MDR- and XDR-TB in the Context of HIV Infection Lesotho program
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Transcript of MDR- and XDR-TB in the Context of HIV Infection Lesotho program
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Dr. Hind E. SattiPartners In Health, LesothoMarch, 2008
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12,275 TB 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; 80% of TB cases are HIV positive(NTP 2008); 109MDR-TB cases currently on treatment
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May 2007: National guidelines for management of MDR-TB Collaboration with MOHSW
and WHO Developed from WHO
global guidelines. July 2007: Training of
health staff Training materials for
health staff at district level.
Training materials for MDR-TB treatment supporters.
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• Building national lab capacity Equipment Staffing Training and supervision infrastructure
• Close relationship with SRL Culture and DST while national capacity is being built Proficiency testingCentral TB laboratory is now performing culture and
first line DST as well as the Rapid RIF testing.
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All NTP staff TB Officers at district hospitals Health centre nurses providing TB care
Routine HIV screening of MDR-TB patients, partners, family members
Protocol for “medium-risk” and “high-risk” Sputum sent to national TB laboratory
Initially sent to MRC Pretoria (March 2007) First-line DST now available in Maseru (Sept
2007) Screening of household contacts
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Outpatient TB clinics and general outpatient clinics Treatment supporters Family members
Inpatient Cross-infection of patients Protection of health workers (TB and HIV)
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MDR-TB Clinical Teams at all district hospitals Medical Officer ART Nurse TB Officer TB Coordinator
Empiric treatment for high-risk suspects
Early initiation of ART in all co-infected patients, regardless of CD4
Referral to Maseru for complicated patients
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MDR-TB Treatment Supporters Village Health Worker;
community volunteer; KYS counselor
Accepted by the patient
Trained and supervised by District MDR-TB Clinical Team
Incentives
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Twice-daily DOT Injections Psychosocial
support Screening
household contacts Accompaniment to
clinical visits
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Very sick patients Bedridden Severely wasted
Severe side effects Severe hypokalemia Acute renal failure
Severe OIs Meningitis Esophageal
candidiasis
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Started on August 2007 109 patients enrolled. 48 patients pre GLC cohort. 72% HIV co-infection rate History of multiple failed TB treatments Average of 8 household contacts per
patient
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Geography Advanced HIV disease Severe malnutrition/wasting Clinical complications and side effects Working through the “backlog” quickly