Programmatic Management of Drug-resistant Tuberculosis

PMDT Training for Treatment Site Physicians & Nurses

Grand Opera Hotel Manila, Sta. Cruz, City of Manila November 14 - 18, 2011

PMDT Training for Treatment Site Physicians & Nurses

BACKGROUND AND MECHANICS OF THE TRAINING

Grand Opera Hotel Manila, Sta. Cruz, City of Manila November 14 - 18, 2011

Definitions
Drug-resistant TB
Mono-resistant TB: TB in patients whose infecting isolates of M. tuberculosis are confirmed to be resistant in vitro to one first-line anti-TB drug Poly-resistant TB: TB in patients whose infecting isolates are resistant in vitro to more than one first-line drug other than both Isoniazid and Rifampicin

Definitions
Drug-resistant TB
Multidrug-resistant TB (MDR-TB): is active TB involving M. tuberculosis organism that are resistant to at least Isoniazid AND Rifampicin, the two most powerful anti-TB agents. An MDR-TB strain can be resistant to more than these two antibiotics.

Estimated Proportion of TB Cases that Have MDR - TB

Estimated % of New TB Estimated % of cases with MDR TB Retreatment TB cases with MDR TB 3.4 20 4.9 23
3.8 21

Global

Western Pacific Region (WPR) High MDR TB Burden Countries

Philippines

4.0

21

Number of MDR TB Estimated, Notified, Enrolled in 2010

Estimated Global Western Pacific Region (WPR) High MDR TB Burden Countries Notified Enrolled on Category IV Tx

290,000
77,000

53,108 (18%)
4,222 (5.4%)

45,553 (85.8%)
2,210 (52.3%)

250,000

46,748 (18.6%)

38,652 (82.7%)

Philippines

8,800

522 (5.9%)

548

What is PMDT?
A collective strategy using the different components of the national TB control program to effectively manage drug-resistant tuberculosis. It include activities on case detection, treatment, surveillance, monitoring and evaluation of the programs performance.

National TB Control Program

Case detection rate: > 85% Success rate: > 90% TB in Adult TB in Children PMDT PMDT TB/HIV
Detect & Treat 15,000 MDR-TB Cases by 2016

MDG: To reduce prevalence and mortality by half by the year 2015

ACSM

PPMD

CATCH TB TB in Prison

2010 2016 Philippine Plan of Action to Control Tuberculosis. Department of Health, Philippines

Rationale for PMDT

Rationale for PMDT

Rationale for PMDT

MDR-TB Management Framework

5 ELEMENTS OF DOTS
TB
Political commitment Quality assured microscopy

PMDT

Sustained Political commitment Rational case finding: accurate & timely diagnosis through quality assured culture and DST Appropriate treatment strategies that utilize 1st and 2nd line drugs under proper management conditions

Supervised treatment

MDR-TB Management Framework

5 ELEMENTS OF DOTS
TB
Regular availability of 1st line drugs Standardized records & reports

MDR-TB
Uninterrupted supply of quality assured 1st and 2nd line drugs Standardized recording and reporting system designed for DR-TB program

Category IV Treatment
Category IV Treatment is a complex and very long process that usually lasts from 18 to 24 months

It is critical to ensure that DR-TB patients adhere to treatment until successful completion because:
DR-TB treatment is the last therapeutic option for many patients There is serious public health consequence if therapy fails

Main Treatment Center Hospitals, PPMDs, DOTS facilities, housing facilities

Satellite Treatment Center Hospitals, PPMDs, DOTS facilities

Ambulatory management of DR-TB cases at PMDT facilities

Treatment Site PPMDs, DOTS facilities, NGOs, FBOs

PMDT Training of Treatment Site Physicians & Nurses

Designed to enable health care staff to provide quality management of DR-TB cases at the level of local health facilities as treatment sites.

Treatment site staff eligible for training include DOTS facility physicians and nurses who will directly provide management for DR-TB cases.
5-day comprehensive course composed of modular training with individual and group exercises and field visits to treatment facilities

PMDT Training of Treatment Site Physicians & Nurses

Modules A to G (Day 1 to Day 4)

Module H (Day 5) Field Visit at Treatment Center (SPMC)

PMDT Training of Treatment Site Physicians & Nurses

SILENT READING to allow participants work through the modules at their own pace Facilitators to facilitate pacing of the group, provide individual or group feedbacks, and attend to any clarifications, needs, issues, and concerns
Updates on PMDT will be provided

PMDT Training of Treatment Site Physicians & Nurses

Participants satisfactorily completing the course can already be tapped as treatment partners for DR-TB patients who would continue category IV treatment at their respective treatment sites. After the course, decentralization of DR-TB cases at their respective treatment sites can already be arranged at the agreed schedule of the treatment center staff, ntp coordinator, treatment site personnel, and of the patient.

Region NCR

TC LCP PHDU KASAKA SLH PTSI Tayuman DJNRMH

STC Gat Andres MMH Moonwalk HC Lagrosa HC Tondo Forshore HC Gracepark HC Lacson HC Batasan Hills SHC Reg. 1 MC Cainta HC Bicol MC

PMDT Expansion

1 CAR 4A 5 6

ITRMC BGHMC DLSHSI; BRH SMMGHHSC WVMC; DPOTMH

7
9 10 11 12

ECS
ZCMC German Doctors SPMC KCHO

VSMC
ISI PPMD DRH

CARAGA

CRH

Stop the Generation of Drugresistant TB.

Continue Quality DOTS Implementation and Provide Diagnosis and Treatment to Patients with Drug resistance.

Thank You Very Much!