TUBERCULOSIS CONTROL
Experience of Guyana
Dr Jeetendra Mohanlall
The National Tuberculosis Programme
Mission Statement
To reduce the incidence and prevalence of
tuberculosis and to mitigate its impact
through a multisectoral response that
provides high quality and equitable
prevention, treatment and support
services.
TB Clinics in Guyana
Progress from 1
central TB clinic
in 2000 to 18
decentralized
clinics in 2013
Laboratory Network
EX-QC
•Mabaruma
•Port
Kaituma,
•Moruca
•Matthew’s
Ridge
NPHR Lab
•WDRH
•Linden
•NA
•Skeld
on
Quality
Control
•Suddie
•Charity
•Bartica
•Mahdia
•Kato
•Lethem
•Annai
•Aishalton
•Karasabai
•Sand
Creek
•Fort
Wellington
1
Barima-Waini
Pomeroon Supenaam
2
Essequibo Islands West Demerara
34
7
Cuyuni Mazaruni
Demerara-mahaica
5
1
0
8
6
Mahaica Berbice
Upper Demerara-Berbice
Potaro-Siparuni
Upper Takatu/ Upper Essequibo
Areas DOTS being expanded
Areas DOTS Operational
Areas to be further integrated into
the PHS
9
East Berbice Corentyne
TB/ HIV TRENDS
2005 -2012
800
New cases
700
600
500
400
300
200
100
0
Total number of new TB cases
Number of new TB cases tested for HIV
Number of new TB cases coinfected with
HIV
2005
656
456
2006
691
566
2007
701
562
2008
623
516
2009
629
562
2010
674
614
2011
683
633
2012
725
693
163
159
198
123
156
161
147
213
Years
Strengths of the NTP
 Strong political commitment
 Strong support from Technical Partners and funding
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agencies (GF, CDC, PAHO etc.) Phase 2 of GF grant in
the process of being implemented.
Implementation of the 5 components of DOTS
Implementation of all 12 WHO recommended TB/HIV
Collaborative Activities - PPM, TB/HIV inclusion in HIV
Vision 2013-2020 and HIV GF phase 2 proposal
National TB Guidelines, Strategic plan 2013-2020 and
training tools developed
National TB M& E plan developed (2013-2015)and
compendium of indicators
The Integration of TB services
 Coordination by a central management unit -
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forecasting and budgeting for TB medication, development
of guidelines and policies for TB control and supervision of
TB services provided by TB clinics
Human Resource Capacity: Main Coordinators and most
of the support staff employed in programme. Dedicated
staff at Clinics in the regions.
Strong M&E function for informed decision making at
the NTP.
Mobile teams – supporting DOTS programme daily in the
high burden region and also involved in default tracking.
Laboratory Services: Robust network of 20 sputum
microscopy sites around the country and the NPHRL has
developed the capacity for TB cultures and DST.
TB CONTROL IN PRISONS
Interventions DOTS supervisor for prisons hired.
 Case detection - Respiratory Symptomatic register at






all Facilities
DOTS (all facilities)
Isolation Area (5 facilities)
Enabler’s programme for inmates diagnosed with
TB.(milk supplement)
Mass screening done periodically.
Proposed procurement of mobile unit.
Hiring of key staff by prison’s authority.
Challenges
 The need for further decentralization of TB services into
the PHC system.
 Cure rate still at a level below the recommended WHO
target (over 85%)
 Default rates – especially among mobile population,
substance abusers, homeless
 Lack of a proper in patient facility for difficult TB patients
(e.g. homeless MDR TB patient). TB step-down care facility
on stream to be completed by end of 2013.
Opportunities
 Potential linkages with countries with successes in TB
management- Technical Co-operation (Suriname,
French Guyana), Histoplasmosis study supported by
CDC.
 PPM – Davis and St. Joseph Mercy Hospital
 Phase 2 ,Round 8th Global Fund TB project approval.
 Technical collaboration from PAHO and technical
assistance from CDC.
 Operational Research.
 Increased focus on TB/HIV in HIV GF proposal
 IMAI expansion for increased integration in PHC
services
RISKS
 Migration of Skilled Health Workers/ high staff turn
over
 Potential reduction in available external funding
 Patients continue to default on TB treatment.
 Co-morbid Conditions including diabetes, HIV and TB
 The emergence of MDR TB .
National Tuberculosis Strategic Plan
2013-2020
Projections Toward Universal Coverage
 The overarching goal of the National Strategic Plan for
Tuberculosis (NSPTB) is to reduce the incidence and
prevalence of tuberculosis all across Guyana.
 This goal takes cognizance of the targets set by
international conventions including the Millennium
Development Goals (MDG’s) and the Stop TB
Partnerships.
Goals and Objectives
Pursue high-quality DOTS expansion and enhancement
1. Increase TB case detection rate of all forms of TB from 82%
in 2012 to 90% by 2015.
2. Increase treatment success from 71% in 2010 to 85% by
2015
3. Decrease defaulters’ rate from 18% in 2010 to 7% in 2015
and to less than 5% in 2020.
Goals and Objectives Cont’d
4. Strengthen the Supervision, M&E system at all levels
to ensure that at least 95% of all planned activities are
implemented effectively and efficiently.
TB/HIV collaborative activities
5. Increase and sustain the proportion of TB patients
tested for HIV from 96% in 2012 to 100% by end of 2015
6. Ensure that 100% of TB/HIV co-infected patients
receive Co-trimoxazole prophylaxis.
7. Ensure that 100% of HIV patients receive INH
preventive therapy (IPT) at their HIV Care &
Treatment Sites.
Goals and Objectives Cont’d
8. Increase the proportion of TB/HIV co-infected
patients who are receiving antiretroviral therapy (ART)
from 92% in 2011 to 99% in 2020.
9. Establish infection control in all health care facilities
(100%) providing both DOTS and ART services by
2020.
Establish MDR-TB services
10.Establish a routine drug resistance surveillance system
by the end of 2013.
Goals and Objectives Cont’d
11.Ensure that all High Risk Groups including Category 2
failures have access to lab diagnosis services for MDR
by the end of 2013 and all Category 1 failures by the end
of 2013.
12.Provide second-line anti-TB drugs to 100% of
diagnosed MDR cases annually and by the end of 2020.
Goals and Objectives Cont’d
Engaging all care providers (PPM): Strategic
alliances with academic, private and other
members of civil society.
13.Scale up PPM services within the private institutions,
military, police, prisons, and chronic disease clinics
such that it contributes to at least 20% of total TB
cases detected by the end of 2020
Goals and Objectives Cont’d
Research
15.Develop and strengthen capacity for research on TB,
TB/HIV, and MDR-TB at all levels.
-Nation wide KAPB study (knowledge ,Attitude, Practice
and Belief)
-MDR study
Key Strategies
 STRATEGY 1: Pursue high-quality DOTS expansion and
enhancement
 STRATEGY 2: Address TB/HIV, MDR-TB and the needs of
poor and vulnerable populations
 STRATEGY 3: Engaging all care providers (PPM): Strategic
alliances with academic, private and other members of civil
society.
 STRATEGY 4: Advocacy, Communication and Social
Mobilization (ACSM)
Thank you
Questions?