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Country Profiles - Sri Lanka
The country has a population of 19 million and is among
the low TB prevalence countries in the Region. It is estimated that prevalence
of TB is 79 per 100 000 population. The incidence rate of new smear-positive
cases is estimated to be 27/100 000 population. The country has achieved the
global targets for case detection and treatment success rate. The case
detection rate for 2007 was 85.6% and treatment success for the 2006 cohort
of new smear-positive cases was 87%.
Preliminary data from a new survey in Sri Lanka shows an MDR-TB rate of
1.4% among newly diagnosed cases. Culture and DST is performed for all patients
who fail Category I regimens, at the time of initiation of treatment for all
patients commencing Category II regimens, contacts of MDR-TB cases, all patients
commencing re-treatment regimens, HIV infected TB cases, migrants and
prisoners. MDR-TB is diagnosed at the central reference laboratory, and patients
are treated initially at the referral hospital after which they are referred for
treatment at hospitals in their respective districts. Second-line anti-TB
drugs for treatment of MDR-TB cases are procured by the government from the
open market. Periodic stock-outs have been reported. The success rate among
MDRTB cases is not yet known. National guidelines for the treatment of MDR-TB
have not yet been developed. The country has submitted an application to the Green
Light Committee and will initiate an MDR-TB case management project supported
by the Global Fund.
TB patients have been included under the annual
surveillance for HIV since 1993. Only one HIV positive case has been detected
from among the TB patients tested. However, since 80% of HIV cases reported
in the country are in the age group of 20-44 years, this is a concern
especially since the annual notifications for HIV have been increasing since
1987. A national policy for provision of CPT and ART to HIV positive TB
patients is in place.
The NTP’s plan and budget are aligned with the national
health sector development plan. The public-private approach for TB control
has been initiated on a limited scale maintaining ISTC. Forty two public
hospitals including medical college hospitals and five military hospitals
have been involved by NTP. There is a plan for initiation of Practical Approach
to Lung Health (PAL).
The government provides the majority of funding for the
TB programme, with additional resources from the Global Fund.
Major achievements
 Reaching the global targets in 2005;
Reduction in default rate;
Introduction of fixed dose combinations
(FDCs) and paediatric formulations of FDCs;
Decentralization of diagnostic centres;
Initiation of PPM activities; and
Improvements
in the infrastructure.
Major challenges
and constraints
High
turnover of trained staff;
Introducing TB control in prisons;
Managing cases in tea estates (limited
access to services, overcrowding etc.);
TB
control in conflict-affected areas (no supervision, inadequate staff etc.);
Lack of
opportunities for development for the key staff; and
Stigmatization of TB.
Planned activities
Training of different categories of health
staff including private sector and community DOT providers by using the
modules developed for each category;
Assessment of the laboratory capacity and
planning scale up of Culture and DST facilities;
Improving procurement and supply management
by training of key staff;
Establishing interventions to address
HIV-related TB (TB/HIV) and drug resistant TB;
Strengthening advocacy, communications and
social mobilization approaches;
Improving surveillance, monitoring and
evaluation-
 Maintenance and updating of the software
package;
Regular supervisory visits from the central
unit to districts and from the district to peripheral facilities and organization
of review meetings;
Conducting a joint review of the national TB
control programme with partners; and
Initiating
PAL as a pilot project in 2009.
TB epidemiological profile, Sri Lanka
TB Unit of the WHO Regional Office for South-East Asia
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