Download TB Epidemiology - WHO Western Pacific Region

Country Progress Report
(Papua New Guinea)
The ninth Technical Advisory Group and National TB
Programme Managers meeting for TB control in the
Western Pacific Region
Manila, Philippines
9 -12 December 2014
TB Epidemiology
TB epidemiology
TB Epidemiology
• High transmission of TB in communities as a high proportion of SS+
patients are among the young economically productive age group 15-35
years old, mainly among females;
• High transmission of TB within households: 28% of TB cases are children,
2013;
• TB in urban areas: 70% of cases during last 5 years ( settlements,
overcrowding, culture of “extended families”)
• TB in mainly in Southern region: NCD is the most important “TB hotspot”;
reports 5 x national average notification, 25% caseload, only 5 %
population
• TB/HIV: half of provinces have high TB/HIV burden
• Estimated MDR TB rate, 2013- New
4.5%
-Retreatment 24%
Major successes
• Steady increase of case notifications
• Procurement of all medicines from GDF , no stock outs
• TB patients receiving HIV tests have increased from 13% in 2011 to 24% in
2013.
• DRS is going to finalise by the end of 2014.
Major Successes, 2014
1. NSP 2015-2020
2. TB CN , 2015-2017, was
approved by GF, 21 Million
USD
3. External review of TB
program, Feb 2014
4. TB CN for NCD, 10 million
AusD, DFAT
5. M/XDR TB Emergency
Response Team since
August 2014
6. Inter-ministerial Task Force
since Nov 2014
7. Campaign by PM, Oct and
Nov, 2014
Major challenges
Health System related factors:
•Lack of manpower at all levels , HR crisis (quantity)
•Poor managerial capacities at all levels
Poorly supervised staff resulting in low staff morale (unprofessional behavior, low motivation, and
absenteeism)
“You can have the best strategy and the best building in the world, but if you don’t have hearts and minds of
the people who work with you, none of it comes to life”. Renee West
Poor capacities in strategic planning, budgeting and monitoring, and program evaluation
•Poor maintenance of infrastructure ( run down facilities with obsolete equipment)
•Limited ownership at provincial, district, health facility, and community levels
•Poor coordination and communication between different levels of government
because of fragmentation of organizational and administrative health structures
Major challenges
TB program specific factors:
–TB patients present late for diagnosis resulting to on-going transmission in the
community
–Clinicians over reliance on x rays and clinical assessment of TB and lack of labs
resulting in low bacteriological confirmation of TB ( high rate of sputum not done)
–Limited supervised treatment, most patients self administer
–High defaults with limited retrieval actions
–Limited supervision and constructive feedback at all levels
–High child TB, BCG uptake low <60%; BCG stock-outs
–Slow uptake of TB/HIV collaborative activities in most provinces
–Weak involvement of provincial offices in the implementation of drug resistant
TB, poor monitoring and supervision of DR TB, infrastructure inadequate for DR
TB management/ infection control issues
National TB Strategy/Policies
• Timeframe:2015-2020, aligned with WHO End
TB strategy and National Health Sector Plan
• NSP prioritized 30 BMUs ( 10% of BMUs) in 14 provinces
– 75% defaulters ( all cases)
– 65% smear not done
– 53% of national TB burden
• GF support needed for 28 BMUs (12 provinces)
– Two BMUs to be supported by DFAT and MSF
National TB Strategy
( targets and budget)
Reach the unreached
• Intensive case finding: among child contacts of
bact pos. patients and PLWH
• Contact investigation: not working fully, info
not available.
• TB-HIV: In practice is happening, but data not
collected by HIV program.
• Child-TB: serious issue; special intervention in
GF CN
Laboratory
• LED microscopes: No roll out
• Xpert; 17 in country (National 1, Regional 4,
Provincial 12 and District 0 (See map)
• Quality Assurance
– Participation: per quarter between 19.5% and 35.6%
of microscopy sites
– s Laboratory Information Management System
– Manual entry
• TA partners;
– WHO, QMRL, DFAT and World Vision
GeneXpert Locations in PNG
Current
Proposed
Partners/PHO/Private
Surveillance
• Quality of TB reports
– Provincial teams (informally designated – TB TB/Leprosy
Officer, M and E officer and Health Information officer)
were trained on data quality assessment that includes
availability, completeness, consistency, accuracy and
timeliness
• New Case Definition roll out
– Forms for drug sensitive TB will be revised to align with
the WHO new case definitions
– MDRTB Guidelines revision initial meeting was
conducted in October. This is still on-going.
Surveillance
• Data Analysis and utilization
– National Level: Quarterly reports are circulated by NTP
Manager; also used to identify and prioritize facilities to
focus on.
– Provincial Level: some provinces analyse their data for
management meetings and provincial reviews.
PMDT
Province
No. tested No. rif-resistant (%)
NCD and Central Province
945
95 (10 %)
Western Province
188
55 (29%)
Morobe
86
6 (7%)
Madang
114
9 (8%)
Eastern Highlands
600
2 (0.3%)
Chimbu
157
2 (1.3%)
•Treatment success rate: 14%, 2011
•Special case: Daru ( dilapidated hospital, high transmission of DR-TB in the community (half of
MDR TB cases are new) and hospital (4% staff sick with M/XDR TB) , no doctors, high level of
outrage)
•Barriers: HS barriers ( no HCWs ), lack of PC3 lab, high costs of culture and DST, high initial LTFU
rate
Action plans:
Completion of DRS
M/XDR TB emergency Response team
DFAT NCD project
Implementation of PMDT activities in TB NSP ( partially financially supported by GF)
Continuous advocacy
MDR/XDR-TB
Emergency Response
• Established in August 2014
• Five (5) meetings conducted
• One meeting conducted by Health Minister & governors of
Western, Gulf & NCD to gain political interest.
• Budget needed: PGK8M (K2M for Prime Ministers Media
Campaign & K6 to Gulf, NCD & Western)
• Partners’ presence
• Highlights of provincial responses:
– Action plans submitted
– Intensive LTFU tracing ( decreased from 36% to 14%, NCD)
– Argument manpower support
• Treatment supporters
• Additional hospital staff
Bold policies and supportive
systems
•In 2014, the GoPNG began to implement its major health
financing reform which provides universal coverage through its
“Free Primary Health Care and Subsidised Specialist Services
Policy.”
•Health facilities will no longer charge user fees as they used to
whenever operating funds could not support their service
delivery levels .
•The policy was put into effect on the 24th of February 2014 and
is targeted at poverty reduction and addressing the inequities in
health care access.
Drug Regulation - Progress since the last meeting
• Medicines and Cosmetic Act 1999 and Regulation 2001 is
under review and the first national consultation workshop
was held in Sep 2014
• Provincial Pharmaceutical Inspectors Training held in Sep
2014
• National Strategic Plan on Strengthening Medicines
Regulatory Framework was developed in Nov 2014
• QC testing of TB drugs at TGA Australia
• Global Fund Concept Note for HSS has been endorsed in
Nov 2014. The grant will be used to strengthen product
registration, setting up a QC lab, compliance and inspection
• 2-week training on Logistics Management Information
System in Nov 2014
Patient centred care: involvement
of patients and civil society
•Community mobilization activities:
development of CBOs based on NSP
•Involvement of patient groups in TB control :
were involved in NSP and CN development,
members of of TB WG
•Forms of social support to TB patients:
transportation costs and food are included in TB
GF CN and NCD DFAT project