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Key Milestones achieved in 2008
DOTS
The entire population in the Region now lives within
access to DOTS facilities; The overall case detection rate reported in 2007
was 68.5%, close to the global target of 70%, and the overall treatment
success rate for the cohort of new smear-positive cases initiated on
treatment in 2006 was 87%. By the end of 2008, five* countries—Bhutan, DPR
Korea, Maldives, Myanmar and Sri Lanka—had achieved or maintained both global
targets for case detection and treatment success under DOTS, based on UN
population figures for the Member countries.
Strengthening
national laboratory networks
External quality assurance for smear microscopy is being
strengthened in all Member countries through training of laboratory staff.
Seven countries—
Bangladesh,
India, Indonesia, Myanmar,
Nepal, Sri Lanka, and Thailand—have at least one
national-level laboratory with facilities for mycobacterial
culture and drug susceptibility testing for the detection of MDR-TB cases. Bangladesh, Nepal
and Sri Lanka are in the
process of having their national reference laboratories accredited for
quality assurance of culture and drug susceptibility testing, while
additional reference laboratories are being accredited in India, Indonesia,
Myanmar and Thailand.
Recognizing that TB-HIV co-infection must be addressed
effectively, national HIV/AIDS and TB programmes in
seven countries in the Region have developed national policies and strategies
for TB-HIV. National level TB/HIV coordinating bodies have been established.
The regional strategic framework for TB/HIV is also being revised and
updated. TB/HIV activities are widely available in Thailand
and are being expanded in India
and Myanmar.
India
is implementing an intensified package of TB/HIV interventions in the nine
states with a high HIV prevalence. There has been a more than 5 fold increase
in referrals from HIV counselling and testing centres to the TB services and more than 3 fold increase
in referrals from the TB to HIV services over the last 3 years. Indonesia,
with a concentrated HIV epidemic, has established interventions in Papua and
Java Bali, which are the country’s HIV high-prevalence areas. Cross-referrals
between the TB and HIV programmes have been
strengthened, and the TB recording and reporting systems in these countries
revised to include information on TB/HIV co-infection.
Bangladesh,
India, Nepal, and
Timor-Leste have established MDR-TB case management
under their national programmes. Nepal has recently expanded to all five
regions in the country, while India
is gradually expanding services to additional states. Indonesia and Myanmar are expected to begin
enrolling MDR-TB patients in early 2009. Two countries, Bhutan and Sri Lanka, have submitted
applications to the Green Light Committee and plan to commence MDR-TB case
management in 2009.
National guidelines for the management of childhood TB
were finalized in Bangladesh,
Indonesia and Myanmar. Myanmar and Nepal
received their first grants for anti-TB paediatric
formulations through the Global Drug Facility (GDF), supported through
UNITAID, while paediatric grants were approved for
DPR Korea and Sri Lanka.
India
is introducing infection control measures in health facilities while Indonesia, Myanmar
and Thailand
will undertake assessments and prepare infection control plans in 2009.
Countries have also included measures to address
vulnerable populations at higher risk and cross-border issues in their
national plans for TB control and Global Fund applications.
Public and private
partnerships
TB technical working groups and/or specific task forces
and sub-working groups have been established both at the regional and at
national levels in Bangladesh,
DPR Korea, India, Indonesia, Myanmar,
and Nepal.
A major strategy towards improving case detection and treatment
success rates has been the inclusion of public health care providers
operating outside the Ministry of Health, such as the railways, military and
prison health services, as well as private providers in all Member countries
where patients seek services through the private health sector. The
International Standards of TB Care were endorsed by professional bodies--
medical associations in India,
Indonesia, Myanmar, and Nepal. Inter-sectoral
collaboration and public-private partnerships for delivery of services were
further scaled up in eight Member countries—Bangladesh,
India, Indonesia, Myanmar,
Nepal, Sri Lanka, Thailand and Timor-Leste. Over 350 medical colleges, 22 000 private
practitioners, 1 500 large public and private hospitals, 150 corporate institutions,
2,500 nongovernmental organizations and 550 prisons are now working with
national TB control programmes. Some recent
initiatives in countries were formal inclusion of pre-service training on the
principles and practices of TB control and establishing of referral
mechanisms through providing lists of DOTS centres
to teaching institutes, inclusion of private laboratories in diagnostic
network and QA systems, and launching of “IMPACT” a coalition of professional
associations for TB control, in India. In 2008, India also formally established a widely
inclusive national partnership, becoming the second country in the Region to
establish such a partnership, in addition to Indonesia. Indonesia
intensified training of private and public hospital and laboratory staff and
introduced coordination meetings between community health facilities and
hospitals to improve transfer mechanisms between lung clinics and puskesmas. In Myanmar, services have been
resumed throughout the network of PSI Sun Quality Clinics and the NTP plans
further expansion of public/private mix services through the Myanmar Medical
Association. There are also very encouraging examples of community-based
approaches in several countries, but these need to be systematically
documented and the experiences used to more widely replicate successful
models at the national level.
Surveillance,
monitoring and evaluation
TB prevalence and incidence were revised for Timor-Leste based on a review of more recent data and trends in
cases notified and for DPR Korea based on an ARTI survey completed in 2007.
Annual reports were received from all countries and are being used to
finalize the Regional and WHO Global reports for 2009.
In five countries in the Region, drug resistance surveys
were conducted or will continue through 2008-2009, to assess the extent of
anti-TB drug resistance among TB patients. The overall rates
of multi-drug resistant TB (MDR-TB) in the Region is 2.8 % among new
smear-positive patients and 18.8% among previously treated patients.
Surveillance for HIV prevalence among TB patients is
undertaken routinely in Thailand
and in nine states in India.
In Myanmar, Nepal, Sri Lanka and in the remaining
states and union territories in India, data from sentinel surveys
are used to follow trends in HIV prevalence among TB patients.
These surveys are contributing to more accurate
estimations of the burden of disease. At the same time, countries are
beginning to focus on mechanisms that will ensure that routine case
notifications begin to reflect the disease magnitude and trends. Data
management software was upgraded in Myanmar
and Nepal and further
improvements made in the Windows-based EPI centre software in India.
Training on data management and analysis for central and international level programme staff were conducted in Bangladesh, India,
Myanmar and Thailand.
The practice of quarterly and annual internal reviews and
larger joint reviews every two/three years, inviting international experts
for joint monitoring and evaluation together with national programmes and partners was continued. These have helped
to objectively review the performance of the respective national TB programmes, and lead to substantial improvements in programme performance.
Resources
Domestic funding for TB control continues to account for
over half of the funding for national TB control programmes.
By the end of 2008, a total of 23 proposals were approved by the Global Fund
in support of TB control programmes in the Region.
In addition, nine Member countries benefit from funds from other development
partners and donor governments with the exception of Bhutan and Maldives where the only external
funds are through WHO country budgets.
All 11 Member countries continue to access quality-assured
affordable anti-TB drugs on a regular basis through grants or direct
procurement services of the Global Drug Facility.
Operational
Research
National TB programmes and
partners are engaged in carrying forward several operational research
projects. Examples are public-private mix (PPM) models in India and
Indonesia; field testing of new diagnostics and shorter treatment regimens in
India; approaches to community-based TB care in Bangladesh, India, Indonesia,
Thailand and Timor-Leste.
In addition, some support continues to be received through
the small grants scheme under TDR. National workshops on operations research
priority setting and dissemination are held regularly in India.
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