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DOTS-PLUS IN TANZANIA:
PREPARATION PHASE
Global DOTS Expansion Working Group
Meeting, Paris: 28 October 2004
Prepared by:
Dr. S. M. Egwaga
NTLP - Tanzania
NTLP - MOH
Situation of MDR-TB in Tanzania
• Drug Resistance data available (1999 – 2003)
• MDR TB among new pulmonary cases 1% or
about 60 new cases each year
• MDR TB in previously treated cases – 6% or 30
cases per year
• Some of the cases are clinicians dealing with
TB patients
• There is no provision in the DOTS strategy for
the management of MDR-TB
NTLP - MOH
Rationale to deliver MDR-TB
in Tanzania
• Government of Tanzanian has resolved do deliver
standard TB care to all patients including the small
pool of MDR-TB as part of equity to services and to
minimise transmission and spread of MDR-TB
• The Ministry of Health has decided to establish and
integrate a DOTS-plus component within the regular
DOTS-programme.
• Priority remains DOTS-programme and DOTS-plus
component will be complementary and not compete
for funds.
NTLP - MOH
External assessment to deliver MDR-TB
in Tanzania
• In May 2003 and March 2004, a DOTS-plus
consultant visited the country to assess
preparedness to implement DOTS-plus and
eligibility to apply to the International Green
Light Committee (GLC) for preferentially priced
second line drugs.
• The consultant concluded that DOTS-plus could
be introduced in the Tanzanian situation, but a
number of essential conditions should first be
met.
NTLP - MOH
Conditions to deliver MDR-TB
in Tanzania
• To update notification system for re-treatment cases to
clearly distinguish failures, relapses, treatment after
default, chronics and others
• Strengthen systematic collection of specimen for culture
and drug-susceptibility testing in the country for new
and re-treatment cases
• To build quality assured laboratory capacity in order to:
– conduct Drug Resistance Surveillance(DRS)
– Minimise contamination rate from present 15% to
lower levels
– diagnose MDR – microscopy, culture and DST
– monitor, guide and evaluate category 4 treatment
NTLP - MOH
Conditions to deliver MDR-TB
in Tanzania
• To establish a reference hospital (future centre of
excellence) for the hospitalisation of MDR cases
identified country wide
• To adopt a centralized approach for the intensive phase
of treatment of MDR-TB in Tanzanian situation (to
concentrate expertise and and build experience)
• To decentralize the continuation phase, integrating
treatment delivery within the regular DOTS programme
• To appoint personnel (medical doctors and nurses) to
work in the MDR-TB hospital
NTLP - MOH
Conditions to deliver MDR-TB
in Tanzania
• Strengthen laboratory network with lower levels and
improve feedback mechanism and with supranational
laboratories (MRC)
• To agree on a relatively cheap category 4 regimen since
most of second-line drugs have never been used in the
country
• To consider applying for Category 4 drugs through the
GLC
• To apply to WHO to train personnel from the CRTL and
MDR hospital through the GLC mechanism
NTLP - MOH
Progress made to introduce MDR-TB
in Tanzania
• A new MDR-TB ward for 24 patients under construction
within National TB hospital
• Two medical doctors and 6 nurses deployed specifically
to work in the MDR-TB ward
• Formed a technical committee to oversee
implementation of MDR-TB from NTLP, MUCHS and
NIMR and TB hospital
• Updated and computerised TB notification system
countrywide with BOTUSA/CDC support to identify
failures among re-treatment cases
• WHO has agreed to train medical personnel together
with other 2 countries in SS Africa
NTLP - MOH
Progress made to introduce MDR-TB
in Tanzania
• Agreed on category 4 treatment regimen: 6 months
Pyrazinamide, Ethionamide, Kanamycin, Ofloxacine,
Cycloserin / 12 months Ethionamide, Ofloxacine,
Pyrazinamide.
• Estimated cost for cat. 4 regimen about $600-700 per
patient – relatively cheaper than in settings with a
history of uncontrolled second line drug-use where PAS,
Cycloserin and Capreomycin may need to be used,
costing up to $3000-3800.
• Requests to be submitted to GLC for considerations
NTLP - MOH
Progress made to introduce MDR-TB
in Tanzania
• Quality of laboratory services significantly
improved:
–
–
–
–
Central laboratory under major rehabilitation
New equipment procured
Internal quality control adhered in all procedures
Contamination rate reduced from 15% to 10% in less
than one year
– Established centralised feedback mechanism to lower
laboratories
– Improved registration system of MDR-TB cases
throughout the country and all data captured centrally
NTLP - MOH
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