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Treating tuberculosis in Chechnya: a remote control approach

содержание презентации «Treating tuberculosis in Chechnya: a remote control approach.ppt»
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1Treating tuberculosis in Chechnya: a 9(previously-treated cases) Drugs: local
“remote control” approach. Gabit Ismailov purchase validation scheme by MSF
MedCo MSF-H, Russian Federation. pharmacists network DOT by MoH healthcare
2Background. 1994-1996 – first Chechen workers: Intensive phase in the TB
war 1999-… - second Chechen war. hospital Continuation phase DOT by primary
3MSF in Chechnya. MSF programmes: healthcare workers in “DOTS corners”
Donation of non-food items Drug daily/intermittent Follow-up: Direct
Distribution Primary Health Care Mental Sputum Smear Microscopy Chest X-Ray.
Health TB Surgery Emergency response. 10Assuring TB treatment adherence in a
4TB programme background. TB programme conflict zone. Individual case management
in Chechnya started in May 2004 4 Defaulter tracing activities Health
hospitals 5 districts 300,000 people in education Mental health counselling Peer
the catchment area over 750 TB patients support groups Continuing medical
enrolled since the start of the programme. education Incentives and enablers food for
5“Remote control”. MoH staff runs daily patients food for healthcare workers
TB services Experienced national staff in “Runaway” bags FDCs.
the project locations supervise and 11Case Finding. From May 2004 up to
organise TB services Regional coordination March 2006, 670 patients were enrolled in
office in Nalchik, Kabardino-Balkaria the programme: 543 smear+ pulmonary TB
Infrequent visits by international staff cases 111 smear- pulmonary TB cases 16
to project sites since December 2004 A extrapulmonary TB cases (only 12 children)
small country management team in Moscow. 433 new case 237 previously treated cases
6Programme quality control mechanisms. male:female ratio ~ 2:1 3 HIV+ cases.
Cross-checking of collected data (TB 12Outcomes. Outcomes. Cured. Rx
registers, lab registers, etc) Regular comp-leted. Died. Failure. Rx
meetings with national MSF staff; inter-rupted. Trans-ferred out. TOTAL. New
programme updates; discussions, etc. sputum smear-positive cases*. 94% (138).
Regular international and national 2% (3). 1% (1). 1% (2). 1% (2). 1% (1).
trainings Occasional supervisory visits by 100% (147). New sputum smear-negative and
international staff including “on-site” extrapulmonary*. 0% (0). 94% (15). 0% (0).
validation, e.g. cross-checking slides, 0% (0). 6% (1). 0% (0). 100% (16).
patient interviews, etc. Previously treated cases**. 66% (33). 0%
7Project Goals. Cure all TB patients (0). 16% (8). 16% (8). 0% (0). 2% (1).
from the districts in Chechnya where MSF 100% (50). ALL CASES. 80% (171). 8% (18).
operates. Establish and maintain a system 4% (9). 5% (10). 1% (3). 1% (2). 100%
of good quality diagnosis by the means of (213). * Cohorts Q2-4 2004 and Q1 2005 **
direct sputum smear microscopy. Treat all Cohort Q1 2005, 47 previously treated
diagnosed TB patients with the first-line patients.
anti-TB drugs and maintain good treatment 13Problems. Some patients are not
adherence. Ensure access to quality enrolled (“chronics”) Some patients from
counselling services for all TB patients outside the catchment area Very few
and relatives. Ensure access to quality children with TB enrolled Extrapulmonary
HIV/AIDS follow-up and ARV therapy for all TB Few women enrolled Drug resistance in
TB-HIV co-infected patients in supported previously-treated cases?
TB facilities. 14Success. Very good outcomes for new
8Case Finding. Passive case finding cases Very good treatment adherence
Direct Sputum Smear Microscopy No reliable Dedicated team Motivated patients.
reference laboratory Cross-checking 15Reasons for “success” in new cases in
between 4 participating laboratories with suspected high drug resistance settings.
MSF involvement QC % of agreement over 80% Null Hypothesis: The outcomes are true
Starting external MoH QC PA Chest X-Ray No (we’ve done a great job!) Or are there
culture, no DST Active case finding among some caveats? selection bias unreliable
risk groups by MoH but only “on paper” data collection? no primary drug
Systematic obligatory HIV testing by MoH. resistance in the region other …
9Treatment and follow-up. Standard 16Current Status. TB and HIV
treatment regimens: 2HREZ(S)/4HR (new co-infection Programme expansion? MDR-TB?
cases) 2HREZS/1HREZ/5HRE
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Treating tuberculosis in Chechnya: a remote control approach

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