Respina lecture tb philippine experience 1 jenifer ann mendoza

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Respina lecture tb philippine experience 1 jenifer ann mendoza

  1. 1. Tuberculosis: Philippine Experience Jennifer Ann Mendoza-Wi, MD, FPCP, FPCCP, FCCP Past Chairperson Philippine Coalition Against TB (PhilCAT)RESPINA 2011
  2. 2. Outline To present updates on the current state of TB control in the Philippines* To present achievements and challenges in TB control in the country To present what professionals and professional societies can do (PhilCAT)*as presented in August 2011 during the Annual PhilCAT Convention
  3. 3. Where is the Philippines now?  Impact: Prevalence: 799/100,000 to <400/100,000 Mortality: 87/100,000 to <44/100,000  Outcome: 85% Case Detection (NS+s) 90% Treatment Success 15,000 MDR-TB cases 15,000 TB-HIV cases (PICT)Presented by: *Rosalind G. Vianzon, MD, MPHNational TB Program (NTP) managerNCDPC, Department of HealthRepublic of the Philippines
  4. 4. Prevalence and Mortality Rates from Tuberculosis, Philippines, 1990 - 2015 (per 100,000 population) (SOURCE: WHO Global Tuberculosis Control. 2000-2009)1,100 Prev, All forms Mortality, All forms1,000 900 800 700 600 500 400 300 200 100 0 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
  5. 5. Tr ends of CDR (New Sm+ , All Forms) ,100 Cur e and Treat m ent Success , 2000 - 2015 90 80 5 o 89 0 70 t 70 to 60 85 50 40 CDR,New Sm+ 30 CDR, All forms Cure 20 Success 10 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
  6. 6. Strategy 1. Localize implementation of TB control DOTS Compliance Assessment Tool - for province and highly urbanized city 8 system standards for DOTS Compliance Pilot-tested in the BIG 3 regions
  7. 7. Classif icat ion schem e: St age of Com pliance 8 Self-Assessment DOTS Points (DCAT) Sustaining:  Multiyear TB plan 3 consecutive years and with initiatives on MDR- TB and  Governance structure – “PP” vulnerable populations  Network of quality-assured labs DOTS Performing: DOTS compliant and achieves the casefinding  Efficient TB drug mgm’t system and caseholding targets and EQA standards  DOTS service network DOTS Compliant:  Activities to increase demand achieves the 8 standards  Regular monitoring/analyses
  8. 8. Strategy 2. Monitor health system performance200,000 200,000160,000 160,000120,000 120,000 80,000 80,000 40,000 40,000 0 0 4A NCR 3 Luz Viz Min 4A NCR 3 Luz Viz Min TB Sxs TB Sxs TB cases
  9. 9. TB Cases and TB Sxs, 2010 10% 9% 24% 29% 14% 16% 8% 9% 21% 20% 20% 20%4A NCR 3 Luz Viz Min 4A NCR 3 Luz Viz Min
  10. 10. Strategy 2. Monitor health system performance Ongoing surveys: 2nd Drug Resistance Survey (DRS) Data Quality Audit (DQA) Client Satisfaction Survey (CSS) 1st Mortality Survey Systems performance: Scorecards (LGU, CHD, Central units)
  11. 11. Strategy 3. Engage All Health Care providers200,000 Public 3200 Private Public Private160,000 2400120,000 1600 80,000 800 40,000 0 0 Relapse EP New Sm+ New Sm- Total
  12. 12. Strategy 3. Engage All Health Care providersInitiatives Sites Partners Nos.CATCH-TB selected Public hospitals within Metro Manila WHO-CIDA 14SECURE- Private hospitals in PTSI- TB various regions TBLINC- 41 USAID Hospital Remaining DOH-ownedexpansion hospitals in Metro Mla GFATM 9
  13. 13. Strategy 4. Promote and strengthen positive behaviour of communities Proportion of symptomatics who are self-medicating and not consulting HCP reduced by 30% (4thNPS 2014) Default rate with > 7% reduced by 40%876543210 1 2 CARAGA6 7 8 3 4B 5 9 10 11 CARARMM 4A 12 NCR PHL
  14. 14. Strategy 5. Address MDRTB, TB-HIV and needs of vulnerable population T B Clinical Risk Groups Populations at RiskMDR-TB TCs, TSats, Culture, DST R Inmates Jail, Prison 7 penal farms, NBP CIW,City/Prov JailsTB-HIV Nationwide NCR I Elderly Inst’tn Veterans MC, Golden AcresTB-DM For research (PGH,Other hosps) S Indigenous Groups (Rural poor) Mansaka,Mandaya, Subanen, Manobo TB-Parago-nimiasis Endemic sites K Urban Poor R.U.P.approach, Payatas, SM
  15. 15. Strategy 6. Regulate and make available quality TB diagnostic tests and drugsTypes of drugs provided by NTP: TB Kit 1 - Category 1, 3 treatment for adult TB Kit 2 - Category 2 treatment for adult Pediatric Kit - treatment of disease for children INH syrup (IPT) - preventive therapy for childrenTypes of laboratories with QA diagnostics: Microscopy Center - DSSM Culture Center - conventional LJ, LPA DST Site - precipitate method ; all public NTR
  16. 16. Points of Care for PMDT (Diagnostic and Treatment Facilities) Tx Gene Cent ers Xpert TxMicroscopy Sat ellit es TxMicroscopy Sit es
  17. 17. Strategy 6. Regulate and makeavailable quality TB diagnsotic tests and drugs
  18. 18. Strategy 7. Certify and accredit TB care providers DOTS Service Providing Facility S e l lff Se Asses Asses s m e n tt smen Technical T o o l ls Too s Assistance Provider DOTS Certifiers1,166 DOTS certified CHD NTPsas of June 2011
  19. 19. Strategy 8. Secure adequate funding, improve allocation & efficiency of utilization COSFIT – TB costing and financing tool TB-DOTS OPD Package – case payment of PhilHealth for TB
  20. 20. CHALLENGES Finding more and finding fast the TB cases Addressing “difficult” and “costly” groups of cases Introducing, adopting and sustaining the new tools for diagnosis Addressing limited human resources, particularly at implementing levels Balancing partner’s support with their contribution to the Program
  21. 21.  PHILCAT What Professionals and PHIL.TIPS DOH PHILHEALTH Professional Societies Can Do for TB- PhilCAT PAFP PCP PCCP PCOM PPS PSMID  To describe non-clinical but nevertheless important activities and programs shown to improve TB control efforts in the community and country  To show how these activities enhance TB control by assuring sustainability and accessibility of TB services
  22. 22. Barriers to accessing TB care in poor communities: Economic barriers- poverty Geographical barriers- distance from services providing TB diagnosis and treatment Socio-cultural barriers- STIGMA and lack of knowledge of TB and available TB services Health systems barriers- poor health seeking behavior of patients; lack of health system responsiveness
  23. 23. COUGH… and TB
  24. 24. Interventions to InvolvePrivate Practitioners
  25. 25. PhilCAT Activities
  26. 26. Installing PPMD Units Nationwide: A Project Under the GFATM
  27. 27. Local Guidelines International Guidelines Medical CurriculaEducation and Training
  28. 28. Annual PhilCAT Convention DOTS Referring COURSEEducational and Collaborative Meetings Advocacy Symposium for BHWs Ang Katotohanan Tungkol sa TB (Tuberculosis) 10 Roles of a TB- D.O.T.S. Advocate
  29. 29. NCC Meeting 1994 PhilCATInvolvement in program planning ADVOCACY International Collaboration
  30. 30. PPMD…an ADVOCACY, not just a Strategy VVMF PPMD PMDT- ITRMC…another challenge!
  31. 31. Recognition/Awards
  32. 32. Fighting TB Through Unified ActionMABUHAY AT MARAMING SALAMAT PO ! ! !

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