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Key issues in DOTS implementation

Key issues in DOTS implementation. Dr Saidi M. Egwaga. TB in the world 2002. People infected  2 billion New TB cases 8.6million New ss+ TB cases 3.8million Prevalence HIV in new adult cases 12% Prevalence MDR in new cases 3.2% Deaths from TB (inc HIV) 1.8m.

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Key issues in DOTS implementation

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  1. Key issues in DOTS implementation Dr Saidi M. Egwaga

  2. TB in the world 2002 • People infected 2 billion • New TB cases 8.6million • New ss+ TB cases 3.8million • Prevalence HIV in new adult cases 12% • Prevalence MDR in new cases 3.2% • Deaths from TB (inc HIV) 1.8m

  3. Global targets for TB controlMILLENNIUM DEVELOPMENT GOALS • WHA by 2005: 70% case detection, 85% cure DOTS beyond public health services • MDGs by 2015: Halve prevalence and deaths HIV/AIDS, drug resistance, migration

  4. Progress towards Global TB Control targets • Case Detection Rate 36% (target 70%) • Cure Rate 83% (target 85%)

  5. High treatment success in DOTS areas 100 DOTS smear+ target 85% 90 non DOTS smear+ 80 70 60 Treatment success (%) 50 40 30 20 10 0 1995 1996 1997 1998 1999 2000 2001

  6. What countries have achieved in 2002 Outstanding progress in some countries: • Increase case detection and cure: India, Indonesia, Myanmar, Pakistan, Cambodia, Viet Nam • Increase case detection but low cure: South Africa • Some progress: Mozambique, Afghanistan, Philippines

  7. Financial resources • New sources available GFATM 189 million to TB and TB/HIV control for 2 years FIDELIS (CIDA) WB,TBCTA, etc. • Gap to be addressed 200 million per year in countries 20 million per year for technical assistance

  8. Major challenges • Health workforce crisis • High turn-over • Need for updated training and retraining (pre-service and in-service) • Retention • Brain-drain • Deployment • HIV epidemic • HRD is absent in MoH strategic planning

  9. Major challenges • Access to health services • Poor health care infrastructure • Weak laboratory networks • Health systems reform • Little involvement of some PHC providers in TB control • No link with other public health care providers (e.g. hospitals, prisons, etc) • Inadequate involvement of private sector • Inadequate cultural sensitivity

  10. Major challenges • Insufficient political commitment • Shortages of staff at different levels in some NTPs • Inadequate funding for training and supervision, monitoring and evaluation • No budget line for TB drugs in most countries

  11. Major challenges • TB / HIV epidemic in some countries • Overloaded health care services • Stigma • High death rates among TB patients • Competition for scarce resources • Collaboration between NTPs and NACPs

  12. Country experience in addressing challenges • Training needs assessments (Indonesia) • Collaboration with training institutions (Tanzania) • Community involvement (Uganda) • Involvement of private sector (India, Philippines) and NGOs (Bangladesh)

  13. Country experience in addressing challenges • Link with hospitals (Indonesia, India, China) • National Programme evaluation (China) • Rapid DOTS expansion (India) • Collaboration between NTPs and NACPs (Kenya, Tanzania, Brazil) • COMBI (Kenya, Bangladesh, India)

  14. Total patients placed on treatment and population covered under DOTS each quarter, India (1994-2003) 238,204

  15. STOP TB Partnership • Very good positive spirit of the DEWG • Stop TB is working in countries • Progress in some countries despite difficulties • Countries gaining momentum and some very close to targets

  16. HOWEVER... • No time for complacency • 2004 is the year of accelerating actions in TB control

  17. Ultimate Goal: a generation of children free from tuberculosis

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