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Improving TB-DM Care in the Pacific: Partnerships and Progress

Improving TB-DM Care in the Pacific: Partnerships and Progress. R. Brostrom, MD-MSPH Hawaii TB Control Branch Chief Regional TB Field Medical Officer, CDC-DTBE CDR USPHS. TB-DM: Partnerships and Progress in the Pacific. Stop TB Strategy and PPM TB-DM in the Pacific Pacific Partnerships

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Improving TB-DM Care in the Pacific: Partnerships and Progress

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  1. ImprovingTB-DM Care in the Pacific: Partnerships and Progress R. Brostrom, MD-MSPH Hawaii TB Control Branch Chief Regional TB Field Medical Officer, CDC-DTBE CDR USPHS

  2. TB-DM: Partnerships and Progress in the Pacific • Stop TB Strategy and PPM • TB-DM in the Pacific • Pacific Partnerships • Clinical Partners • Policy Partners • Research Partners • Summary - Questions

  3. Components of the Stop TB Strategy • “Evidence suggests that failure to involve all care providers used by TB suspects and patients: • hampers case detection, • delays diagnosis, • leads to inappropriate and incomplete treatment, • contributes to increasing drug resistance, • places an unnecessary financial burden on patients.” • Pursue high-quality DOTS expansion and enhancement • Address TB-HIV, MDR-TB, and the needs of poor and vulnerable populations • Contribute to health system strengthening based on primary health care • Engage all care providers • Involve all public, voluntary, corporate and private providers through Public-Private Mix (PPM) approaches • Empower people with TB, and communities through partnership • Foster community participation in TB care, prevention and health promotion • 6. Enable and promote program-based operational research WHO Stop TB <http://www.who.int/tb/careproviders/ppm/en/>

  4. US Pacific Region for TB Control

  5. Pacific Partnerships for TB

  6. Tuberculosis Campaign Challenges: 1912 “Lack of therapeutic treatment standards” “Poor reporting of cases under supervision” “Excessive charges to patients” Public Private Mix: New Priority?

  7. Advancing TB-DM Care: Why Partnerships? • Expertise Sharing • Out of our TB comfort zone • Chronic Disease model • Training Needs for screening • Resource Sharing • Attempting minor program expansion in a time of major program contraction • Maximize external funding support • Glucometers, A1C test kits, TSTs

  8. TB cases with DM Percent Adult TB Patients with Diabetes *Stephenson, BMC Public Health. 2007; 7: 234 ** Restrepo, Bull WHO,2011; 89: 352-9

  9. A1c > 7 DM No DM A1c < 7 Leung CC, et.al. ,Diabetic control and risk of tuberculosis: a cohort study. Am JEpidemiol.167, 2008

  10. TB-DM Outcomes: Relapse Baker et al. BMC Medicine 2011, 9:81 The impact of diabetes on TB treatment outcomes: A systematic review

  11. TB-DM Outcomes: Death during TB Tx Baker et al. BMC Medicine 2011, 9:81 The impact of diabetes on TB treatment outcomes: A systematic review

  12. Partnerships in the PacificPartial List of Best Practices

  13. Best Practices: Regional Standards(Curry Center, CDC Diabetes Program)

  14. Best Practices: Saipan Island

  15. Best Practices: RMI Community Clinic

  16. Best Practices: TB Screening

  17. Best Practices: TB Screening • Ebeye: 3/10 to 8/11 (18 mo.) • Asymptomatic Diabetics Screened: 264 • # TSTs Completed 146 • # TSTs Positive 40 (27%) • # abnormal CXR 9 • # culture positive cases 5 • Asymptomatic people with diabetes in Ebeye: TB Case Rate: 3,425 / 100,000 • (11 x NTP Rate: 298 / 100,000)

  18. Best Practices: TB-DM Educational ToolAustralian Respiratory Council • Standardized approach • DOT-based education • Weekly topics: TB and DM • Simplified and focused • “Brief Intervention” • 5 min or less • Repeated messages

  19. Best Practices: Operational Research CDC, SPC • Kiribati • Evaluating extent of TB-DM • Outcomes for TB-DM • Hawaii - Guam - Saipan • Measuring A1C in TB-DM cases • Can TB programs improve glucose control during treatment?

  20. Best Practices: Hawaii Clinics • TB-DM Integration Plan - October 2011 • Establish Referral Centers for DM care • Diabetes Education Training • RN’s • DOT Staff • Integrate for Public-Public Mix • Latent Screening Centers • LTBI Treatment Centers • DOT Centers

  21. TB-DM: Partnerships for Progress - Summary Improved Life-Long Diabetes Control Improved TB Outcomes

  22. US Centers for Disease Control and Prevention WPRO, World Health Organization International Union Against TB and Lung Diseases Curry International TB Center Secretariat for the Pacific Community Australian Respiratory Council CNMI Public Health Department Pacific Islands Health Officers Association Pacific Islands TB Controllers Association Acknowledgments

  23. Questions?

  24. Pacific Partnerships for TB-DM • TB rates very high • Diabetes rates very high • 40% over 40 • “Double-digit diabetes” • Resource limited setting Challenge • Small programs • Multi-tasking is the rule • “Culture of collaboration” Opportunity

  25. Best Practices: Ummm Not so Much…

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