Irada Akhundova M.D. Ph.D., Scientific Research Institute of Lung Diseases Baku, Azerbaijan
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Transcript of Irada Akhundova M.D. Ph.D., Scientific Research Institute of Lung Diseases Baku, Azerbaijan
Irada Akhundova M.D. Ph.D., Scientific Research Institute of Lung DiseasesBaku, Azerbaijan
14th Annual Congress of Turkish Thoracic Society 13-17 April, 2011, Antalya, Turkey
Follow up of treatment of Drug Resistant TB patients after
release from prison
There was a great need to organize continuation of treatment for DR-TB patients after release from prison
- DOTS-Plus treatment in prison started April 2007 and the patients with more than 2 year sentence were one of the (last but not least) criteria for enrollment.
Start of pilot project for released Drug Resistant TB patients
- April 2009 (upon start of follow up) 135 DR-TB patients were enrolled in prison who were mainly with sentences more than 2 years.
- ...the ICRC started to initiate piloting follow up of released DR-TB patients in cooperation with MoJ and NTP.
- May 2008, when DOTS-Plus project started for civilian patients and there were trained staff in civilian sector regarding MDR management...
March 17 2009, the Memorandum of Understanding on the follow up of released Drug Resistant TB patients to
complete their treatment in civilian anti-TB fasilities was signed between MoH, MoJ and ICRC.
TRIPARTITE AGREEMENT
On the basis of tripartite agreement DR-TB patients released from prison without completing treatment were transferred with transport out to civilian TB facilities.
Start of pilot project for released Drug Resistant TB patients
DR-TB patients continue their treatment after release from prison April 2009 – December 2010
12862
85
135
48
111
98
7240
157
159
208
130
33
119152
154
144
156173
148
194
117
237
265
185180
118
163
155
136
266
228
297
83216
DR-TB patients continue their treatment after release from prison April 2009 – December 2010
12862
85
135
48
111
98
7240
157
159
208
130
33
119152
154
144
156173
148
194
117
237
265
185180
118
163
155
136
266
228
297
83216
4
3
1
2
1
2
1
0
3
1 1
4
1
2
1
5
2
0
2
1
4 4
3
1
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Since April 2009, 50 DR-TB patients were transferred out to civilian sector
2009 -17 patient 2010 – 24 patient 2011 - 8 p.
The number of Drug Resistent TB cases released while being under DOTS-Plus
treatment in prison
Coverage: Whole country
Continuation of treatment is organized for DR-TB patients in civilian sectorTreatment provided regions (city, village, settlement)
Number of cases
Treatment fcilities where released DR-TB patient receive treatment
Treatment (in hospital or ambulatory)
Baku 20 patients Policliniks N10, Binagadi region, TB dispensary N 4 TB dispensary 5, TB dispensary 6, TB dispensary 7,
Buzovna settlement, TB dispensary 2
18 ambulatory + 2 in patient
Gobustan city 1 patient United City Policlinics N17 of Gobustan city Ambulatory
Shirvan city 2 patient City Policlinics N1 of Shirvan city Ambulatory
Sumgayit city 3 patient TB dispensary Ambulatory
Salyan city 2 patient TB dispensary Ambulatory
Masalli city 2 patient PHC unit of the Gizilavar village Ambulatory
Astara city 2 patient TB unit of city hospital 1 ambulatory + 1 in pat.
Sheki city 2 patient TB dispensary Ambulatory
Yevlakh city 2 patient TB dispensary Ambulatory
Aghjabedi city 1 patient TB Unit of Central District Hospital Ambulatory
Tovuz city 1 patient TB department of city hospital Ambulatory
Nakhchevan city 2 patient 1 in TB dispensary and 1 in village medical point Ambulatory
Tartar city 1 patient TB dispensary Ambulatory
Barda city 1 patient TB dispensary Ambulatory
Goychay city 1 patient TB dispensary Ambulatory
Hajiqabul city 1 patient TB dispensary Ambulatory
Bilasuvar city 1 patient City Policlinics Ambulatory
Mingachevir city 1 patient TB dispensary Ambulatory
Goranboy city 1 patient Village medical point Ambulatory
Zerdab city 1 patient TB dispensary Ambulatory
16
1
11
12
712
0
5
10
15
20
25
30
2008(Dec) 2009 (Apr-Dec) 2010(Jan-Dec) 2011(Dec)
Baku Cities and rayons of Azerbaijan
Transfer out patients and their treatment location
33
75
86
108
11
7
11
7
13
8
14
9
17
12
17
12
19
15
23
17
24
17
26
15
27
14
32
19
34
20
34
18
36
14
37
15
41
19
45
22
48
26
50
23
0
5
10
15
20
25
30
35
40
45
50
Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb
Transferred out Under treatment
Transfer out patients and their treatment location
The form is created for each released DR-TB patient to register bacteriological status of the patient every month.
Follow up form
Resistance
3
43
4
0
5
10
15
20
25
30
35
40
45
PDR MDR XDR
PDR
MDR
XDR
MDR CASES WITH CO-INFECTIONS
80,59%
6; 13%
13; 28%
MDR+Hepatitis MDR+Hepatitits+HİV MDR
37
3
12
4
In prison (SS-/CC-), out of prison (SS-/CC-)
In prison (SS- CC+), out of prison (SS-/CC-)
In prison (SS- /CC+), out of prison (SS+/CC+)
In prison (SS- CC+), out of prison (SS+/CC+)
In prison (SS+ /CC+), out of prison (SS+/CC+)
Most of the patients release from prison with culture negative.
Every month sputum specimens are collected from each patients for smear, culture, DST and transported to prison Lab
Any changes in treatment is done by concilium (technical expert commition)
Patients' bacteriological status
Transfer out patients and their treatment outcomes
1 1
18
86
2 1
24
41 2 2 1
14
8
0 0 0 0 0
8
0
5
10
15
20
25
2008(Dec) 2009 (Apr-Dec) 2010(Jan-Dec) 2011(Jan-Mar)
transfer out cured Defaulted Failure Died Transfer in Under treatment
50 patients were released from DOTS-Plus Project in prison
49 of them released after MOU was signed by MOJ,ICRC,NTP
13 cured
8 defaulted
4 failure
2 died
1 Transfer in to prison (re-jailed)
22 under treatment
Interim treatment outcomes
13 8
4
2
1
22
still under treatment CuredDefaulted FailureDied Transfer in
Valuable experience
Implementation mechanism
Project set up
Recording and reporting system
Infrustructure
Trained staff
Resources
Experience and implementation mechanism of the project
Due to the ICRC phase out of health program, the follow up project will be carried out by the NGO – “Health Care Support” who mainly is involved in TB, HIV and other communicable diseases according to its regulation.
The followings were gained during piloting follow up project;
THANK YOU FOR YOUR ATTENTION!