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ADRESSING MDR TB IN THE CONTEXT OF HIV:  Lessons from Lesotho

ADRESSING MDR TB IN THE CONTEXT OF HIV:  Lessons from Lesotho. Dr Hind Satti PIH Lesotho Director MDR-TB program. TB Situation in Lesotho. 12,275 TB new cases notified in 2007 Estimated prevalence of 544 per 100,000 population

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ADRESSING MDR TB IN THE CONTEXT OF HIV:  Lessons from Lesotho

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  1. ADRESSING MDR TB IN THE CONTEXT OF HIV:  Lessons from Lesotho Dr Hind Satti PIH Lesotho Director MDR-TB program

  2. TB Situation in Lesotho • 12,275 TB new cases notified in 2007 • Estimated prevalence of 544 per 100,000 population • Estimated annual incidence for all cases is 691 per 100,000 population • Estimated incidence of Sputum smear positive cases is 281 per 100,000 population • 75% of new TB cases among age-group 15-44 years • Estimated all TB deaths is 107/100,000 annually • The HIV prevalence rate in Lesotho stands at 23.2% in 2005 • 64% of TB cases are HIV positive (WHO 2007), 80% (NTP 2008)

  3. The Social Context of Drug-Resistant TB • Drug-resistant TB patients vulnerable population • Disease has socioeconomic causes and consequences • Addressing adherence is key to treatment success • Community-based models of care ideal for addressing these issues

  4. Socioeconomic Causes and Consequences of TB • Poor housing • Malnutrition • Overcrowding • Poverty • Poor infrastructure

  5. WHAT ARE THE BARRIERS TO CARE? • Diagnosis of TB and MDR-TB in patients with HIV • Having facilities to care for very sick patients • Infection control in a high HIV setting • Having a mechanism to deliver MDR-TB care (± HIV treatment) in urban and rural areas • Shortage of trained human resource • Extreme poverty (the social and economic devastation) • Migration of workers to South Africa to work in the mines

  6. Diagnosis: Built laboratory capacity for mycobacterial culture and drug susceptibility testing

  7. Drugs: quality-assured drug supply at an affordable price

  8. Facility to care for the very sick: refurbishment of an existing hospital to create an MDR-TB/HIV center of excellence

  9. Inpatient Care • Very sick patients • Bedridden • Severely wasted • Severe side effects • Severe hypokalemia • Acute renal failure due to injectable and ARTs. • Severe OIs • Cryptococcal meningitis • CMV retinitis

  10. Infection control in a high HIV setting: masks for all staff and state-of-the art ventilation in facilities Occupational policy.

  11. Adherence • Adherence crucial in successful treatment of drug-resistant TB • Barriers to adherence are socioeconomic and must be addressed • Adverse effects also contribute to poor adherence

  12. Accompaniment (including Directly Observed Therapy (DOT))is the basis for successful treatment • Accompaniment allows programs to ensure that patient will complete an adequate course of treatment. • Accompaniment facilitates the management of side effects and the prevention of some of them. • Through the process of Accompaniment, medical worker can predict and prevent the episodes of non-adherence • When patients receive all their medications under observation they become non-infectious sooner, and this helps reduce transmission

  13. Community-Based Care • Twice-daily DOT • Injections • Psychosocial support • Screening household contacts • Accompaniment to clinical visits • Offer HTC, FP, chronic disease screening and HCG at home.

  14. Poverty: assistance with food, housing, fuel and transportation

  15. Facts about the program • Over 200 patients enrolled on treatment. • 30% were from mining companies. • 80% MDR-TB/HIV co-infection. • NO DEFULTERS. • All co-infected patients were started on ARVs regardless of their CD4 count. • Decentralized to all districts hospitals. • Over 2000 community health workers were trained. • All children on treatment are orphans: lost both parents or one of them due to MDR TB/HIV.

  16. Con………. • The program trained over 200 health workers from all districts. • We offer international training for other countries on MDR TB/HIV and infection control (3 groups from 3African countries were trained).

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