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The Philippines’ National Tuberculosis Program

(NTP)

ROSALIND G. VIANZON, MD, MPHInfectious Disease Prevention and Control Division

DPCB, Department of Health, Manila

For the Innovative TB Control Strategies to Reach the Goal

of TB Elimination by 2035

National Taiwan University Hospital International Convention Center

Taipei, Taiwan - March 14, 2015

+Strategies to Control TB - InternationallyTimeline Activity Description

1991 World Health Assembly (WHA) resolution recognized TB as a major global public health problem

70% Case Detection rate of New Smear Positive85% Cure rate* by year 2000

1994 DOTS Strategy was launched 5 elements

2001-2005

First Global Plan to Stop TB Increased political commitment: 2000- Amsterdam Declaration, 2001 – Washington Commitment to Stop TB, 2004 -Stop TB Partner’s Forum in Delhi

2005 WHA resolution advocating for sustainable financing for TB control and prevention

2006-2015

Second Global Plan to Stop TB – STOP TB Strategy

6 components – pursue high-quality DOTS expansion & enhancement, address TB-HIV, MDR-TB & other challenges, contribute to HSS, engage all care providers, empower people with TB, & communities, enable & promote research

2014 Post-MDG Strategy End TB Strategy

ccoommmmuunniittiieess,,, eennaabbllee && pppppprroommoottee rreesseeaarrcchh

2014 Post-MDG Strateggy End TB Strateggy

World Health Assembly 2014

At the 67th World Health Assembly, Member States adopted the new post-2015 Global TB strategy and targets, and related resolution on 19 May 2014

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Integrated, patient-centered TB care

and prevention

Bold policies and supportive

systems

Intensified research

and innovation

Post-2015 Global TB Strategy Pillars and Principles

+Country Profile

� about 7,100 islands

� 17 administrative regions

� 91 provinces

� 109 cities

� 2,500 municipalities

� 3,200 barangays

Luzon

Visayas

Mindanao

DOH – DPCB (NTP)

16 Regional Health Offices & ARMM

2,500 Rural Health Units(DOTS Facilities)

Barangay Health Stations

83 Provincial/129 CityHealth Offices

• Formulate policies and guidelines• Provide technical assistance• Provide drugs/laboratory supplies• Monitor and evaluate implementation

• Monitor and supervise implementation• Distribute drugs/supplies to the city/mun• QA Centers

• Manage TB patients• Store anti TB drugs• Microscopy services

• Identify TB symptomatics• Do DOT

+Strategies to Control TB - PhilippinesTimeline Activity Description

1997 -2002

DOTS Strategy( plus Scale-up)

70% Case Detection Rate of New Smear Positive85% Cure rate5 elements

2002 -2006

Public-Private Partnerships

DOTS beyond public sector – Private sectorDOTS beyond general population – Vulnerable groupsDOTS health center workers – Communities

2006-2010

National Strategic Plan to Control TB (8 Strategies)

Reduce the prevalence & mortality by half by 2010 contributing to the achievement of the MDGs

2010-2016

PhilPACT 8 strategies

≥2016 Still for planning – conduct of NTPS in 2015

2010-2016

PhilPACT 8 strategies

+ Vision

20502040203020202010

TTB FREE Philippines

1 active case per1M population

20155

MDGoals

Prevalence rate 500/100,000

Death rate 29/100,000

+Philippines in 2012

484

55

24 461

265

1,000

399

Mortality Prevalence

Incidence rate

+Program Indicators

0

20

40

60

80

100

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

CDR, All forms CDR, New Sm+ Cure Rate Success Rate

CDR = 70 to 85TSR = 85 to 90

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+Progress towards

2015 targets set within the

MDG framework

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+Philippines

* low TB HIV burden* <50% MDR TB detected and notified

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+Treatment Outcome

+Trend of Case Detection Rate (All Forms)

and Treatment Success Rate, 2000 to 2013

0

20

40

60

80

100

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

CDR, All forms Success Rate

100,000

130,000

160,000

190,000

220,000

250,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Est. Incd (TB all forms) Cases Detected (all forms)

Case Detection Rate of All Forms of TB 2000 - 2013

+ Contribution of the Private Sector (CDR, All forms), 2003 to 2013

11%

+Drug Susceptible TB Situation in 2013(based on Prevalence Rate)

0�

50000�

100000�

150000�

200000�

250000�

300000�

Est.�No�of�incident�TB�cases�

No fied� TSR�

229,918�(87%)�

Target�258,375�

88�%�

NSM�(+)�42%�

NSM�(-)�����54%�

�� EP (2%)

)�������������������������������������Relapse

(2%)

+ DR-TB Situation in 2013

+Our Directions and Plans

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Updated PhilPACT

The roadmap for TB control in the

Philippines.

Updated

+ Objectives StrategiesReduce local variation in TB control program performance

1. Localize implementation of TB control2. Monitor health system performance

Scale up and sustain coverage of DOTS implementation

3. Engage both public & private care providers4. Promote & strengthen positive behaviour of

the communities5. Address MDR-TB, TB/HIV, and needs of

vulnerable population

Ensure provision of quality TB services

6. Regulate and make available quality TB diagnostic tests and drugs

7. Certify and accredit TB care providers

Reduce out-of-pocket expenses related to TB care

8. Secure adequate funding and improve allocation and efficiency of fund utilization

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Impact Targets based on PhilPACT

Indicators Status as of Dec, 2013

Targets for 2016

Mortality rate 27/100,000 23 / 100,000

Prevalence rate 438/100,000 414 /100,000

+ Trends of Disease BurdenBacillary PTB 1983

1st NTPS1997*

2nd NTPS2007

3rd NTPS

Smear-positive 6.6 3.1 2.1

Culture-positive 8.6 10.0 6.3

Smear-positive* N/A 3.1 2.0

Culture-positive* N/A 8.1 4.7

* Extrapolated to the general population

From Dr. Tupasi’s lecture PMDT PIR, 10 2008

+Outcome Targets based on PhilPACT

Indicators Status as of Dec 2013

Targets for 2015 -2016

Susceptible patientsCase Detection Rate, All forms

87% 90%

Treatment Success Rate, All forms

88% 90%

MDR-TB patients

Notification Rate 16% 62%

Treatment Success Rate 41% 75%

+NTP Impact Indicators Per Year

Indicator/Year 2010 2011 2012 2013

Mortality Rate

30/ 100,000

29/ 100,000

28/ 100,000

27/ 100,000

Incidence Rate

275/ 100,000

270/ 100,000

265/ 100,000

292/ 100,000

Prevalence Rate

502/ 100,000

484/ 100,000

479/ 100,000

461/ 100,000

+Output Targets based on PhilPACT

Indicators Status as of Dec 2013

Updated Targets

Total no. of presumptive TB examined

2,481,418 (45%) 5.5 million

Total TB cases provided with treatment

855,904 (57%) 1.5 million

Total no. of children given treatment or given INH preventive therapy

102,747 (14%) 730,000

Total MDR-TB cases detected and registered

7,883 (40%) 19,500

Total TB patients who underwent provider initiated counselling and testing on HIV/AIDS

8,623 (19%) 45,000

+Output Targets based on PhilPACT

Indicator Status as of Dec 2013 85%

Total no. of presumptive TB examined 2,481,418 (53%) 4,675,000

Total TB cases provided with treatment

855,904 (67%) 1,275,000

Total no. of children given treatment or given INH preventive therapy 102,747 (17%) 620,500

Total MDR-TB cases detected and registered 7,883 (48%) 16,575

Total TB patients who underwent provider initiated counselling and testing on HIV/AIDS

8,623 (23%) 38,250

+ Policy Instruments

� Administrative Order (2)� Revised TB HIV collaboration� Use of Rapid Diagnostics tools

� Revised NTP Manual of Procedure

� Updated PhilPACT

� TB Research Monograph

� Draft policies (3):� Hospital DOTS � Revised TB DOTS in Jails and Prisons � TB Management during Disasters

+ Existing Partnerships

� Philippine Tuberculosis Society, Inc.

� Philippine Coalition Against TB

� International PartnersIMPACT Project (USAID)KOFIHKOIKARIT-JATASIAPS-MSH (USAID)The Global Fund Project (PBSP)USAID (Other Initiatives)World Health Organization

+ Key Challenges• Still many missing TB cases due to the following:

– Lack of access to quality assured TB diagnostic services

– Limited involvement of non-NTP care providers– Persisting stigma on TB– Passive case finding

• Low number of detected and enrolled MDR-TB cases and with high number of default

• Weak TB HIV collaboration especially at the service delivery level and geographic coverage is still limited

+ Key challenges

• Slow development and implementation of initiatives to increase access amongst vulnerable groups

• Weak health system– Weak logistics and data/information management

systems– Variable capacity in TB control program

management by TB teams at all levels– Lack of manpower at the service delivery levels

• Other funding sources / models not yet maximized

+ Major Activities

� Ongoing roll-out of training on the Revised MOP

� Scale-up of DR-TB service facilities:- Diagnostic (GX) centers, Satellite Tx Centers

� Roll-out of iTIS, TB-HIV strengthened collaboration

� Researches on new regimens for DR-TB (3)

� Conduct of the 2015 NTPS

� Finalization of MDRTB Benefit Package

+ Thank You!