“World TB day and TB
in Mongolia”
O.Batbayar MD,MPH (University of London)
National Tuberculosis Program
World TB day-Stop TB in my Life
Time
2012 оны Сүрьеэтэй
Тэмцэх Өдөр
TB in Mongolia
• Mongolia is one of the 7th high burden TB
country in West Pacific region of WHO.
• 3985 cases last year per 2.7 population ( 12000 cases
per 270 mln USA population)
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185 MDR cases
Total 19 XDR cases
400 paediatric cases
TB incidence 219 per 100000
TB prevalence 280 per 100000
TB Mortality 21 per 100000
2011 statistics is promising
Last ten years incidence, treatment
success and mortality
Сүрьеэгийн төслүүдийн үр дүн
Шалгуур үзүүлэлт үүд
2002 он
2011 он
Сүрьеэгийн илрүүлэлт
57%
75%
18% -р
нэмэгдсэн
Сүрьеэгийн өвчлөл
(10,000 хүн амд )
15.2
14.4
0,8 -р
буурсан
Эмчилгээний амжилт
86%
86.1%
Тогтвортой
түвшинд
барьж байна
Сүрьеэгийн нас баралт
(100,000 хүн амд )
3.6
2.9
0.7 –р
буурсан
Last ten years incidence and
treatment success
Сүрьеэгийн өвчлөл,эдгэрэлтийн түвшин
Timeline
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1968: The TB laboratory was established
1992: The TB laboratory network was developed
1994: NTP was established and DOTS launched
1994: Organization of the National Reference Laboratory
1997: Quality assurance system was introduced, Supranational Reference Laboratory (SRL) Japan
1997: First Drug Resistance Survey (DRS) conducted
1999: 100% DOTS coverage
2001:Reogranization of the TB Department under the National Center for Communicable Disease (NCCD)
2001: GFATM Round1 launched, later on RCC1
2002: National Programme of Communicable Diseases (NPCD) approved, TB program is a sub-programme of the NPCD
2005: GFATM Round 4 launched, Later on RCC 4
2006: launching of GLC approved project for management of 375 patients with drug-resistant TB (DR-TB)
2007: Second DRS conducted
2008: The review of the NTP
2009: Testing of drug resistance to second-line anti-TB drugs (SLD) started
2010: second National Programme of Communicable Diseases (NPCD) approved for the years 2010-2015, TB program is a subprogramme of the NPCD
2010: National strategic plan to stop TB in Mongolia, 2010-2015 (Objective 3-expand programmatic management of MDR-TB)
2010: Updated the guidelines on tuberculosis care and service (appendix 3- guidelines on drug resistant TB services and care) approved
by MOH, 2010
2010: National TB Infection control (IC) guidelines developed and approved
2010: GLC approved second cohort for 790 patients
2011: GFATM Round 10 approved and the consolidated grant will be launched in July 2011
2012 ; ACSM strategy is in development process
Current TB situation
• Political and financial commitment
– National strategic plan to stop TB in Mongolia
(Objective 3-expand programmatic management of
MDR-TB), MoH, 2009
– National guidelines on tuberculosis care and service
updated and approved by MoH, 2009 (appendix 3guidelines on drug resistant TB services and care)
– Successful resource mobilization from the GFATM
(since 2006 –present, single stream funding)
MDR-TB patients enrolled
(2003- 2011)
• MDR-TB estimates burden by WHO: 106 new MDR-TB
cases every year
• BUT BY END OF 2011 – WE DIAGNOSED 180
• First three month of 2012 – 22 new cases
• DRS survey 2007:
– among new cases: 1.4%
– Among retreatment cases 27.5%
• 893 MDR-TB cases were diagnosed, out of them:
– 58.1% (519) have been enrolled to treatment, 26.5% (237) died,
and 1.3% (12) refused treatment, 1.1% (10) were treated abroad
or private hospital, 0.8% (7) were not able to be enrolled in
treatment due co-morbidities, 12.1% (108) were on the waiting
list.
National TB reference laboratory
with 37 branches and sputum
transportaion scheme
Сүрьеэгийн лабораторийн ойрын 5 жилийн
оношлогоонд гарч буй ахиц дэвшил
2008
2009
DST on SLD
LED microscope
2011
MGIT 960 & SIRE
 CAPILO test
MIRU
 INNO LiPA Rif
HAIN test
2010
 ADA
LED microscope
2012
 MODS
LAMP
Current MDR-TB situation
• Available infrastructure:
– NTRL (DST, culture, liquid culture, LPA on
FLDs)
– Treatment is available through GFATM
support
– Infection control:
– Administrative measures
– General infection control order, approved by
MoH, 2010
– TB infection control guidelines, 2010
Treatment outcomes
Final outcomes for 2008 cohort
Year
Cured
Treatment
completed
Failed
Defaulted
Died
Cure
rate
Treatment
success rate
Total
2006
50
21(42.0)
11(22.0)
8 (16.0)
2(4.0)
8(16.0)
42.0
64.0%
2007
64
40(62.5)
9(14.1)
4(6.3)
6(9.4)
5(7.8)
62.5
76.6%
2008
65
48(73.8)
2(3.1)
3(4.6)
6(9.2)
6(9.2)
73.8
76.9%
179
109(60.9)
22(12.3)
15(8.4)
14(7.8)
19(10.6)
60.9
73.6%
Total
Partners
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World Vision International Mongolia (WVIM) started the implementation of the GF TB grants
since 2005. It has been collaborating with the “Enerel” charity and Prison Hospital on
provision of TB care services for vulnerable population as homeless and prisoners,
conducting active case finding and ACSM activities
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Mongolian Anti-Tuberculosis Association (MATA) worked as sub-recipient (SR)
for GF supported project since 2003 on the implementation of home-based and
lunch-DOT for TB patients through trained health volunteers nationwide. Also they led
ACSM activities for general population as well as for patients and their family to
reduce stigma and discrimination against TB.
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Mongolian Association of Family Clinics (MAFC) implemented the
PPMD since April 2009 within the Round 1 RCC. The MAFC has been
carrying out the following interventions: training TOT among family
physicians on early detection and treatment, referral of TB suspects to a
secondary and tertiary level of TB services, transportation of sputum
samples from primary health care services to TB dispensaries, and
developing clinical guidelines for family doctors
Partners
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Mongolian Antituberculosis Union newly formed in 2011
Health Science University of Mongolia (HSUM) collaborates closely with the NTP
on the revision of the curriculum of relevant health sciences courses including
medical course, nursing and pharmacy. The HSUM is instrumental in on formalizing
of policy documents in collaboration with the Ministry of Education.
The GFATM provides financial support
World Health Organization (WHO) provides technical assistance through its
Country and Regional Offices.
Strength and Weakness
Strengths of T B Control
Program
• Good and detailed National
Strategic Plan to Stop TB in
Mongolia (2010-2015)
• KAP survey for health
providers completed and
published
• KAP survey with general
population in final stages
• Partnerships in place and
community mobilization
• Commitment of staff and
available technical support
Challenges in TB Control
Program
• Human resources (all)
• Limited knowledge of TB (all)
• Stigma and discrimination
(all)
• Coordination
• Significant amount of data
but not used appropriately,
TB prevalence survey not
contacted
• Engaging all
providers/community groups
• Political commitment
Challenges and some factors
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Various vulnerable groups
(homeless, alcoholics, poor)
difficult to reach
Seeking diagnosis late
Treatment default
Infection Control
practices/guidelines not
implemented
No diversified funding for TB
control activities
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Limited knowledge on TB (all) and
availability of services among
population
Limited knowledge on Interpersonal
Communication and Counseling skills
(providers)
Lack of target specific messaging on
TB
No coordination or/and consistency of
TB messages among partners
Coordination, planning, partnerships,
networks
No standardized training curriculum
and tools for providers and community
volunteers
Health providers have no interest to
work in TB sector
Currently limited efforts to gain political
support for TB
Best TB Dispensary
TB HR seminar and Paediatric
department
TB day
• HRD strategy
• ACSM strategy
• TB patient social care
and isolation
• KAP survey
• TB incidence among
HCW
• MoU with high burden
districts
• TB registration web
• Media and web
• Activity among TB
patients
• AXA among school
children
• Debjee- amongTB
Voluntary Workers
• TV education
program
Thank you