Detecting tuberculosis cases through PublicPublic and PublicPrivate Mix Onion Guide, Step 4

1
Detecting tuberculosis cases through
Public-Public and Public-Private Mix (Onion
Guide, Step 45)

• Meeting of the National Tuberculosis Control
  Programme Managers
• Tunisia, Tunis, 7-9 May, 2007
• Dr Amal Bassili
• STB/WHO/EMRO

2
Step 5 Public-Private mix including suspect
management for Undetected cases at private
health facilities
3
Step 4 Public-public mix including suspect
management for Undetected cases at public health
facilities
4
Step-related component of the Stop TB strategy

• Engage all health care providers
• Public-Public and Public-Private Mix
• International Standards for TB Care (ISTC)

5
Strategic Directions

• Developing national situation analyses, national
  policies and operational guidelines followed by
  implementation, scaling up and evaluation of PPM
  DOTS
• Working on the integration of PPM DOTS into TB
  control strategies, including national human
  resource plans
• Monitoring and evaluating the impact of scaling
  up of PPM-DOTS on TB burden and equity in access
  and financial protection for the poor
• Conducting operational research that would
  evaluate ongoing initiatives in order to refine
  PPM DOTS policies and tools.

6
Step-related Tools

• National situation analysis mapping providers
  and provides baseline information about their
  engagement

7
Step-related ToolRevised Recording and Reporting

• Source of referral TB treatment card, TB
  laboratory register, suspect register, TBMU
  register, request for sputum smear examination
• Extent of PPM implementation, and extent of
  non-NTP engagement (through referral diagnosis
  and referral treatment and notification) yearly
  report on programme management in TBMU
• Suspect management quarterly report on suspect
  management

8
Step-related Tools

• In-depth review missions
• NTP reports
• DQ-online
• Global TB report
• Research reports

9
Step-related activities

• 1-Preparation for PPM DOTS
• 2-Delivery of TB services through PPM DOTS
• 3-Training for PPM DOTS
• 4-Suspect management by non-NTP providers.

10
1-Preparation for PPM DOTS indicators
11
2-Delivery of TB services through PPM
DOTSindicators
12
Eastern Mediterranean Region Summary of PPM,
2005 (Global TB report 2007)
13
Eastern Mediterranean Region Summary of PPM,
2005 (Global TB report 2007)
14
2-Delivery of TB services through PPM
DOTSindicators
15
3-Training for PPM DOTS indicators
16
4-Suspect management by non-NTP providers
indicators
17
(No Transcript)
18
(No Transcript)
19
Significant reduction in the of self-referral
20
Contribution of different sectors/providers to
case detection , Syria, 2006
21
Cases by source of referral, Syria, 2006
Few cases are detected from contacts, health
centres, police and prisons. Action
strengthening contact tracing and case
detection/notification from these facilities
Private practitioners contribute to the majority
of detected cases due to ban of selling ATT in
the private sector
Few cases seek care at NTP facilities Action
strengthening ACSM
22
(No Transcript)
23
Notifications from UNRWA during 1998-2005, Syria
24
TB Suspects referred to laboratories for
confirmed diagnosis during one year period,
Tehran, Iran, SGS study 2003-2005
25
Sputum smear positive TB cases detected in NTP
and private labs during one year period, Tehran,
Iran, SGS study 2003-2005
Total208
26
Proportion of confirmed sputum smear positive
cases notified to NTP
27
Proportion of cases detected in the health system

• 208 in NTP and 531 in private labs, of these 82
  were registered by NTP
• By subtracting the 82 found in NTP, the
  undetected cases were 449 in private labs
• Accordingly, the proportion of cases detected by
  NTP is 208 divided by (208449) i.e 32
• Limitations of not covering all providers,
  non-representativeness however, indicates that a
  considerable proportion is missed from the
  surveillance system

28
Concluding remarks..

• PPM is one of the key strategies to increase case
  detection by the health system
• With increasing PPM coverage, the contribution of
  each sector to suspect referral and case
  detection is expected to increase
• National situation analysis allows the country to
  map non-NTP providers thereby provides a baseline
  for future monitoring of PPM coverage
• With 100 coverage, it is expected that no
  substantial change in the contribution of each
  sector to suspect referral and case detection
  over time (saturation).