adamawa state tb and leprosy control programme overview, 2014
DESCRIPTION
Tuberculosis and Leprosy Control in Nigeria; Interventions and resultsTRANSCRIPT
ADAMAWA STATE TUBERCULOSIS AND LEPROSY CONTROL
A presentation @ the 1st Quarter Zonal TBL Review Meeting:
2014
By: Stephen John, MD, MPH/ICHDProgramme Manager
Outline…• Background• Activities planned & outcome• TB data presentation & analysis• EQA• STOP TB thematic areas• Leprosy data presentation & analysis• TB REACH • Challenges/Recommendations• Plans for 2nd Qtr, 2014
BACKGROUND INFORMATION• Land Mass 42,000 sq km• No of LGAs 21• State population 3.8 million• Total No of HF >1297• DOTS Expansion:
• Total # of DOTS Centers 142 (1/27,000 pop: G=12)
• 118 notified TB cases in Qtr, 1• 20 HFs detected between >10 TB patients
• Microscopy Center Coverage:• Total # of Microscopy Centers 44 (1/87,000 pop:
G=4)
• Total No of MDT clinics 98
Activities Implemented
Key activities planned & implementedPlanned Funding Source Outcome Remarks
Supervisions: State Team, LGTBLS &QA Supervisions
NLR, GFATM, TB CAREWHO
State Team: 19 LGAs reportedLGTBLS: 231QAO: 38 laboratories supervised
Improved reporting/feedback system
Meetings: TB/HIV TWG, Qtrly Prog. Review & QA Lab Meeting
GFATMIPs
Implemented (except TB/HIV TWG)
FHI 360 sponsors TB/HIV TWG
TB REACH: ACF, ACSM, GX, Supervision, OR
WHO Yr 1 & 2 successfully ended, No-cost extension approved
Improved TB case notification
Radio Jingles on TBL
TB REACH On-going
ACF in 2 Districts of Girei LGA
Janna Health Foundation /ATBLCP
Over 600 screened for TB. HIV & Leprosy: 12 TB cases detected
Adamawa TB Case Notification: 2005 - 2012
2005 2006 2007 2008 2009 2010 2011 2012 20130
500
1000
1500
2000
2500
3000
3500
4000
27522849
2623
29982866
2900
2644
3329 3460
1198 1293 12961184
984
1314
1122
1812
1667
197 209 178129 121 92 156 193 291
All TB SM +ve EPTB
TB Reach
TB case notification: Comparing Q4 of ‘12 and ‘13
Qtr 4 '12 Qtr 4, '130
100
200
300
400
500
600
700
800
900
1000787 781
441
367
48 65
All Cases Sm +ve EPTB
EQA Activities
EQA
• 36 Microscopy centers participated• 29 had >95% concordance• Rechecking/Panel testing• Labs with errors identified• Slide positivity rate among suspects: 11%
Trends of Cure Rate: 2006 – 2012
2006 2007 2008 2009 2010 2011 20120
20
40
60
80
100
77
83 82 83
77 82 82
7377 77 78
91
78 75
Cura Rate (CAT I) Cure Rate (CAT 2)
STOP-TB Thematic Areas
CTBC• 20 LGAs involved• Main role is TB suspect identification & referral• CV activities supported by:– HAF– TB Reach– ADSG– FHI360
CTBC Data: 2010 - 2013
2010 2011 2012 20130
500
1000
1500
2000
2500
479
515
1560
2225
134
176
257410
TB Suspects Refered TB Cases Notified
TB/HIV• Key Partners:– FHI360, Optimum Initiative, Janna Health Foundation– WHO/FMOH/NLR, TB CARE 1.
• DOTS/HCT sites:• 115 of 142 (81%) DOTS centers
TB/HIV Data: 2009 - 2013
2010 2011 2012 20130
500
1000
1500
2000
2500
3000
3500
2417 2518
3100 3164
18811942
2239
2419
487 475 423 426367 389 384 394
116 176 207 245
Counseled Tested Positive On CPT On ARV
TB/HIV Data: Comparing Q4, ‘12 & ‘13
Qtr 4, '12 Qtr 4, '130
100
200
300
400
500
600
700
800
900
1000
691747
501
586
77 9075 88
3964
Counseled Tested Positive CPT ART
Thematic Areas: Contd..• PPP:– 18 facilities: 12 had patients on treatment (9 in 3rd Qtr)– 58 TB cases notified in the Qtr (37 in 3rdQtr)
• TB in Congregate Settings:– 2 prisons & 1 barracks– 3 TB case notified (2 in the Barrack Med Centre)
• ACSM:– Advocacy on-going– Training on TB & ACF expected in 7 high endemic LGAs
• DR-TB:– Suspects have access to preliminary screening (Gx)
Leprosy
Leprosy Control Interventions…– Rapid Village Surveys (RVS)– Intensified Contact Examination (ICE)– Community Volunteers
Trends of Leprosy New Case Detection: 2006 - 2013
2006 2007 2008 2009 2010 2011 2012 20130
50
100
150
200
250
300
257 242 237
196
234
171
234
200
Leprosy NCD
Trends of MB & Child %: 2008 – 2013
2008 2009 2010 2011 2012 20130
20
40
60
80
100
5 5
7 40
4
92 91
9492
9896
Child % MB%
Buruli Ulcer
• Nil Cases in the Quarter
Update on TB REACH:Nomads/Koma Communities (Wave 2 Year 2)
Background• Target Population: 0.5m• Evaluation Population: 3.7m• Control Population: 2.6m• Objective:– To expand TB services in an innovative and highly
collaborative manner through the involvement of the Nomadic and Koma leadership to ensure that the communities have ownership over the design, implementation and sustainability of the project
– To determine whether or not the incidence rates of TB among the target population is higher as compared to the evaluation population
Key Interventions• Mainly 3:–ACSM:
• Committee exists; meets, plans and implement activities quarterly (mainly advocacy & resource mobilization to sustain the project)
• Radio jingles & TV programmes
–Active Case Search (Rapid surveys & Intensified Contact Examination)
• Community Health Education/Seminars on TB• Screening of community members for TB• Transport of TB suspect sputum where necessary
–Use of GeneXpert equipment:• Transportation of an early morning sputum specimen from SS-
TB suspects for GeneXpert analysis
TB Suspect Management: 2013
0
5000
10000
15000
20000
45100
6790
5287
549 893
TB Cases Notified (TB Reach) : 2013
20130
200
400
600
800
1000 893
486
45
All SS+ EPTB
Data from GeneXpert: 2012 (n = 1031)
11519
817
674
MTB+/Rif- MTB+/Rif+ MTB-/Rif- MTB+/Rifdt Inv/Err
11%7%0.6%
2%
79%
TB Reach & the Programme• Government:– Improved contribution
• Increased Stakeholder participation/support• Dissemination:– National Council on Health– Union Conferences– TB Reach meetings
• Other States & TB Control among Nomads• Sustainability…..
Key Challenges• DOTS: – Strengthening– Expanding PPM
• EQA:– Limited microscopes
• CTBC:– Attrition– Incentives
• TB/HIV:– Test Kits
Recommendations• State Team to ensure strategic expansion– Mainly private facilities (on-going)
• NTBLCP to provide microscopes (State Gov’t too)• CV motivation:– Standardize incentives?
• Continuous advocacy for HIV Test Kits
Plans for 2nd Qtr, 2014• NLR activities:– Training (low endemic)– Supervision
• GFATM Activities:– Meetings– Supervision
• TB Reach (No-cost extension approved):– ACF– Supervision
Thank You