Transcript Key issues in DOTS implementation

Key issues in DOTS
implementation
Dr Saidi M. Egwaga
TB in the world 2002

People infected
2 billion

New TB cases
8.6million

New ss+ TB cases
3.8million

Prevalence HIV in new adult cases 12%

Prevalence MDR in new cases
3.2%

Deaths from TB (inc HIV)
1.8m
Global targets for TB control
MILLENNIUM DEVELOPMENT GOALS

WHA by 2005:
70% case detection, 85% cure
DOTS beyond public health services

MDGs by 2015:
Halve prevalence and deaths HIV/AIDS,
drug resistance, migration
Progress towards Global TB
Control targets

Case Detection Rate 36%
(target 70%)

Cure Rate 83%
(target 85%)
High treatment success in DOTS areas
100
Treatment success (%)
90
DOTS smear+
target 85%
non DOTS smear+
80
70
60
50
40
30
20
10
0
1995
1996
1997
1998
1999
2000
2001
What countries have achieved in 2002
Outstanding progress in some countries:



Increase case detection and cure:
India, Indonesia, Myanmar, Pakistan,
Cambodia, Viet Nam
Increase case detection but low cure:
South Africa
Some progress:
Mozambique, Afghanistan, Philippines
Financial resources

New sources available
GFATM 189 million to TB and TB/HIV control for 2
years
FIDELIS (CIDA)
WB,TBCTA, etc.

Gap to be addressed
200 million per year in countries
20 million per year for technical assistance
Major challenges

Health workforce crisis
– High turn-over
– Need for updated training and retraining
(pre-service and in-service)
– Retention
– Brain-drain
– Deployment
– HIV epidemic
– HRD is absent in MoH strategic planning
Major challenges

Access to health services
– Poor health care infrastructure
– Weak laboratory networks
– Health systems reform
– Little involvement of some PHC providers in
TB control
– No link with other public health care
providers (e.g. hospitals, prisons, etc)
– Inadequate involvement of private sector
– Inadequate cultural sensitivity
Major challenges

Insufficient political commitment
– Shortages of staff at different levels in
some NTPs
– Inadequate funding for training and
supervision, monitoring and evaluation
– No budget line for TB drugs in most
countries
Major challenges

TB / HIV epidemic in some countries
– Overloaded health care services
– Stigma
– High death rates among TB patients
– Competition for scarce resources
– Collaboration between NTPs and NACPs
Country experience in addressing
challenges

Training needs assessments (Indonesia)

Collaboration with training institutions
(Tanzania)

Community involvement (Uganda)

Involvement of private sector (India,
Philippines) and NGOs (Bangladesh)
Country experience in addressing
challenges

Link with hospitals (Indonesia, India,
China)

National Programme evaluation (China)

Rapid DOTS expansion (India)

Collaboration between NTPs and NACPs
(Kenya, Tanzania, Brazil)

COMBI (Kenya, Bangladesh, India)
Total patients placed on treatment and
population covered under DOTS each
quarter, India (1994-2003)
800
250000
238,204
Total cases treated
700
600
500
400
300
200
200000
150000
100000
50000
100
Quarter/Year
3
I/0
02
III
/
2
I/0
01
III
/
1
I/0
00
III
/
0
I/0
99
III
/
9
I/9
98
III
/
8
I/9
97
III
/
7
I/9
96
III
/
6
I/9
95
III
/
5
I/9
III
/
I/9
94
0
4
0
Total patients treated .
Population covered (millions) .
DOTS population
coverage
STOP TB Partnership




Very good positive spirit of the DEWG
Stop TB is working in countries
Progress in some countries despite
difficulties
Countries gaining momentum and some
very close to targets
HOWEVER...
No time for complacency
 2004 is the year of
accelerating actions in TB
control

Progress towards 70% case detection
80
Case detection rate (%)
70
Target 70%
60
50
All smear+ cases
40
Forecast 2002:
1.4m smear+ = 37% DDR
30
20
Smear+ cases DOTS
10
0
1990
1995
2000
2005
Year
2010
2015
Ultimate Goal: a generation of children free from tuberculosis