Programmatic Management of
Multidrug Resistant TB (PMDT)
5th Joint International Monitoring
Mission of NTP, Thailand
23 August, 2013
Situation
• 2006 Drug Resistance Survey: 1.7% new & 34.5% previously treated
MDR-TB (2,190 cases in 2012); 2012 survey results awaited
• MDR-TB management implemented by NTP in 2008/09; 2012-2016
PMDT plan & updated TB Guidelines drafted
• MDR-TB risk groups defined (Re – On – Pre)
• Culture & drug susceptibility testing (C/DST) for first line TB drugs
available at Regional level and in Bangkok, and rapid molecular
testing in various sites
• 2012: 492 confirmed MDR-TB cases reported to WHO, number on
treatment unclear, outcomes on first cohort not available yet
• 100 MDR-TB treatment centres registered with NHSO
• No reported stock outs of second line TB drugs (SLD), drugs for
adverse drug reactions available and covered under NHSO
Issues
• MDR-TB plan and updated TB Guidelines not yet available
• Diagnostic algorithms unclear (with doctors discretion), multiple
(re-) confirmation of test results
• Delay and/or under-reporting of cases, no MDR-TB module in
TBCM, reporting to NTP only from late 2011
• Inconsistent treatment practices: Regimens not as per guidelines,
low SLD dosages, daily DOT not always done
• Limited experience in managing MDR-TB cases, no M/XDR
treatment committee at Regional level
• Multiple sourcing (GPO & GDF) & funding of SLDs (NHSO, GF &
Hospital funds), different ordering cycles (GPO & GDF)
• Unclear reimbursement / funding under NHSO, SSS and GF for
C/DST, follow up cultures, treatment of migrants
Recommendations
• Finalise and publish 2012 DRS results
• Finalise MDR-TB Plan and updated TB Guidelines, disseminate
and monitor implementation
• Establish an integrated comprehensive web-based case based
information system (Summary recommendation 2)
• Support clinical practice via clinical case meetings coordinated
by ODPC, and link with National MDR-TB Expert group
• As part of supportive patient-centered care approach, ensure
availability of DOT observer for all cases throughout treatment
• Ensure timely provision of support packages to patients and
DOT observer
• Reimbursement of full PMDT package, including all diagnostic
and follow up tests, under the respective insurance schemes
• Develop mechanism to ensure migrants with MDR-TB diagnosed
early and treated based on experiences from GF SSF project
THANK YOU