National TB Control Program

Manila, Philippines

National TB Control Program

Manila, Philippines
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Quelapio M.I.D.,Philippine Institute of Tuberculosis | Mira N.R.C.,Philippine Institute of Tuberculosis | Orillaza-Chi R.B.,Philippine Institute of Tuberculosis | Belen V.,Philippine Institute of Tuberculosis | And 6 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2010

SETTING: The Philippines ranks eighth among 27 priority countries for multidrug-resistant TB (MDR-TB). OBJECTIVE: To describe a model of public-private partnership in MDR-TB management. METHODS: An exploratory study of integrating MDR-TB management initiated in private-public mix DOTS into the National TB Programme (NTP). RESULTS: Recognising that MDR-TB was a threat to DOTS, the Tropical Disease Foundation initiated MDR-TB management in 1999. An official mandate for the integration of MDR-TB services into the NTP was issued by the Department of Health in 2008. With an increased government budget augmented by support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, 1294 MDR-TB patients were placed on treatment from 1999 to 2008. The treatment success rate improved from 64% in 1999 to 75% in 2005. There are now five MDR-TB treatment centres with 181 treatment sites in Metro Manila, and three culture centres. People trained include 12 master trainers, 31 trainers, 25 treatment cen tre and 381 treatment site staff. CONCLUSION: Mainstreaming into the NTP of this unique model of MDR-TB management through a dynamic public-private collaboration can be considered best practice in implementation science of an evidence-based intervention leading to change in health care policy and practice. © 2010 The Union.


Ahuja S.D.,Bureau of Tuberculosis | Ashkin D.,Ag Holley Hospital | Avendano M.,University of Toronto | Banerjee R.,Mayo Medical School | And 67 more authors.
PLoS Medicine | Year: 2012

Background: Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB. Methods and Findings: Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]).Conclusions:In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment.Please see later in the article for the Editors' Summary. © 2012 Ahuja et al.


Awan I.N.,Pmas Arid Agriculture University | Ali Rizvi S.K.,Pmas Arid Agriculture University | Nadeem Saqib M.A.,Quaid-i-Azam University | Shahzad M.I.,Pmas Arid Agriculture University | And 6 more authors.
Pakistan Journal of Zoology | Year: 2012

Tuberculosis (TB) is a fatal and contagious disease. The annual death toll occurring from TB is approximately 2 million according to World Health Organization (WHO). The removal of disease from global face needs immediate treatment for which early diagnosis is pre-requisite. Existing tests for the diagnosis of TB are not efficient and robust. In the present study Mycobacterium tuberculosis specific six antigens namely cfp-10, esat-6 and hspx, along with three antigens which are components of immunodominant mycolyl transferases ag85a, ag85b, ag85c were expressed and purified to evaluate their potential use in immunoassays like Western blotting and multiplex microbead immunoassay. Protein expression of all six antigenic genes was optimized for time and different concentrations of inducer isopropyl β-D-1-thiogalactopyranoside. Protein products were confirmed by Western blotting and purified through immobilized metal affinity chromatography (IMAC) technique using columns having affinity for His-tag. Each fluorescently labeled set of microbeads were coated with one of the M. tuberculosis specific antigenic proteins and later on human plasma samples of reactivated TB patients along with healthy BCG as well as tuberculin skin test negative controls were tested for presence of antibodies against these antigenic proteins individually in a multiplex format. The results were generated in median fluorescence intensity form which detected antibodies against M. tuberculosis specific antigenic proteins only in reactivated TB patients. This system detected antibodies against four antigenic proteins in 100% of reactivated TB patients. Thus, M. tuberculosis antigens described in this study seem to have purified at the level to be used in the development of immunoassays for the detection of M. tuberculosis infection in TB patients of different categories like active and latent TB. © 2012 Zoological Society of Pakistan.


Khan I.H.,University of California at Davis | Ravindran R.,University of California at Davis | Krishnan V.V.,University of California at Davis | Krishnan V.V.,California State University, Fresno | And 11 more authors.
Clinical and Vaccine Immunology | Year: 2011

Two billion people are infected with Mycobacterium tuberculosis, the etiological agent of tuberculosis (TB), worldwide. Ten million to 20 million of the infected individuals develop disease per year. TB is a treatable disease, provided that it is diagnosed in a timely manner. The current TB diagnostic methods are subjective, inefficient, or not cost-effective. Antibody-based blood tests can be used efficiently and cost-effectively for TB diagnosis. A major challenge is that different TB patients generate antibodies against different antigens. Therefore, a multiplex immunoassay approach is needed. We have developed a multiplex panel of 28 M. tuberculosis antigen-coated microbeads. Plasma samples were obtained from over 300 pulmonary TB patients and healthy controls in a country where TB is endemic, Pakistan. Multiplex data were analyzed using computational tools by multivariate statistics, classification algorithms, and cluster analysis. The results of antibody profile-based detection, using 16 selected antigens, closely correlated with those of the sputum-based diagnostic methods (smear microscopy and culture) practiced in countries where TB is endemic. Multiplex microbead immunoassay had a sensitivity and specificity of approximately 90% and 80%, respectively. These antibody profiles could potentially be useful for the diagnosis of nonpulmonary TB, which accounts for approximately 20% of cases of disease. Since an automated, high-throughput version of this multiplex microbead immunoassay could analyze thousands of samples per day, it may be useful for the diagnosis of TB in millions of patients worldwide. Copyright © 2011, American Society for Microbiology. All Rights Reserved.


PubMed | National TB Control Program, Mahatma Gandhi Institute, Stop TB Partnership, Burnet Institute and 2 more.
Type: Journal Article | Journal: PloS one | Year: 2016

Currently, only 62% of incident tuberculosis (TB) cases are reported to the national programme in Pakistan. Several innovative interventions are being recommended to detect the remaining missed TB cases. One such intervention involved expanding contact investigation to the community using the Xpert MTB/RIF test.This was a before and after intervention study involving retrospective record review. Passive case finding and household contact investigation was routinely done in the pre-intervention period July 2011-June 2013. Four districts with a high concentration of slums were selected as intervention areas; Lahore, Rawalpindi, Faisalabad and Islamabad. Here, in the intervention period, July 2013-June 2015, contact investigation beyond household was conducted: all people staying within a radius of 50 metres (using Geographical Information System) from the household of smear positive TB patients were screened for tuberculosis. Those with presumptive TB were investigated using smear microscopy and the Xpert MTB/RIF test was performed on smear negative patients. All the diagnosed TB patients were linked to TB treatment and care.A total of 783043 contacts were screened for tuberculosis: 23741(3.0%) presumptive TB patients were identified of whom, 4710 (19.8%) all forms and 4084(17.2%) bacteriologically confirmed TB patients were detected. The contribution of Xpert MTB/RIF to bacteriologically confirmed TB patients was 7.6%. The yield among investigated presumptive child TB patients was 5.1%. The overall yield of all forms TB patients among investigated was 22.3% among household and 19.1% in close community. The intervention contributed an increase of case detection of bacteriologically confirmed tuberculosis by 6.8% and all forms TB patients by 7.9%.Community contact investigation beyond household not only detected additional TB patients but also increased TB case detection. However, further long term assessments and cost-effectiveness studies are required before national scale-up.


Soomro M.H.,Isra University of Pakistan | Shahzad F.,University of Bergen | Khan M.A.,Association for Social Development | Qadeer E.,National TB Control Program | Morkve O.,University of Bergen
Journal of Medicine (Bangladesh) | Year: 2015

Background: Tuberculosis is a serious global public health, social and economical problem that affects millions of people particularly in low income countries. The aim of this study was to see the loss to follow up pattern in Tuberculosis patients in district Rawalpindi, Pakistan. Materials and method: A cross-sectional study was conducted in district Rawalpindi between August and October 2010. All sputum smear positive Tuberculosis patients diagnosed and treated in public sector, urban and rural diagnostic centers of the district Rawalpindi during the year 2008 were included in the study.All cases other (smear negative pulmonary and extra-pulmonary) than sputum smear positive and all private hospitals were excluded. Results: A total of 451 patients were enrolled in the study. Majority of the patients (89.6%) were provided with the treatment support. Geographically dropout rate was observed higher in urban patients than in rural 18.7% vs. 10.5%. On the other hand by patient gender, drop out was seen more in male patients than in females 16.5% vs. 13.1%. By patients age groups, interestingly patients under the childhood age group all the patients completed the treatment while drop out was observed more in older age group. Conclusions: Loss to follow up pattern was seen more in urban patients, by gender more in male patients and by age groups observed more in older patients. © 2015, J MEDICINE. All rights received.


Soomro M.H.,Shaheed Mohtarma Benazir Bhutto Medical University | Soomro M.H.,University of Bergen | Qadeer E.,National TB Control Program | Khan M.A.,Association for Social Development | Morkve O.,University of Bergen
Tanaffos | Year: 2012

Background: Tuberculosis (TB) is a major cause of mortality affecting millions of people in third world countries. In DOTS monitoring of patients is facility-based and treatment supporter-based; by these two ways patients' compliance to treatment is monitored. The aim of this study was to evaluate the role of treatment supporters and their impact on patients' treatment outcomes. Materials and Methods: The study was a cross-sectional survey in the routine TB control program operational context. All sputum smear positive TB patients that were diagnosed and registered by the public sector in the urban and rural diagnostic centers in 2008 with available outcomes were included in the study. Data of 451 patients were collected during August-October 2010 from 15 health facilities. Results: The majority of patients (89.6%) were provided with treatment supporters. Of 404 (89.6%) cases with treatment supporters, in 203 (50.2%) the supporters were lady health workers, in 46 (11.4%) were community health workers and health facility workers, and in 155 (38.4%) were family members and community volunteers. A total of 384 (85.1%) were categorized as "treatment success", 31 (6.9%), as "transferred out", 17 (3.8%), as "expired", 16 (3.5%) as "defaulted" and three (0.7%) as "treatment failure". The treatment success rates in patients supervised by Lady health workers, community health workers and health facility workers, and family members and community volunteers were 93.1%, 89.1% and 73.5%, respectively. Conclusion: We found a significantly higher treatment success rate (93.1%) in patients supervised by lady health workers compared to others. The overall treatment success rate was 85.1%. © 2012 NRITLD.


PubMed | National TB Control Program, Association for Social Development and University of Bergen
Type: Journal Article | Journal: Tanaffos | Year: 2014

Tuberculosis (TB) is a major cause of mortality affecting millions of people in third world countries. In DOTS monitoring of patients is facility-based and treatment supporter-based; by these two ways patients compliance to treatment is monitored. The aim of this study was to evaluate the role of treatment supporters and their impact on patients treatment outcomes.The study was a cross-sectional survey in the routine TB control program operational context. All sputum smear positive TB patients that were diagnosed and registered by the public sector in the urban and rural diagnostic centers in 2008 with available outcomes were included in the study. Data of 451 patients were collected during August-October 2010 from 15 health facilities.The majority of patients (89.6%) were provided with treatment supporters. Of 404 (89.6%) cases with treatment supporters, in 203 (50.2%) the supporters were lady health workers, in 46 (11.4%) were community health workers and health facility workers, and in 155 (38.4%) were family members and community volunteers. A total of 384 (85.1%) were categorized as treatment success, 31 (6.9%), as transferred out, 17 (3.8%), as expired, 16 (3.5%) as defaulted and three (0.7%) as treatment failure. The treatment success rates in patients supervised by Lady health workers, community health workers and health facility workers, and family members and community volunteers were 93.1%, 89.1% and 73.5%, respectively.We found a significantly higher treatment success rate (93.1%) in patients supervised by lady health workers compared to others. The overall treatment success rate was 85.1%.


PubMed | National TB Control Program and University of Bergen
Type: Journal Article | Journal: Tanaffos | Year: 2014

Tuberculosis (TB) is a contagious, airborne disease and remains a major global public health hazard. TB is a major cause of mortality and is affecting millions of people in low-income and middle-income countries. Worldwide, one person out of three is infected with the Mycobacterium tuberculosis. Timely diagnosis and treatment are the two key factors for better outcomes. Non-adherence to TB treatment is an important barrier for TB control programs. This study was designed to understand the barriers encountered by TB patients when seeking health care.A qualitative study was conducted during the months of August and December 2010 on 15 health facilities. In-depth interviews were conducted with 23 TB patients (13 males and 10 females) aged 15-65 years. In addition, 15 health personnel were also interviewed.Most patients were found to be well informed about the idea of taking TB medications under direct supervision and its overall importance. However, many of them were not convinced with either drugs or treatment protocols. We found that limited knowledge of patients, loss of employment, financial burden, social stigma and long distance from health facility were the main barriers for TB adherence.More patient-centred interventions and attention to the barriers are required to improve the treatment adherence. Direct observation of patients and regular home visits by health workers can reduce the risk of non-adherence.


Khan S.N.,Pmas Arid Agriculture University | Niemann S.,Molecular Mycobacteriology Research Center | Gulfraz M.,Pmas Arid Agriculture University | Qayyum M.,Pmas Arid Agriculture University | And 5 more authors.
Pakistan Journal of Zoology | Year: 2013

Globally, Pakistan with population of around 180 million moved up two spots to 6th in the list of countries with the highest number of tuberculosis (TB) patients in the world according to WHO report (2011). Global TB control is further challenged by drug-resistant TB. For controlling the spread and better understanding of Mycobacterium tuberculosis (M. tb) isolates circulating in this region, it is important to explore the characteristics of these strains. In this study 71 isolates were tested for drug sensitivity and 41 out of 71 were found to be resistant. Out of these 41 isolates, 21 (51%) were resistant to isoniazid (INH) and rifampicin (RIF) and remaining have different drug resistance patterns. Genes associated with drug resistance like ahpC, katG and inhA for INH, rpoB for RIF, rrs and rpsL for streptomycin (STR) and embB for ethambutol (EMB) resistant isolates were checked for mutation using PCR amplification and sequencing. Out of 27 RIF resistant strains, 22 have mutation affecting four amino acid codons of rpoB; 531 (52%), 516 (15%), 526 (7.0%) and 512 (7.0%). In codon 512 two isolates showed insertion of GCC. These insertions were novel and observed for the first time in Pakistani isolates. The overall sensitivity of mutation detection in rpoB gene was 88.8% and specificity was 100%. Out of 24 INH resistant isolates, 19 (79 %) had S315T mutation in katG while 5 isolates had no mutation in this region. Thus, the overall sensitivity of mutation detection in katG gene was 79 % and specificity was 100%. These 5 isolates were further checked for mutation in promoter region of inhA and ahpC. In 2 isolates there was G to A transition at -88 of the promoter region of ahpC while 3 isolates had C to T transition at point -15 for inhA promoter region. Out of 14 STR resistant isolates, 7 isolates showed the mutation K88M, K88R and K43R in the gene rpsL while no mutation was found in the gene rrs in STR resistant strains. Six (67%) out of 9 EMB resistant isolates showed the mutation M306I while no mutation was found in 3 isolates. The mutations observed in this study are similar to the mutations commonly present worldwide. However, our results have shown one novel mutation in rpoB gene that can be considered for improving molecular methods used for the detection of multidrug-resistant strains. Furthermore wide range of screening is needed to characterize drug resistant strains prevalent in this region. Copyright 2013 Zoological Society of Pakistan.

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