Improving TB Case Detection and Quality of Care through and Quality of Care through Implementation of Urban DOTS in Kabul, Afghanistan

Azizullah, Hamim, MD, MPHTechnical Advisor, TB CARE I - AfghanistanTechnical Advisor, TB CARE I Afghanistan

Background• Population: 5 million

• Overcrowding

• Irregular NTP monitoring and supervision visits to health facilities

• Overcrowding

• Unsanitary facilities• Poor TB indicators:

Case notification rate: 26%Conversion rate: 43%

• Inadequately trained health facility staff

Success rate: 46%

• Only 22 of106 health facilities provide • Insufficient communication and

coordination between the private/public sector and the

TB control services

• Poor health infrastructureNational TB Program (NTP)

Methodologygy• Create a partnership

between NTP and • Conduct DOTS awareness

raising events at health facilities between NTP and public/private sector

E d DOTS bli d

raising events at health facilities, schools and in communities

I l d d i • Expand DOTS to public and private health facilities in Kabul city

• Implement standard operating procedures (SOP) for TB case detection, treatment and

• Standardized DOTS recording and reporting

infection control

• Recruit more public and private recording and reporting tools

Recruit more public and private health facilities for DOTS implementation

TB Awareness Event at Marifat High School

Methodology (Cont.)

• Enrolled 56 public and 8 private

gy ( )

health facilities as TB diagnostic and treatment centers

• The 64 facilities:Provided free TB services to 75% of Kabul’s populationIdentified11,900 TB suspects

Parliament member speaking during the launch of Urban DOTS at Nomad Hospital in Kabul city suspects

Registered 3,282 TB casesUrban DOTS at Nomad Hospital in Kabul city

General Director of Primary Health Care at the Inauguration Ceremony for Urban DOTS in Kabul

Urban DOTS Public-Private Mix Performance in TB Control 2009 2011TB Control, 2009-2011

P t Indicators 2009 2010 2011

Percentage Improved

Total health facilities in Kabul 106 111 111 NAH lth f iliti idi DOTS (TB Health facilities providing DOTS (TB diagnosis & treatment) 22 48 56 50%

TB suspects identified/examined 2,856 10,150 11,900 317%

All TB cases notified 1,934 2,738 2,728 41%New TB sputum smear positive ( SS+) cases notified 814 1,022 1,083 33%cases notified 814 1,022 1,083 33%

TB sputum smear conversion rate 43% 62% 70% 27%

New TB SS+ treatment success rate 46% 62% 70% 24%

Urban DOTS Public-Private Mix Performance in Identifying TB Suspects, TB Cases, and New SS+

14000

Cases in Kabul, 2009 – 2011

10000

12000

8000

10000

mbe

r

TB suspects

4000

6000Num

TB suspects

TB Cases

New SS+ cases

0

2000

Urban DOTS02009 2010 2011

year

Urban DOTS Implemented

Urban DOTS Public-Private Mix Performance in TB Sputum Conversion Rate in Kabul 2007-2011

100%

Sputum Conversion Rate in Kabul, 2007-2011

70%70%

80%

90%

62%

70%

50%

60%

70%

Performance

43%

30%

40%

50% Performance

National Target

Project Target

10%

20%

30%

Urban DOTS 

0%2009 2010 2011

Implemented

RecommendationRecommendation• The urban DOTS public-private mix contributed

significantly to TB services and improved:Case notification S t i Sputum conversion Treatment success rate

• This strategy should be scaled up in other urban settings. g

Thank You

Azizullah, Hamim, MD, MPHTechnical Advisor TB CARE I-Afghanistan

E-mail: ahamim@msh.orgTel: +93 797 109 109