MDR-TB GLOBALLY
AND IN THE REGION
2013
Dr Samiha Baghdadi
Medical officer – STB
WHO – EMRO
Cairo March 2014
The structure of the presentation
• MDR-TB burden globally and in the region
• MDR-TB notification
• MDR – TB treatment outcomes
• Regional challenges and strategic directions
• Ambulatory care for MDR-TB
Global coverage of data on DR-TB
1994-2013
MDR-TB rate among New TB cases
Graph 2: MDR rate among new
6.3
6.2
5.2
5
3.5
2.9
2.9
2.9
2.9
2.3
2.2
2.2
2.2
2.2
1.8
1.7
1.2
1.1
0.9
0.9
0.82
0.5
JOR
SYR
SOM
IRN
AFG
IRQ
LIB
PAK
EGY
BAH
KWT
UAE
OMN
KSA
YEM
QTR
LEB
DJI
SUD
TUN
MOR
PAL
EMR
MDR-TB rate among previously treated TB
cases
Graph3: MDR rate among previously treated
67
48.2
41
35.4
35.4
35.4
35.4
32
31
29
25
16
15
14.4
14.4
12.2
12
10.8
10.8
10.8
10.8
8.3
LEB
IRN
SOM
AFG
IRQ
LIB
PAK
SYR
JOR
EGY
KSA
YEM
DJI
SUD
MOR
TUN
BAH
KWT
QTR
UAE
OMN
PAL
EMR
Estimated MDR-TB among TB cases
by WHO region
Contribution of WHO regions to MDR-TB burden
2012
Graph 1: Contribution of WHO regions to MDR-TB burden 2012
WPR
25%
AFR
13%
AMR
2%
EMR
6%
SEAR
30%
EUR
24%
Countries notified at least 1 XDR case
MDR-TB cases 2012
Estimated, notified and enrolled on treatment
Estimated Number of MDR-TB cases among
notified TB cases 2012
Graph 3: Estimated number of MDR-TB cases among notified TB cases
11000
1100
770
PAK
AFG
SOM
750
IRN
580
SUD
420
IRQ
330
EGY
300
250
150
97
84
81
36
19
15
10
MOR SSUD YEM
SYR
SAA
DJI
LIB
TUN
JOR
LEB
6
OMN
6
QAT
3
BAH
2
UAE
1
0
W&G KWT
Confirmed MDR-TB cases among notified TB
cases 2012
Graph 5: Confirmed MDR-TB cases 2012
1602
420
116
PAK
IRQ
EGY
116
SUD
96
DJI
80
MOR
50
IRN
31
20
15
13
13
AFG
SAA
TUN
JOR
SYR
8
YEM
6
LEB
6
OMN
4
3
2
BAH SSUD QAT
2
UAE
0
KWT
0
0
SOM W&G
LIB
Contribution to MDR-TB notification by
region 2012
WPR
5%
AFR
22%
SEAR
23%
AMR
3%
EMR
3%
EUR
44%
Treatment outcomes
Treatment success rate by country 2011
Treatment success rate of MDR_TB cases 2011
100
86
72
70
67
69
58
53
27
66
Regional challenges/risks foreseen
• Unstable situation in many countries in the region, namely (Afghanistan, Egypt,
Lebanon, Iraq, Pakistan, Somalia, Syria, Tunisia and Yemen). This situation
resulted in several challenges as follows:
•
•
•
•
•
Huge population movement across the region
Huge staff turn over
Destruction of infrastructure
Limited movement in the field
Sever loss of drugs and equipment
• Limited lab capacity
• Culture and DST are not available in Somalia and South Sudan. DST is not available in
Afghanistan.
• Most of the countries in the region did not widely apply the new diagnostics.
• DR survey and surveillance:
• Updated survey is ongoing in Iraq, Iran, Pakistan, Sudan, and needed in Syria.
• There is a need to document/report results of DR surveillance that is ongoing in GCC countries, and
expand the continuous surveillance in the remaining 15 countries.
• Libya is still the only country in the region without proper management of MDR-TB management.
Regional challenges/risks foreseen
• Expected financial gap to support scaling up MDR-TB
activities in most countries, mainly (Djibouti, Egypt,
Lebanon, Jordan, Iran, Pakistan and Syria).
• Limited human resources at country level (MDR local
support on continuous basis is needed in Afghanistan,
Iraq, Pakistan and Sudan mainly).
• Limited consultancy capacity in the region in general ( a
team of 5 consultants was established last year to support
countries)
The strategic directions of the work of EMR_GLC
• Improve planning for PMDT (update the regional plan
•
•
•
•
•
and support planning at country level),
Develop regional high standard ambulatory based
model
Develop Regional framework and guidance about the
utilization of New diagnostics and lab support,
Scale up R&R for MDR, infection control at all levels, HR
capacity,
Promote prequalified regional companies; develop
mechanisms for joint proposals, drugs grants.
Operational research
Promote using ambulatory model in MDRTB care
Justification:
• Limited country capacity (infrastructure: hospitals,
infection control) and financial.
• New diagnostics increase case detection (X-Pert).
• Long waiting list of detected cases.
• Global experience is encouraging
However :
Ambulatory care does not exclude hospitalization
What do we need for ambulatory model
• Networking:
• Diagnosis,
• Treatment,
• Treatment follow up,
• Side effect management,
• Daily observation and care,
• Social support
Some basic items for provincial profile
Population
Admin areas
Geographical description
Notified cases/notification rate ( TB type, Age and gender)
Treatment outcomes ( TB type, Age and gender)
Estimated MDR-TB cases among new and previously treated
Infection control
Lab coverage
EQA for DSM
C/DST coverage
PPM coverage
PHC coverage
Hospitals available
Referral system
Community support
16. Provincial map (PHC facilities, hospitals, laboratories, TB facilities, PPM
facilities, patient distribution, MDR cases distribution) and community support
points.
17. Security issues
18. MDR focal person
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
RO support to countries for AT
• Briefing about ambulatory model 2012
• Training on planning 2013
• Follow up planning process 2013
Future plans 2014
• Monitoring missions and evaluation
• Lesson learnt
SWOT analysis
Stakeholder analysis/matrix
Provincial profile
Provincial map
Strategic frame work
OP plans