tb in india msf missions perspectives_joanna & camillo

7/28/2019 TB in India MSF missions perspectives_Joanna & Camillo

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TB in India

MSF Missions perspectives

MSF TB workshop Delhi 2013By Joanna Ladomirska and Camilo Gomez


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TB/DRTB in India epidemiological highlights (1)

2.000.000 new TB cases every year with 300.000 deaths

100.000 new MDRTB cases estimated by WHO (wentdown to 66.000 ?)

MDRTB official prevalence 4,1% (3% NC 17% RC)

Other data on MDRTB: Chandigarh : 17,4% (9,9% NC 27,6% RC)

Mumbai: 24% NC and 41% RC (2009)

Sweiri TB hospital: 14% MDR, 60% pre-XDR, 20% XDR, 6% XXDR

Hinduja lab: 70,1% FQ resistance

MSF OR first data: 21% with Rif resistance


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DRTB epidemic not linked to HIV man made

High burden

Heterogeneity of the epidemiological context

Amplification of resistance profiles ("MumbaiTDR 2012", clear trend)

70% treated in private sector

Dynamic context ...

TB/DRTB in India epidemiological highlights (2)


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DRTB in India government numbers

Diagnosis: FLDST: 35 LPA, 10 LC - DST, 3 SLC - DST, 30

GeneXperts SLDST: 3

100.000 suspected screened, 16.800 diagnosed(> half in 2012)

Treatment: 6000 MDRTB in 2012

Plans: SLDST: 8 in 2012, 12 in 2014, 22 in 2015 In coming 5 years

160.000 MDR treated, 4100 XDR 3.000.000 DST / year


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TB in India MSF perspective (1)

Magnitude of TB/DRTB epidemic in India

Model of care

Package of care (national protocols and their

implementation / drugs / patient support)

Prevention and IC

Resources

Regulatory and legal issues Advocacy mechanism


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Magnitude of TB/DRTB epidemic in India

Government in denial

No reliable data how to adapt a strategy?

Surveys? Model of care

dysfunctional public and unregulated private

baseline context for all the rest discussions in avacuum


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Package of care national protocols and their implementation

diagnosis GeneXpert role and SLDST availability ... possibilityto decentralized DST?, coverage / access

intermittent treatment, no FDC, standardize not DST based

approach for DR treatment, no mono and poly knowledge abortion access gaps in DOTS implementation, slow scaling up

drugs quality issue in public and private

government supply system availability of intermittent regimen drugs role of WHO

patient support concept itself more service than patient oriented approach

barriers to adherence not analyzed


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Prevention and IC very low awareness

IC procedures?

Resources

money internal / external? HR

Regulatory and legal issues gaps for CU, new drugs ...

Advocacy mechanism epidemic not linked to HIV, need for different advocacyplatform

government not taking into consideration internationalfindings has to be Indian


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TB in India opportunities

technical expertise research capacity strong civil society structure, legal frame for

advocacy, media local production of drugs India international role => when the world

speak about TB, world speak about India BRICs RIC with highest burden CAME and operations present louder

advocacy?

Fascinating context for MSF intervention ...


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5 Projects:

OCAChhattisgarh (MCHC)

Manipur (HIV-MDR)

OCBMUMBAI (HIV/DRTB)AP-CG (PHC)

Nagaland (Hospital)

+ CAME in Delhi ...

TB in MSFprojects inIndia (1)


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TB in MSF projects in India (2)

Integrated approach:

Chhattisgarh OCA and OCB PHC in area affectedby conflict

Nagaland OCB Primary and secondary health carefor neglected population

Vertical approach:

Mumbai OCB HIV/DRTB

Manipur OCA HIV/DRTB

Different level of government involvement /collaboration


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TB in MSF projects Data DSTB

Project 2012 Annual numbersof DSTB cases

CG OCB 129CG OCA 99Manipur OCA 263Nagaland OCB 187Mumbai OCB 11Total 689


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TB in MSF projects Data DRTB

DRTBdiagnosed

Accumulative

MONO POLY MDR Pre

XDR

XDR XXDR Empir. TOTAL

CG OCB 2 4 4 10

CG OCA 2 7 9

ManipurOCA

4 1 29 10 3 47

NagalandOCB

4 1 12 4 1 22

Mumbai OCB 9 8 40 41 16 4 35 153

TOTAL 21 14 92 55 17 4 38 241

* Mumbai currently: XXDR 7%, XDR 20%, PreXDR 26%, MDR 15%, Mono and Poly 8%, Empirical 24%


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TB in MSF projectsDiverse contexts and challenges

Mumbai: complicated resistance profiles co-morbidities, co-infections pediatrics psycho social aspects hospitalization of severe cases

CG accessibility insecurity continuity of care community perception / cultural believes

Nagaland severe cases and unusual presentations

community perception / cultural believes remote area

Manipur accessibility cross border patients HIV co-infection


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TB in MSF projects - Components

1. direct care (DS and DR TB)2. capacity building impact on partners

through support3. advocacy / catalyze for change (including OR)

impact of island of excellence versus advocacy frominside approaches

central and state levels

Those 3 components are present in vertical orintegrated approach, with different level ofactivities.


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TB in MSF projects general aspects

Operations versus advocacy objectives

The way forward? Define MSF role in overall advocacy line Define MSF short and long terms objectives

Intersectional and CAME coordination


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Why this workshop?

Complex context

"campaigning in a vacuum (protocols, drugregistration)

need for new approaches and specific support

clarification of MSF position towards specificproblems to adapt advocacy strategy at

mission level. Importance of India and its opportunities

for MSF


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THANK YOU!

Let's discuss ...

tb in india msf missions perspectives_joanna & camillo

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