Sixth Meeting of the Working Group on MDR-TB of the Stop Tb Partnership

20 – 22 September 2007

Tbilisi, Georgia

Lessons learned about the management of

second-line anti-TB drugs

Jaime Bayona, MD, MPH (PERU)

Health Promoters = 10 Patients = 14Health Promoters = 10 Patients = 14

Expanding the Community-Based

MDR-TB Care Model

Year 1996: Carabayllo (Northern Lima)

Expanding the

Community-Based MDR-TB Care Model

Year 2007: 12 Regions

• Piura

• Lambayeque

• La Libertad

• Ancash

• Lima y Callao

• Junín

• Ica

• Arequipa

Health Promoters = 700 Patients > 6,000Health Promoters = 700 Patients > 6,000

Lesson # 1: Political will

Global Fund & NTPNTP√2006

Global FundNTP√2005

Global FundNTP√2004

Gates FoundationNTP√2003

Gates FoundationNTP√2002

Gates FoundationNTP√2001

Private donorsNTP98-00

Private donorsNTP1997

Private donors1996

ITRSTR

Source of fundingGLCYear

Fuente: Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis-DGSP/MINSA

NTP Peru’s budget: Years 1991-2006

0

2

4

6

8

10

12

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Average budget during 1991- 2005:

3 000,000 USD

Millones $ USD

9 780,000 USD

Change of leadershipHigh turnover of staffHealth Sector Reform

133

813 12

2

36

0

20

40

60

80

100

120

140

Dr PS Dr RA Dr ET Dr RC Dr DZ Dr CB

Months

Adapted from Revista de la Sociedad Peruana de Neumologia Vol 48-N°1 – En-Abr 2004

Lesson # 2:

Uninterrupted access to good quality 2nd line anti-TB drugs

is a constant challenge

Donor(s)

&

local

representative

of donor

Lesson # 3: Managerial support useful at the start, with the plan of transferring

responsibility to NTP

• Selection of the regimen (STR or ITR or empiric)

• Process of purchasing

• Distribution

• Use of the MDR TB meds

Donor(s)&

local

representative

of the donor

Lesson # 4: Promote expanding partnerships while maintaining state leadership

PARTNERS TB CONTROLWHO/PAHOPIH/SESHARVARD

MSLICDC

TASK FORCE

Lesson # 5: The process of ordering the drugs needs to be improved

Donor

&

Principal

Recipient

GLC approval date Request for quote6 m

Request for ordering3 m

Meds delivery

6 m

Lesson # 6: The quality of the medicines purchased outside GLC is unknown and uncertain

• Shortage of meds: CM, PAS, CS

• Short shelf life

• Cold chain (PASER)

• Modification of regimen

• Enrollment process/ordering

• Change in duration of treatment

Lesson # 7: Several constraints need to be resolved

Lesson # 8: It is important to have a warehouse with Good Storage Practices in place

Lesson # 9: Technical assistance should be also uninterrupted

Lesson # 10: Sharing experiences enriches all parties involved

Thank you very much!

¡Muchas gracias!