tb control in urban settings: authors: said mirza sayedi fileusaid-funded tb care i project is the...

TB Control in Urban Settings:���Urban DOTS contribution to treatment outcome of new sputum smear positive ���TB cases in Kabul city, 2008 – 2011

Authors: Said Mirza Sayedi1, Azizullah Hamim1, M. K. Rashidi2, G. Qader3, L. Manzoor4, ���F. Habibuddin5, P. G. Suarez6, D. Safi1 Affiliations: 1Technical Advisor, TB CARE I, Afghanistan; 2Country Project Director, TB CARE I, Afghanistan; 3Senior Technical Advisor TB CARE I, Afghanistan; 4Urban DOTS Team Leader, National Tuberculosis Program (NTP) of the Ministry of Public Health, Afghanistan; 5Urban DOTS Coordinator, National TB Program; 6Global TB Technical Lead, Management Sciences for Health, Arlington, USA

Kabul’s Poor Health Conditions §  Health infrastructure insufficient to reach 5 million residents

§  Poor tuberculosis (TB) service delivery

§  Low TB treatment success rate = 46%

§  High TB treatment transfer out rate = 46%

TB CAP Responds §  USAID-funded Tuberculosis Control Assistance Program (TB

CAP) introduced the urban directly observed treatment, short course (DOTS) program.

§  The program engaged both the public and private sectors in ���DOTS implementation in Kabul.

§  TB CAP conducted the following interventions:

v Trained health facility staffs on DOTS

v Conducted regular monitoring/supervision visits

v Improved coordination and collaboration between the public and private sectors

v Renovated facilities to provide a safer working environment for staff

For more information, please contact: S. Mirza MD, Technical Advisor, TB CARE I, Afghanistan; Tel: +93 700 481 618; Email: smirza@msh.org

Acknowledgement The Government of the United States of America through the US Agency for International Development (USAID) for funding the TB CARE I project.

TB CARE I Measures TB CAP’s Impact §  USAID-funded TB CARE I project is the follow-on to TB CAP.

§  TB CARE I worked with National TB Program to measure the success of TB CAP’s urban DOTS intervention.

§  Collected TB data from 56 health facilities

§  Compared treatment outcomes from:

v 2008: pre-intervention

v 2009: intervention (began in July)

v 2010/2011: post-intervention

Conclusion §  Urban DOTS helped to

significantly improve TB treatment outcomes in Kabul city (see table and graphs).

Recommendations §  Urban DOTS should be

expanded in similar settings to improve TB case detection and treatment outcomes by engaging both the private and public sectors in DOTS implementation.

A health worker consulting a TB patient while providing DOTS in an urban facility

Urban DOTS Improves TB Treatment Outcomes in Kabul

Treatment Outcomes in New TB Sputum Smear Positive Cases

2008 N=875

2009 N=871

2010 N=1022

2011 (1stQ) N=240

Percentage Improvement

TB Treatment Success Rate 410 (47%) 383 (44%) 642 (62%) 170 (70%) 33%

Transfer Out of TB Treatment Rate 397 (46%) 387 (46%) 270 (26%) 55 (23%) 23%

Death Rate 17 (2%) 18 (2%) 22 (3%) 2 (1%) 1%

Treatment Failure Rate 23 (3%) 41 (4%) 31 (5%) 3 (2%) 1%

Source: National TB Program, Afghanistan, surveillance data, 2008–2011

Trend of Transferred Out of TB Treatment Rate for New Sputum Smear Positive TB Cases in Kabul 2007 – 2011

— Transferred Out Rate

2008 2009 2010 2011 (1st Q)

0% 20% 40% 60% 80%

100%

2008 2009 2010 2011

Perc

enta

ge

Success rate National Target

0% 20% 40% 60% 80%

100%

2008 2009 2010 2011

Perc

enta

ge

Success rate National Target

0% 20% 40% 60% 80%

100%

2008 2009 2010 2011

Perc

enta

ge

Success rate National Target

0% 20% 40% 60% 80%

100%

2008 2009 2010 2011

Perc

enta

ge

Trend of Treatment Success Rate of New Sputum Smear Positive TB Cases in Kabul 2007 – 2011

— Treatment Success Rate���— National Target