zero tb karachi: targeting multiple diseases from a single disease … · 2019. 10. 7. · from a...
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Zero TB Karachi:
Targeting Multiple Diseases
from a Single Disease Platform
Aamir Khan MD, PhD
Executive Director
IRD, Singapore
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Outbreak Response: community-based TB/HIV screening
Zero TB Working with Provincial HIV program
• HIV outbreak response - collaboration
across public and private sector
• Concurrent TB & HIV screening camp
• 1000 HIV positive individuals found
• >800 were children
• 3 MTB positive individuals identified
• Continued active screening for TB/HIV
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Zero TB CITIES is a global initiative
targeted at creating “islands of elimination” with strong local ownership in high burden settings
Zero TB implements evidence-based Search, Treat & Prevent approaches from around the world shown to be successful in controlling TB
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Zero TB Cities and districts – current, new and potential
Almaty, Kazakhstan**Balti, MoldovaBangkok, Thailand**Chennai, IndiaDhaka, Bangladesh*Geissen, GermanyHai Phong, VietnamHanoi, VietnamHo Chi Mihn City, VietnamIndore, India**Karachi, PakistanKathmandu, Nepal**Kano, Nigeria**Kisumu, KenyaLagos, Nigeria **Lima (Carabayllo), Peru
Manila, Philippines**Melbourne, Australia**Mexicali, MexicoMtata, South Africa** Mumbai, India**Muscat, Oman**Odessa, UkrainePattaya, Thailand**Peshawar, PakistanQuetta, Pakistan**Shenzhen, China*Sofia, Bulgaria** Tbilisi, Georgia**Ulaanbaatar, MongoliaVladimir, Moscow
* First of multiple cities planned** Discussions of alignment underway
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Pakistan’s Zero TB Initiative Global Fund Support2016-2017 USD 40m – Zero TB Karachi +32 districts2018-2020 USD 40m – Zero TB Karachi, Peshawar, Quetta + 32 districts
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3 Zero TB Cities /
32 districts
> 3 million
symptom screened
>1.5 million
Screened by CXR
>61,000TB
patients notified
55 mobile X-ray vans
~1200 staff
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Karachi: All Forms TB Notifications2008 – 2018
16,104
14,470
15,993
17,545
19,33618,115
18,693 18,270
20,560
25,064 25,339
0
5000
10000
15000
20000
25000
30000
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
No
tificatio
ns
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TB-HCV Integrated Screening and Treatment
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HCV Testing and Treatment Cascade Jan to July 2019
20371
10078(49%)
9598(95%)
806(8%)
745(92%)
475(64%)
324(68%)
245(76%)
0
5000
10000
15000
20000
25000
Eligible forscreening
Verbalscreening
RDT screening Anti HCV +ve PCR testing PCR positive Baselineevaluation
Treatmentinitiation
Num
ber
of In
div
iduals
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Karachi HCV Micro-Elimination Plan:
Korangi, Landhi, Ibrahim Hyderi
No. of people
screened*
203,593
Anti HCV +ve
14,252 (7%)
Baseline PCR testing
12,826 (90%)
Diagnosed
6413 (50%)
Started on Treatment
5772 (90%)
7% prevalence
10% drop out rate
50% active viremia
Treatment complete
5599 (97%)
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Integrated HCV-TB Diagnostic Services
Expansion of HCV services via integration with
GeneXpert testing facilities throughout the
private and public sector
157Number of GeneXpert machines
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Integrated Practice Units (IPU)
Integration of mental health and diabetes services with 6 existing TB facilities to improve adherence, treatment outcomes and provide holistic care
Mass screening for
Depression & Anxiety
TB Adherence & Mental
Health Counseling
Psychologist-Severe
Case Consultation
Diabetes Screening
and Consultation
Diabetes Medication and
Counseling
Supported by the Harvard Medical School-Center for
Global Health Delivery-Dubai
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Psycho-Social Support Interventions (PSSI)
IPUs developed
across public and private hospital
settings
Counselors trained
and deployed
Screened for
Depression and Anxiety. 30% Symptomatic
Enrolled and given
baseline adherence counselling. 562completed MH
intervention
Screened for
Diabetes. 21%Symptomatic
6 3,500 1,01210 3,441
Integrated Practice Units (IPU)
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92% of patients who completed
the mental health intervention also
completed TB treatment,
compared to a 75% TB
treatment completion rate in those
who did not complete the mental
health intervention (Unpublished data)
Key Finding from Integrated Practice Unit (IPU)
for Mental Health and TB
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Gavi Pilot - Integrating Immunization & Mobile Van TB
Screening Services in Pakistan
Mobile Screening
Vans across Pakistan
55
+
Gavi supported
immunization
services being integrated
in to private sector TB
diagnostic centres
supported by Global Fund
Sehatmand Zindagi
Centres across Pakistan64Balochistan
+
Pooling resources with TB
vans instead of buying new immunization only vans
Karachi
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ConclusionsTargeting Multiple Diseases from a Single Disease Platform
• Demonstrated feasibility in Zero TB Karachi context
– TB, HIV, mental health, routine immunization, diabetes
• Responsive to needs of patients and communities
– Improved community engagement and treatment outcomes
• Synergizes investments from multiple sources
– cost savings, more efficient use of testing platforms, pooled procurement
• More focus required from donors and governments for multi-disease
platforms (i.e. health systems strengthening)