infected. (UPHOLD Records)
Tuberculosis Situation in Uganda
• Uganda has adopted the following WHO objective
– Case detection rate of 70%
– Treatment success Rate of 85%
– Uganda aims at achieving the above objectives
implementing the DOTS strategy with a community
based TB Care Approach
Community-based TB Care
Referral System in rural settings
Ministry of Health
National Tuberculosis
& Leprosy Programme
Baseline Targets
Level
Case Detection
rate(%)
WHO/National
70
Targets
National target
49 (2006)
achieved
Targets for
42 (2006)
UPHOLD
supported districts
Treatment
success rate(%)
85
73 (2005)
78(2005)
Start up
• UPHOLD Received $690,000 for FY 2006/2007 to
support the control of TB in all the 34 UPHOLD
supported districts
• Activity implementation was rolled out in October
2006 at district level
Strategy
Collaboration with other stake holders Districts, NGOs and
CBOs to;
• scale up CB DOTS,
• Improving diagnostics,
• Support BCC (Prevention, treatment and control),
• Support private sector involvement in TB,
• Explore potential collaboration and involvement of schools
in control of TB,
• Support communities to embrace CB DOTS.
Application of the strategic Approach
• Previously AIM supported districts- Consolidate and
Build on what AIM left in place
• NUMAT-UPHOLD-Initiate Activities and eventually
handover to NUMAT
• UPHOLD only- Implement activities up to the end of
the project
• District TB profiles -CDR, TSR, DTUs, TUs etc
Category
Districts
UPHOLD, prev. AIM Pallisa, Budaka, Koboko Marcha/Terego,
supported
Yumbe, Mubende, Mityana, Bushenyi,
Rukungiri
UPHOLD-NUMAT
Lira, Dokolo, Amolatar, Katakwi, Amuria, Gulu,
Amuru, Kitgum, Arua
( red-prev. aim)
UPHOLD only
Bugiri, Mayuge, Kamuli, Kaliro, Mbarara,
Kiruhura, Isingiro, Ibanda, Wakiso, Luwero,
Nakaseke, Rakai, Lyantonde, Nakapiripirit,
Bundibugyo, Kyenjojo
Objectives
• Achieve the WHO targets for TB case detection and
cure rates.
70 % CDR and 85% Treatment success rate
• UPHOLD -5% Increase in CDR and 10% increase
in TSR from the base line indicators
• Strengthen the ability of the country to expand the
use of proven and cost-effective interventions of the
DOTS strategy
Activities
• Build capacity for
 CB DOTS services in sub counties
 TB/HIV case management at health facilities
 TB drug logistics management at health facility level
• Support Supervision activities at health facility-recording,
drugs, case management
• Support supervision and delivery of anti TB drugs and
community levels.
• Monitoring Implementation of activities
• Activity implementation was rolled out in
October 2006 at district level
Methodology
• Districts planned, budgeted and scheduled for TB
control activities
• Involved Central and district facilitators in the
trainings
• Used National TB guidelines and training materials
• UPHOLD Funded the activities
• Technical assistance
• On going monitoring and will do an Evaluation
Outputs
Trained
• 382 Health workers in TB drug logistics
• 342 in CB DOTS/HIV
Supervisions
• Supervision by DTLS in 91 HSDs
• HFs supervised by HSD Focal persons
• 422 sub counties supervised including town councils by
SCHWS
• 48% of patients on CB DOTS( ranging from 10% to 90%)
Results/Achievements in 1st Quarter
2007
Case Notification
• 3,763 TB patients of all forms
• 2163 Smear positive TB patients
• Case Detection rate 50% from 42%
• Two fold increase in districts with CDR greater than
70%
Results -Case Detection rate
• 2006 CDR
• 2007 CDR 1st Qtr
Below target, CDR< 70%
Above Target > 70%
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it g u
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ay iri
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B lis
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Percentage
Comparison of TB case detection rate
for 2006 and 1st Qtr 2007
Comparison of TB case detection rates 2006 and 2007
180
170
160
150
140
130
120
110
100
90
CDR 2006 in %
80
CDR(%)
70
60
50
40
30
20
10
0
Districts
Results TB/HIV collaboration
TB/HIV Collaboration
• All districts are implementing the TB/HIV
collaboration in varying degrees according to
TB/HIV policy
• 1753 (47%) of TB patients are testing for HIV
• 1051 (60%) of all the TB patients test positive
Results –Treatment outcome
Case holding
• CB DOTS coverage per patient is 48% (District
Reports)
• Treatment success rate 78%( No change)
• However more districts have TSR ≥85% (11
districts as compared to 4 last year)
1st Quarter 2006 TB treatment Outcomes in UPHOLD
supported Districts
Defaulted
12%
Failure
0%
Transferred
4%
Cured
34%
Died
6%
Completed
44%
Results-Treatment success rate
• 2005
2006 1st Quarter
Above target, TSR≥ 85%
Below target, TSR< 85%
Challenges
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Poor implementation of the TB/HIV Collaboration
CPT numbers not known at the beginning of treatment
TB cases on ART not known
Inadequate Supervision at all levels
Small no. of patients on CB DOTS
Inadequate Coordination with other partners
Stock-out of essential supplies (e.g., HIV test kits, CPT)
Changes in district capacity to implement due to
redistricting,
• Restructuring- position of DTLS is threatened
• Insecurity in the North and the Northeast parts of the
country
Lessons learned
• MOH as a stake holder in implementation
of TB control activities
• District support is necessary in
implementation of TB activities
• ?Training and Supervision can lead to an
increase is CDR
Way forward
• Extension for one year
• Improve the quality, access and utilisation of key
preventive and curative TB services,
• Consolidating CB TB DOTS.
• Strengthen the capacity of CVs and health workers thru
CMEs, refresher training, and support supervision
• Provision of job-aides, registers, implementation guidelines
and policy/strategy documents to Volunteers and health
workers
• Strengthen TB/HIV collaboration
Thank you