TB EPIDEMIOLOGY AND STRATEGIES IN THE REPUBLIC OF BELARUS

Transcription

1 Tuberculosis in 2017: Searching for new solutions in the face of new challenges 6th TB Symposium Ministry of Health of the Republic of Belarus, Republican Scientific and Practical Center for Pulmonology and Tuberculosis, and Médecins Sans Frontières 1-2 March, 2017, MINSK, BELARUS TB EPIDEMIOLOGY AND STRATEGIES IN THE REPUBLIC OF BELARUS Professor Henadz Hurevich, Republican Scientific and Practical Center for Pulmonology and Tuberculosis

2 TB rates, Republic of Belarus, 2016 Rate No/ cases / Incidence ,3 Prevalence incl. relapses ,1 Prevalence ,7 Mortality 323 3,4 Belarus population Minsk population

3 Incidence tendencies (all departments including relapses) and mortality due to tuberculosis in population of Belarus (per population) ( ) 58,6 9,4 60,4 11,1 10,1 66,165,0 62,3 59,3 56,657,0 54,3 52,4 50,6 12,1 10,0 9,3 8,6 7,9 4,7 4,0 34,1 Заболеваемость (все ведомства) с учетом рецидивов) Mortality Смертность due to от TB туберкулеза ,1 7,8 Incidence (all departments) including relapses 6,8 47,8 41,1 39,7 5,8-39,7% Over 8 years -60,5% Over 8 years 3,4

4 TB INCIDENCE IN BELARUS REGIONS (2016) TB incidence per population <20 Vitebsk 22, Minsk 29,2 Grodno 27,5 MINSK CITY 15,1 Mogilev 36,4 Brest 28,9 Gomel 39,8

5 Paediatric TB incidence (0-17 y.o.) In Belarus (per 100,000 children) 8 Дети (0-17) 6,6 6,2 6,1 7,9 156 Children (0-17) 6, ,4 4, ,1 72 3,8 3,6 2, ,2 39 2,9 52 3,2 58 1,

6 HIV TB TB/HIV

7 Absolute number of new and previously treated MDR TB cases and their proportion (%) among pulmonary TB 80% 70% 60% MDR previously treated 66,4 59,2 ( ), (registered) 69,4 66,7 65,8 67,6 50% 40% 30% MDR new 27,0 32,9 33,8 33,2 34,3 35, % Abs. no. new Abs. no. previously treated РБ 0 РБ

8 2014 XDR-TB ШЛУ-ТБ; 9.6% 9,6 Structure of new and previously treated pulmonary TB patients started in IV cat treatment (2014г., 2016г.) pre-xdr+i 11.3% New cases 790 New cases 975 pre-xdr+fq 11.3% прешлу-i; pre-xdr+i 23.2% 23,2 МЛУ-ТБ; MDR TB , Монорез.( MonoR MDR-TB МЛУ-ТБ; (R+); 8.8% 8,8 63.2% 63,2 XDR-TB ШЛУ; 14.2% 14,2 MDR-TB 63.2 Моно; Mono 11.9% 11,9 Поли; 0, pre-xdr+fq пре- ШЛУ+Fq; 14.4% 14,4% преpre-xdr+i ШЛУ+I; 12,9% 12.9% Previously treated Previously treated pre-xdr+fq прешлу Fq; 14,5 МЛУ-ТБ; MDR-TB прешлу-i; ,9 pre-xdr+i 18.0% 18,0 pre-xdr+fq прешлу- 8.5% Fq; 8,5 пре- ШЛУ+I; 11,3 пре- ШЛУ+Fq; 7,1 МЛУ-ТБ; MDR-TB 37.4% 37,4% ШЛУ-ТБ; XDR-TB MonoR Монорез. 30.3% 30,3% (R+); 4.7% 4,7% Полирез. Poly 0.3% ; 0,3% ШЛУ; XDR-TB 38, Моно; 2,9 Mono 2.9% 2016 Poly Поли; 0.0% 0,0

9 MAIN INNOVATIONS New tuberculosis management regulations Upgrade and reorganisation of laboratories Introduction of rapid bacteriological and molecular tests and new TB/MDR TB diagnostic algorithms Reorganisation of beds, opening palliative wards Creation of 4-modules Tuberculosis register MDR TB consiliums Introduction of practical approach to lung health guidelines in primary health care Social support for ambulatory TB patients paid from state budget Monitoring and evaluation of activities Clinical use of new TB drugs: Bdq, Kfz, Dlm Implementation of pharmacovigilance of new TB drugs Implementation of video DOT

10 Main indicators Successful treatment new cases (Belarus, pulmonary TB), (S+C+, S-C+, S+C-), 2015(excl. MDR TB), % 6M culture conversion rate in MDR patients (confirmed), Belarus, Q1 2016, % Successful treatment MDR TB (confirmed), Belarus,2014 (at from start of treatment), % Successful treatment XDR TB Belarus 2014 (at from start of treatment), % ,7 87,1 83, ,2 62,8 35, нет данных No data Базовый Baseline (2012г.) (2012) Достигнутый Achieved (2012)

11 MAIN BARRIERS: - Inadequate supply of new TB drugs to treat pre- XDR and XDR patients (due to inadequate funding and lack of registration of bedaquiline, delamanid and clofazimine in the country) - Inadequate facilities in many dispensaries and laboratories; - Inefficient funding system that does not allow for redistribution of funds to ambulatory treatment; - Insufficient human resources due to lack of prestige in work in TB treatment facilities, lack of motivation

12 PROBLEM SOLVING 1. Measures are being taken to change the funding model and switch to patient-orientated TB care model (within the framework of the Regional EuroWHO project for TB control and strengthening of healthcare systems in EECA countries (TB-REP) - High-level working group formed; - Comprehensive TB care approach is being implemented - Pilot project developed to change the funding model in Brest and Mogilev regions 2. Sustainable development policy developed for prevention, treatment, care and support for HIV/AIDS and tuberculosis outlining the main directions of TB care system reforms

13 Thanks for your attenrion!