Patients and TB: Improving treatment outcomes through a patient centred approach and access to new treatments

Transcription

1 Patients and TB: Improving treatment outcomes through a patient centred approach and access to new treatments 5 th TB Symposium Eastern Europe and Central Asia Ministry of Labour, Health and Social Affairs of Georgia and Médecins Sans Frontières March, 2016, TBILISI, GEORGIA Outpatient Delivery of Care Substituting for Inpatient Treatment of TB Patients in Kazakhstan Sagit Bektasov Head of MDRTB Treatment Department TB National TB Center, Kazakhstan

2 Decree # 362 of the Ministry of Health & Social Development of г. On some issues of expanded outpatient treatment of TB and MDR TB patients accompanied with psychosocial support in a pilot project Project implementation in 5 regions: Akmolinsk region Aktubinsk region Zhambyl region Kyzylorda region City of Astana

3 Key Project Performance Indicators Proportion of TB and MDR TB patients including: Patients having started and continuing treatment in outpatient settings Lost to follow-up Cured cases of first-diagnosed pulmonary smear-positive TB Cured cases of MDR TB Regularly receiving social support at the outpatient treatment stage

4 Substitution of Inpatient Treatment TB hospital Home Treatment (8) Daily hospitals (32, 457 bed total) Mobile TB Team TB Dispensary DOT in organized catering settings DOT in PHC settings (all regions) НКЛ DOT в ПТО in policlinics (all regions) 4

5 Objectives of the Central Medical Commission (CMC) Decide on administration of outpatient treatment Daily hospital Home treatment Mobile team from a polyclinic DOT points in PHC DOT points in polyclinics Identify type and mechanism for provision of social and psychological support tp TB patients Decide on the scope of necessary social assistance, its frequency and terms

6 Patients in need of 24-hour medical monitoring Home treatment Severe co-morbidities Need to be accompanied to DOT Temporary restricted mobility : elderly, pregnant women, breastfeeding, disabled; HIV/AIDS Daily hospital Adherent to continuous treatment regimen Additional nutrition required Additional treatment required Organized catering settings Food distribution stations Flophouses Shelters Cafeteria persons with lost social contacts homeless

7 Organizing Treatment at Home Treatment provided by a dedicated doctor of the TB dispensary Services provided by nurses daily, except for Sunday (DOT 6 times a week) A vehicle and a driver to be provided for medical staff PHC doctor to visit the patient one a month, and adequate medical specialists from the PHC setting to provide advice and treatment depending on indications The number of patients receiving treatment at home should be limited to no more than patients (max. 25 patients) Patients receiving treatment at home are not eligible for daily social support, yet they may be eligible for another kind of social support (one-time support) Psychological support shall be provided to the patients on the as-needed basis Social worker s support shall be provided to the patients on the as-needed basis

8 Funding Outpatient treatment is funded from the approved budget of the polyclinic that organizes the treatment Head of the polyclinic shall identify the number of beds in the daily hospitals in collaboration with the local healthcare management body The funding allocated for social support to TB patients on outpatient treatment shall be at least 4% of the total amount of funding allocated for TB control measures

9 Proportion of TB and MDR TB patients, smear-negative, ,8 57,1 55,6 47,4 45,4 45,7 39,5 37,3 29,8 64, ,1 50 ТБ МЛУ ТБ 57,8 54,1 54,4 53,6 51,6 43,5 42, ,5 33,3 65,9 59,2 58,1 56,5 54,3 45,2 42,3 40,6 35,1 27, , Акмолинская Актюбинская Алматинская Алматы Астана Атырауская ВКО Жамбылская ЗКО Карагандинская Костанайская Кызылординская Мангистауская Павлодарская СКО ЮКО РК 17% of MDR TB patients start treatment in outpatient settings

10 Treatment Success in TB and MDR TB patients

11 Proportion of Funding for Social Support to TB Patients (%) ,1 4,9 3,7 WHO Standard: 4% ,1 5,1 Funding for social support to TB patients in the country : ,8 thou tenge ,8 thou tenge 3,9 6,3 6,2 3 2,8 3,1 2,7 2,8 1,7 2,1 2 1,7 1,9 1,2 1,2 1,4 1,1 0,8 0,9 0,8 0, ,8 0,5 0,2 0,3 0,4 0,001 0,1 0 Акмолинская Актюбинская Алматинская Атырауская В-Казахстанская Жамбылская З-Казахстанская Карагандинская Кызылординская Костанайская Мангистауская Павлодарская С-Казахстанская Ю-Казахстанская г.алматы г.астана 1,6 РК 2

12 Conclusions Decisions on the type of treatment (inpatient or outpatient) should be made individually on the case-by-case basis, and adapted to the patient s needs : fosters effective treatment Outpatient treatment, also in the intensive phase, is more comfortable for patients Proper organization of outpatient treatment and provision of psycho-social support promote adherence to DOT treatment in TB and MDR Tb patients, which in its turn results in high treatment success

13 Thank you for your attention!