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 Sayedi 1 , Azizullah Hamim 1 , M. K. Rashidi 2 , G. Qader 3 , L. Manzoor 4 , F. Habibuddin 5 , P. G. Suarez 6 , D. Safi 1 Affiliations: 1 Technical Advisor, TB CARE I, Afghanistan; 2 Country Project Director, TB CARE I, Afghanistan; 3 Senior Technical Advisor TB CARE I, Afghanistan; 4 Urban DOTS Team Leader, National Tuberculosis Program (NTP) of the Ministry of Public Health, Afghanistan; 5 Urban DOTS Coordinator, National TB Program; 6 Global 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: Trained health facility staffs on DOTS Conducted regular monitoring/supervision visits Improved coordination and collaboration between the public and private sectors 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: [email protected] 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: 2008: pre-intervention 2009: intervention (began in July) 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 (1 st Q) 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 (1 st Q) 0% 20% 40% 60% 80% 100% 2008 2009 2010 2011 Percentage Trend of Treatment Success Rate of New Sputum Smear Positive TB Cases in Kabul 2007 – 2011 — Treatment Success Rate — National Target

TB Control in Urban Settings: Authors: Said Mirza Sayedi fileUSAID-funded TB CARE I project is the follow-on to TB CAP.! TB CARE I worked with National TB Program to measure the Collected

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Page 1: TB Control in Urban Settings: Authors: Said Mirza Sayedi fileUSAID-funded TB CARE I project is the follow-on to TB CAP.! TB CARE I worked with National TB Program to measure the Collected

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: [email protected]

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%