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Dr. Suha ÖZKAN Ankara Provincial Tuberculosis Coordinater

THE EXPERIENCES AND PROBLEMS OF MULTIDRUG RESISTANT TUBERCULOSIS PATIENTS AT DISPENSARIES IN TURKEY. Dr. Suha ÖZKAN Ankara Provincial Tuberculosis Coordinater. The Research of Treatment with Second-line TB Drugs in Teaching Hospitals, 2005. In National Surveillance 25 %40 24 %35

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Dr. Suha ÖZKAN Ankara Provincial Tuberculosis Coordinater

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  1. THE EXPERIENCES AND PROBLEMS OF MULTIDRUG RESISTANT TUBERCULOSIS PATIENTS AT DISPENSARIES IN TURKEY Dr. Suha ÖZKAN Ankara Provincial Tuberculosis Coordinater

  2. The Research of Treatment with Second-line TB Drugs in Teaching Hospitals, 2005 In National Surveillance 25 %40 24 %35 16 %47 6 %43 14 %78 85 %43 Number of patients Ankara Atatürk H. 63 İstanbul Süreyyapaşa H. 68 İstanbul Yedikule H. 34 İstanbul Heybeliada H. 14 İzmir Suat Seren H. 18 TOTAL 197 Source: TB Control Department, MoH

  3. The Research of Treatment with Second-line TB Drugs in Teaching Hospitals, 2005 • 155 (79%) of 197 patients were male. • 126 had history of treatment failure. • 19 had defaulted previously. • MDR had found in 172 patients. • 63 patients from İstanbul, 11 from İzmir, 5 from Ankara . (Bursa 10, Adana 8, Mersin 6, Trabzon 6) Source: TB Control Department, MoH

  4. The Process of Diagnose and Treatment of MDR-TB Patient START TREATMENT THE CONTROLS IN HOSPITALS AND DISPENSARIES DIAGNOSE BEFORE DIAGNOSE HOSPITAL OUTPATIENT FOLLOW UP DISPENSARY DISPENSARY COMPLETION OF TREATMENT

  5. The Diagnose of MDR-TB in Dispensaries • In pulmonary tuberculosis; • Mycroscopy of smear • Culture • Drug Susceptibility Test • The Type of Bacillus Quality Controlled

  6. MDR in which patient ? • The history of treatment out of order • No bacteriological conversion during treatment • No improve in signs and symptoms • The history of contact to MDR-TB patient • Going to fail in treatment With DOT

  7. The Obligations of Dispensaries • The bacteriology in diagnose and follow up • Directly Observed Treatment • Not to add any new drug during treatment • To transfer the patient to hospital which is specialized on MDR-TB treatment • To send history of patient and information about diagnose and treatment, to hospital with patient

  8. The Problems about Diagnose of MDR-TB in Dispensaries • The deficiency of bacteriology • Treatment out of order (DOT ?) • Non-Standardize regimens • Not to understand treatment failure • The mistake of adding new drugs • The doctors and hospitals who had no experimentation on MDR-TB • The echonomics and social problems in management

  9. Recording MDR-TB Patient in Dispensary • All MDR-TB patients must be recorded in Dispensary • Previous record must be closed, and the patient must be re-recorded with appropriate case defination in treatment failure • The history of disease, bacteriological results and knowledge about treatment must be recorded in patient files • The notes about follow up

  10. The Problems in MDR-TB Registrations • The prescriptions and the health report for drugs • Inadequancy transfer Dispensary from hospital • Inadequte knowledge in Discharge Report • Non registration and out of National Surveillance • No DOT • The deficiency in drugs • No compliance, problems about side-effects

  11. The Follow up MDR-TB Patient in Dispensary • Daily DOT with health staff • Bacteriology in every control • To ask side-effects of second-line drugs during examination • To agree the orders of hospital about treatmen, not to make any change • To advise patient to be controlled in hospital

  12. The Problems in Pursuit and DOT of MDR-TB Patient • Shortages of drugs (sometimes) • Long treatment duration and disgust • Difficulties in DOT because of applying 2 or 3 times in a day • Prevention of health staff and public from transmission • Inadequate knowledge about side-effects • No limitation to drugs in Pharmacies • What to do for contacts ?

  13. The Support of MOH for Second-line Drugs • MOH had supplied second-line drugs since 2003. Ankara Dispensary had delivered with the request of all dispensaries in Turkey, from 2003 to 2008. • The repuests from dispensaries are increasing. • But some patients are still taking drugs from pharmacies with prescription. • The second-line drugs for two or three months were sent to dispensary with the prescription and referral report of patient from hospital.

  14. The Second-line Drug Supply • 2006 • 615 request • Total 212 patients • 188 of them are MDR/failure • Treatment start year • 31 patients before 2005, • 89 patients in 2005, • 66 patients in 2006. • 2 unknown. • 2007 • 747 request • Total 212 patients • 187 of them are MDR/failure • Treatment start year • 49 patients before 2006i, • 68 patients in 2006, • 68 patients in 2007, • 2 unknown. Source: The records of second-line drug supply

  15. The Records of second-line drug supply in 2006-2007 • The total number MDR/treatment failure patients were 272 in txo year. • 92 patients from 2005, 79 from 2006, 68 from 2007. • Most of the patients diagnosed in Ankara Atatürk C.D. Hospital(164). 46 in Süreyyapaşa H, 27 in İzmir Dr. Suat Seren H, 17 in Yedikule H, 6 in Heybeliada Hospital. • Treatment of 12 patients were started in other hospitals. • Nearly the drugs of half of the patients were requested systematicly. Source: The records of second-line drug supply

  16. Dispensary and MDR-TB Patient MDR Treated with second-line drugs Recorded in Dispensary Treatment failure The drug supply from MOH

  17. THE RESEARCH OF TREATMENT WITH SECOND-LINE DRUGS IN TURKEY-2009 • Directorate of Tuberculosis Control in MOH. • Study covered all Turkey. • The patients of 2007 and 2008 are in study. • The data of the patients who were treated with second-line drugs are collected and recorded systematicaly.

  18. THE RESEARCH OF TREATMENT WITH SECOND-LINE DRUGS IN TURKEY-2009

  19. MDR-TB Registries in Ankara TB Dispensaries, 2006-2007-2008 • 8 patients in 2006, 3 patients in 2007, and 13 patients in 2008 were registered in dispensaries (Total 24). • All of them are diagnosed in Atatürk C. D. Hospital. • 17 of them are MDR. 10 of MDR caes had previously treatment failure history. • 4 patients were treated because of treatment failure. • 2 patients were treated because of mycobacterium other than tuberculosis. • There is 1 XDR case.

  20. MDR-TB Registries in Ankara TB Dispensaries, 2006-2007-2008 • 14 patients are male. • 9 patients had SSK, 6 had greencard, 4 patients had no health insurance. • 18 had treated under DOT (16 them with health staff) • 21 patients drugs were supplied from MOH. • 12 patients are still under treatment, 6 patients are cured, 4 patients are defaulted, 1 patient is treatment failure, 1 patient was transfer out.

  21. In Memory Of Dr. Hamdi ECEVİT... 1952 – 04.04.2009

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