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National TB/HIV Policy PDF Print E-mail
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Thursday, 30 August 2012 09:00

NATIONAL POLICY GUIDELINES FOR COLLABORATIVE TB/HIV ACTIVITIES
These policy guidelines for collaborative TB/HIV activities in Tanzania are the result of collective efforts of many individuals and partner institutions working within and outside the country in support of the MOHSW in various ways. Read more ...

Last Updated on Thursday, 14 March 2013 14:51
 
Management of MDR-TB PDF Print E-mail
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Thursday, 19 April 2012 12:23

MDR case management services continued at Kibong’oto National TB hospital with financial support from the GFATM round 6 as planned. The first cohort of the 16 patients admitted in 2009 completed their intensive phase of treatment and were discharged from the hospital for ambulatory treatment at a health facility nearest the patients’ domicile. In order to ensure adequate management of MDR TB in the continuation phase, a system of training district TB coordinators and their respective DOT nurses was set up by the programme in collaboration with University of California San Francisco (UCSF). This included developing district MDR TB training materials followed  by training respective health  workers with financial support from PATH Tanzania. The National MDR-TB operational guidelines were approved by MOHSW in 2010. UCSF supported the programme to train 12 facilitators who in turn trained 38 DTLC 38 and DOT nurses in 3 phases of 12 people each. The participants came from the following districts - Babati (Manyara), Arumeru and Karatu (Arusha), Makete (Iringa), Temeke, Ilala and Kinondoni (Dar es Salaam), Hombolo (Dodoma), Chakechake (Pemba), Mkinga (Tanga), and Newala (Mtwara). 

In 2010, 17 new MDR-TB patients were admitted for treatment at Kibong'oto TB hospital making the total number of patients enrolled since 2009 to 33.  The number of new patients admitted was small because of the ongoing construction within the hospital for a new isolation ward with bed capacity for 20 MDR-TB patients (10 males and 10 females). The wards have self-contained cubicles for 2  patients each thus minimizing nosocomial transmission of MDR-TB strains among the patients and to health care workers.
In November 2010, the first interim analysis was done for the initial 16 MDR-TB admitted at Kibong’oto TB National Hospital. The results were as follows:



At the end of 2010, the MDR TB programme was evaluated by the WHO GLC team and was found to comply with GLC recommendations. As a result, the programme was approved to expand the MDR-TB cohort from the initial 50 patients in the pilot phase to 150 MDR TB patients per year starting 2011.

Last Updated on Sunday, 05 August 2012 14:09
 
Collaborative TB/HIV activities PDF Print E-mail
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Thursday, 19 April 2012 12:21

TB/HIV case finding 2010

A total of 56,849 (90%) of the 63,453 TB cases notified in 2010 were counselled and tested for HIV status. This is above the 85% target of the Global Plan to Stop TB 2006-2015. Of those tested, 21,662 (38%) were found to be  co-infected with HIV which was 0.8% higher than the co-infection rate in 2009 of 37.2%. Among the co-infected cases in 2010, 17,103 (79%) cases were registered at HIV care and Treatment clinics (CTCs) for HIV care and treatment services. Similarly, 19,855 (92%) were put on Co-trimoxazole Preventive Therapy (CPT) and 7,572 (35%) were initiated ART in  both TB and CTCs within the three months reporting period after a two weeks tolerance period after starting TB treatment. Table 7 and Figure 10 below summarises TB/HIV services in the country from 2007 to 2010.


3.3.2  Treatment outcomes of TB/HIV cases notified in 2009
Treatment outcome for new smear positive TB/HIV cases notified in 2009, shows that 5,255 (78.4%) were cured and 542(8.1%) completed treatment resulting treatment success of 86.5%. a total of 532 (7.9%) died while on TB treatment, 18 (0.3%) failed treatment, transferred out were 224 (3.3%) and 133 (2.0%) defaulted treatment. These results show that treatment success rate was slightly lower in HIV positive TB cases compared to HIV negative TB cases. Table 8 below summarises this information.


TB/HIV Interventions in 2010
Development of guidelines/tools 
NTLP collaborated with National AIDS Control Programme (NACP) and other partners to implement TB/HIV activities with support from CDC/PEPFAR. This included support to 15 hospitals in the country in November 2010 to start implementing two of the three component of 3Is (Intensified TB Case Finding, and Infection Control).  The third component - Isoniazid Preventive Therapy (IPT) will be introduced in May, 2011. The experience gained will inform the Ministry on how scale up of these interventions country wide.

In 2010 the programme also developed, printed and disseminated training materials on 3Is – i.e. participants manual and facilitators guide  including job aids on TB infection control. These materials are intended for training health workers implementing 3Is at service delivery level. The TB infection control guidelines have been developed in collaboration with a number of partners supporting TB/HIV services including NACP, ICAP, ITECH and WHO.

NTLP also took a lead to develop IPT M&E tools in collaboration with partners. These tools
included;
-  Form for assessing eligibility and monitoring of patients on IPT form 
-  IPT register 
-  Monthly and cohort report forms 

Support of X- ray costs to improve diagnosis of smear negative TB suspects All 13 hospitals included in the first phase implementation of 3Is were provided with funds to pay for X-ray costs for a total of 9,000 TB  suspects who are smear negative who can not afford the costs. The social workers in each hospital have been directed to identify those who can not afford to pay the X-ray according to government exemption guidelines.

Last Updated on Sunday, 05 August 2012 14:10
 
Tuberculosis treatment outcome for cohort notified in 2009 PDF Print E-mail
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Thursday, 19 April 2012 12:17

New smear-positive cases

Analysis of the TB cohort notified in 2009 shows that the overall treatment success for new smear positive TB cases was 87.9%. This is  the third consecutive year where treatment success rate has exceeded the global target of 87% by 2015 set by the Stop TB partnership Global Plan to Stop TB, 2006 -2015 and WHO target of 85% set in 2005. However, five regions namely; Tabora (79%), Kilimanjaro (77%), Ilala I (84.4%), Ilala II (83.4%) and Kinondoni (84%) failed to meet the global target as shown in Table 6.

Furthermore, the cohort analysis shows that 1,214 (4.9%) patients died during treatment. This is a decline by 35 patients compared to 2008 when 1,249 (5.2%) died. A total of 811 (3.3%) were transferred out, another 545 (2.2%) defaulted while on treatment and the remaining 62 (0.2%) failed treatment which was not different from the cohort report of 2008. Overall, the unfavourable treatment outcome was 10.6% which is below the WHO target of 15%. Figure 7, shows treatment outcomes of new smear positive TB cases treated in cohort of 2009 by region.


The trend of treatment outcome results for the new smear-positive patients in the past twenty years (1999 – 2009) show that the success rate has increased consistently since 2001 from about 80% in 2001 to 88% in 2009. Similarly the mortality rate has been declining since 2006 from 8% to 4.9% in 2009.

Treatment outcome of re-treatment cases notified in 2009

Cohort analysis data is available for 4,121 out of the 4,217 re-treatment cases notified in 2009 giving case holding of 98%. Overall a total 3,501 (83%) of those evaluated were either cured or completed treatment resulting in treatment success rate of 83%. The treatment success among the different re-treatment  categories was as follows; relapses - 82%, failures – 76%, return after default – 77% and others -  84%. The unfavourable outcomes were 15.1% represented by: - death - 357 (8.5%); failures - 31(0.7%); defaulted –112 (2.7%); transferred out 135 (3.2%).  Figures 8 and 9 below summarises the treatment outcome for each category of the re-treatment cases. The trends of treatment success among re-treatment cases since 2006 has been consistently above 80% after introducing FDCs and DOT treatment supporters throughout the country. Similarly the unfavourable outcomes have declined significantly during the same period.

Last Updated on Sunday, 05 August 2012 14:13