Transcript Document

Mongolia Progress Report
Dr. D. Otgontsetseg, Head of recording and reporting unit,
TB surveillance and research department,
NCCD
The ninth Technical Advisory Group and National TB
Programme Managers meeting for TB control in the
Western Pacific Region
Manila, Philippines
9 -12 December 2014
Notified all form TB cases, In Mongolia, 1962-2013
All form TB cases
Notification rate
300
GF project
started
Number of TB cases
5000
4000
Nationwide
screening
DOTS
implemented
250
200
3000
150
2000
100
1000
50
0
0
Year
Notification rate per 100’000
6000
Number of smear positive TB cases, in Mongolia, 1962-2013
Sputum smear positive TB cases
Percent of pulmonary TB cases
100%
2000
80%
1500
60%
1000
40%
500
20%
0
0%
Year
Percentage
2500
1963
1965
1967
1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
Number of SS+ TB cases
Percent of SS+ TB cases among pulmonary TB
Age distribution of all forms of TB cases, in Mongolia, 20092013
2010
2011
2012
2013
Average rate
1600
120.0
1200
90.0
800
60.0
400
30.0
0
0.0
0-1
2-7
8-14
15-24 25-34 35-44 45-54 55-64
Age group
65+
Average notification rate per 100’000
Number of all form TB cases
2009
Cure rate among smear positive pulmonary cases
Mongolia, 2009-2013 year
86
85
84
83
84.5
84.2
83
82
82.6
81
80.1
80
79
78
77
2009
2010
2011
cure rate
target WHO
2012
2013
Failure and default rate among smear positive
pulmonary patients Mongolia, 2009-2013 year
failure
10
percent
8
default
9
8.1
7.2
7.1
7.1
6
4.8
4
4
2.2
2.4
2.9
2
0
2009
2010
2011
year
2012
2013
Major successes
 The global Millennium Development goal and regional
targets for TB control are likely to be met
 Increasing Government funding for TB control
 Revised National TB care guidelines approved by Health
Ministerial order
 WHO revised definition and reporting framework for
tuberculosis introduced in all levels of TB care – pilot in
2014, starting 2015- will be reported officially
 Nationwide TB prevalence survey started in Apr 2014
and field data collection completed in urban areas
 Introduction and roll out of GeneXpert
Major challenges
 Dependence from external funding – sustainability of the
National TB programme after the end of the GF grant
 Diagnosis and management of EPTB and TB in children
 Early detection and treatment of TB among high risk groups
(homeless, alcoholics, migrants)
 Increasing rates of default and failure among TB patients in
the last two years, especially in Ulaanbaatar city
 Lack of awareness of the public about TB
National TB Strategy/Policies
• Timeframe: 2010 - 2015
• Targets: by 2015, reduce TB prevalence to 154 per 100
000 and by 2015, reduce TB mortality to 15 per 100 000
• Alignment with WHO End TB strategy: The new National
Stop TB strategy will be developed in 2015
• National Health Sector Plan will be end in 2015. National
Strategic Plan to Stop TB 2010-2015 is aligned.
• Budgeted
• 70% - GF supported project, 30% - government
Laboratory strengthening
•LED
2 LED: NRTL and 1 province
A prison hospital and 3 provinces received in Nov 2014
•Xpert
3 GeneXpert –NRTL and 2 provinces
NRTL: Total tested 2659, MTB detected 50.2%, error 3.1%, rif
resistance detected 18.6%
•Quality assurance
EQA SSM 36 ZN, 1 LED labs, EQA DST, SSM from RIT, Japan
•Laboratory information management system
Internet-based system www.tubis.mn
•TA partners
SRL –RIT, Japan since 2005
Reach the unreached
• Active case finding: among high risk populations – prisoners,
homeless, medical workers, pregnant women, people living
with HIV
• Passive case finding: adults by smear examination and X-ray,
children tuberculin skin test and X-ray
• Contact investigation: family members of smear positive
patients, children, MDR-TB – target 100%, in practice – 86%
• TB-HIV: screening of people living with HIV for TB by Gene
Xpert, all new and relapse TB cases (16 years old and above)
tested for HIV. So far 181 HIV cases are reported, out of them
31 are co- infected
• Child TB: Operational research on contact investigation,
strategy on child TB will be developed in 2015
Surveillance
• Quality of surveillance system
–Use of national unique ID
–Paper and internet based reporting: on time by
paper; some difficulties using internet-based
system due to internet connection
• New case definition roll out
– WHO revised definition and reporting
framework for tuberculosis introduced in all
levels of TB care – pilot in 2014, starting
2015- will be reported officially
Surveillance
• e-R&R
– Internet based reporting – ‘tubis’;
– Update of the system based on WHO new
definitions
– 90% of TB reporting units use ‘tubis’ platform
• Analysis and usage of data at national and
sub-national levels
– Analysis data at the national level on monthly,
quarterly and annual basis
– Limited capacity at the sub-national level
Notified (n=1375) and died (n=325) MDR-TB
cases Mongolia, 2003-2013
notified
died
250
number
200
started GF supported
MDRTB + pilot project
150
100
50
0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
year
Treatment success for MDRTB patients
Mongolia , 2006-2010
90
80
85.1
77.2
75
71.6
68
70
60
success
50
death
40
failure
30
WHO target
20
10
0
2007
2008
2009
2010
2011
Number of XDR-TB cases
XDRTB
Pre XDRTB
2009
3
2
2010
10
1
2011
6
27
2012
12
9
2013
3
13
2014
6
6
total
40
58
out of them:
Died
30
Address unclear
4
Refused
2
Waiting on treatment
2
2 nd line treatment continued
1
Cured
1
PMDT
•Plan vs universal coverage
–In 2014 planned 219 MDR-TB and 81 PDR patients to enroll in
treatment
•Barriers
–Lack of social support for MDR-TB patients
–Lack of experienced health providers ( high turn over of
staff)
–Lack of management of side effects
–Some MDR-TB patients refuse to receive treatment
due to various reasons (religious, co-morbidities etc.)
PMDT: Priority actions
–Strengthening management of MDR-TB patients
(counseling, follow up of patients, capacity building of
TB providers)
–Establishment of patient support groups in
collaboration with MATA
–Treatment of XDR-TB patients with financial support of
the GF
–DRS planned in 2015
–TB prevalence survey results to be analyzed
–Advocacy to include MDR-TB drugs in Government
budget
Bold policies and supportive systems
•TB care financing and social protection
–TB care financed by the Government
–No health insurance coverage for TB services
–No specific social protection services for TB patients
–Within general social protection system TB patients (especially
employed) may receive disability benefits for certain period
•Strengthening notification mechanism
–An estimated 15-20% of diagnosed TB cases are not notified
–Supportive supervision should be strengthened
–Strengthen internet based reporting and recording
•Drug regulations – Progress since drug regulation meeting in
March 2014
–New drugs for MDR-TB were included in national essential drug
list
–Drug information is in the process of revision in internet-based
system
Patient centred care: involvement of patients
and civil society
• Community mobilization activities
– Patient support groups will be established by
MATA with financial support of Stop TB
Partnership
• CBO involvement and their role
– MATA: lunch DOT and home DOT
– World vision: TB services for prisoners,
homeless
– TB Coalition: advocacy for local governments
Patient centred care: involvement of
patients and civil society
• Involvement of patient groups in TB control
– In the process of establishment
• Forms of social support to TB patients (incentives?
TB Pension? Reimbursement of costs related to
care like transportation costs?)
– Transportation cost only for MDR-TB patients (GF)
– Within general social protection system TB patients
(especially employed) may receive disability benefits
for certain period
Thank you for your attention