Transcript Systematic TB Screening: Country Experience

Systematic TB Screening:
Philippine Experience
The 9th Technical Advisory Group and National
TB Program Mangers meeting for TB control in the
Western Pacific Region
Manila. Philippines
9-12 December 2014
TB Screening Policies
• NTP Manual of
Procedures (2013)
• DOH Policy: Guidelines
for the scaling up and
use of Xpert MTB/RIF as
rapid diagnostic tool
under the NTP
TB Screening Policies
1.Both passive and intensified casefinding
activities are implemented in all DOTS facilities.
Intensified casefinding:
a. close contact
b. high-risk clinical groups (HIV/AIDS,
diabetes, etc.)
c. high-risk populations (inmates,
elderly, IPs, urban and rural poor, etc.)
Intensified Casefinding
• Close contact – all household contacts of index
case are screened for signs and symptoms and
chest xray within 7 days
• Jails and prisons - screening activities among
inmates are implemented:
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upon entry to the jail or prison
during detention through cough surveillance
prior to transfer of inmates to another jail or prison
prior to release of inmates back to the community.
Intensified Casefinding
• TB in urban and rural poor areas
– Community Health Teams and Barangay Health
Workers identify presumptive TB during their
routine activities in the communities and
households
– referred to the local health center for evaluation
Intensified Casefinding
• TB in PLHIV
– All PLHIV at the Social Hygiene Clinic or Treatment
Hub undergo TB screening: symptomatic
screening (e.g., cough of any duration, fever, night
sweats, loss of weight) and CXR.
– If symptomatic, sputum is collected for Xpert
MTB/RIF.
– TB screening is done upon HIV diagnosis and
during monthly and annual follow-up visits.
TB Screening Policies
2. Microscopy, whether by light or fluorescence
microscopy, is the primary diagnostic tool in
NTP case finding.
3. Xpert MTB/RIF is used for TB diagnosis among:
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presumptive DR-TB
PLHIV with signs and symptoms of TB
Children
EPTB
smear negative patients with chest xray findings
TB Screening Policies
• Presumptive TB case:
– any person whether adult or child with signs
and/or symptoms suggestive of TB whether
pulmonary or extra-pulmonary, or those with
chest x-ray findings suggestive of active TB.
– A person with cough of any duration: close
contact, high risk clinical group, high risk
population
TB Screening Policies
4. All household contacts of bacteriologically
confirmed TB cases, DRTB patients and
index childhood TB cases are screened for
TB.
5. All Persons living with HIV (PLHIV) are
screened for TB co-infection.
TB Screening Activities
• Training of regional NTP coordinators and HCW
on new MOP
• Dissemination of policy on Xpert implementation
• Intensified case finding in jails and prisons
• PLHIV screened for TB in HIV treatment hubs
• Increased engagement of public and private
hospitals
• Engagement of pharmacies for referring patients
• Establishment of remote smearing stations
• Expansion of xpert sites
TB Screening Activities
• Total no. of presumptive TB examined - 2,481,418
(45%) of 5.5 million
• Total no. of children given treatment or given INH
preventive therapy - 102,747 (14%) of 730,000
• Total MDR-TB cases detected and registered
7,883 (40%) of 19,500
• 54% of inmates with access to DOTS services
• engagement of public (35%) and private hospitals
(18%)
• Xpert sites expanded to 73
THANK YOU