TB Management: A Medical Aid Perspective presented by

Dr Noluthando Nematswerani

Agenda

1. Background

2. TB as a PMB

3. Current challenges

4. Proposed solutions

Background

WHO Global TB Report 2009

TB is a major public health problem

9.27 million new cases per year

2 million deaths per year

HIV epidemic in Sub-Saharan Africa

TB and HIV

Leading causes of mortality and morbidity

70 % of all TB patients in SA are HIV positive

MDR TB

This is a growing clinical and public concern

489 000 cases worldwide in 2006

Defined as resistance to at least INH and Rifa

Treatment is expensive and complex

Greatest risk factor is history of prior treatment for TB

Orenstein et al Lancet Infect Dis 2009

• 33 studies were included

• Better outcomes when treatment was longer than 18 months combined with DOT throughout the treatment (12 studies)

XDR - TB

Defined as resistance to INH, Rifa, any fluoroquinolone and at least one of three of the second line injectable drugs (kanamycin, amikacin or capreomycin)

As of June 2008 – XDR found in 49 countries

TB as a PMB

Diagnosis and acute medical management; successful transfer to maintenance therapy in accordance to DOH guidelines

Current Challenges

TB is a notifiable disease• Availability of forms to private treating doctors

Lack of follow-up in the private sectorLimited access to TB medication in the private sector• Retail pharmacy• Medical aid funding

Proposed solutions

Establishment of private sector TB clinics for treatment and follow-up

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Thank you