Programmatic Management of Drug-resistant TB (PMDT): While the causes of multi-drug resistant TB are similar in all high burden countries
(low adherence, weak DOTS, poor treatment compliance, inadequate drug supplies, direct transmission, etc.).
The FAST strategy is mainly implemented at specialized and general hospitals with TB units. With support from the USAID TB CARE II Project, the Vietnam NTP developed the “Guideline for FAST strategy implementation”. According to the Guideline, implementing facilities should immediately order GeneXpert MTB/RIF tests for eligible patients including: Pulmonary TB patients AFB(+), presumptive drug-resistant TB patients, presumptive TB among HIV positive people, children with presumptive TB or TB meningitis.
Tumpa, a 14 year old high school student, was diagnosed with TB on March 27, 2011. Although she started taking TB medication the day after, she experienced treatment failure after three months of treatment and was diagnosed with Multi Drug Resistance Tuberculosis (MDR-TB). With her new diagnosis, Tumpa started to take her medication for MDR-TB in August of that year. However, after completing 16 months of treatment, her sputum culture and follow up result remained positive. She was then diagnosed with extensively drug-resistant TB (XDR-TB) in November 2012.
In 2014, approximately 480,000 people developed MDR-TB. 3.3% of new cases and 20% of previously treated patients develop MDR-TB. It was estimated that only 41% of cases were notified that they had MDR-TB in 2014. In low and middle income countries, access to quality TB services is often limited. Since the beginning of TB CARE II in 2010, TB CARE II has worked to decrease MDR-TB.
TB disease occurs most often within the context of economic and social vulnerabilities, and patients receiving TB treatment frequently
Toolkits and job aids in Bengali developed by the USAID TB CARE II Bangladesh project are now featured on the USAID K4Health website and are available for download here: https://www.k4health.org/toolkits/bangladesh-mnch/ykssmaa.
In July 2014, CDC’s Find TB Resources named Adherence to MDR-TB Treatment: The 5 A’s of Patient Support, an online course developed by the DR-TB Training Network, as its Highlight of the Month (http://findtbresources.cdc.gov/newsletter/newsletter14July.html). This online course discusses key principles and steps to facilitate treatment adherence for patients with MDR-TB. The five A's presented in the course are: assess, advise, agree, arrange, and assist.
TB CARE II is excited to announce that it will be expanding its field support presence into South Africa for FY2015. TB CARE II will build on the activities and approaches utilized by the USAID TB Program South Africa, also implemented by University Research Co., LLC (URC), which from 2009-2014 has supported the National Department of Health (NDOH) in improving early case detection, increasing access to diagnostics, ensuring treatment support for patients on TB treatment and ensuring that there is provision of appropriate and timely HIV care for TB patients and ART treatment for all TB/HIV
As a component of the project, TB CARE II Bangladesh supports nongovernmental, community based organizations (NGOs) in urban and rural areas with TB case notification rates below the national average to increase detection and management of TB and MDR TB services
and to improve community knowledge and awareness of TB and MDR TB. The geographic coverage varied under different waves of grants as indicated in the table below.Since April 2012, TB CARE II has supported 11 grantees for periods of one-to-two years each.
The community MDR TB planning tool focuses on operationalizing implementation of MDR TB community level interventions, drawing on information gained from the experience of several countries implementing a community model to deliver MDR TB services to patients.
The tool provides a situation analysis table to facilitate understanding of the health system context and model to provide MDR TB services in country, and considers TB and MDR TB country/district burden and the resources available in order to identify gaps in provision of MDR TB services.