TB Control Programme, Khyber Pakhtunkhwa commemorates World TB Day every year in March to create awareness about this disease. An estimated 60,000 new TB cases occur in Khyber Pakhtunkhwa every year while Pakistan ranks 5th among high burden TB countries in the world. Government of Khyber Pakhtunkhwa has pledged to achieve the objectives set out in the Global Plan to Stop TB. For this purpose, the government is providing quality sputum diagnostics and curative services of cost.
There are 225 TB care facilities and 810 treatment centres all over the province. Since its inception in 2002, successfully treated approximately 374365 TB patients. In 2014, the programme registered 42,396 patients with 96% Treatment Success Rate (TSR).
Provincial TB Reference Laboratory (PTRL), Hayatabad, Peshawar is the first state of the art laboratory in the region. PTRL is operational since 2012:
Florescence Microscopy (LED) is introduced and installed at district level intermediate labs in the province to diagnose TB.
2nd line Drug Susceptibility Test (DST) has started for the first time in Khyber Pakhtunkhwa while External Quality Assurance (EQA) of 2nd line DST is conducted in PTRL.
TB culture lab is established in Abbottabad. Laboratory software is functionalized for the first time in PTRL.
TB Control Programme initiated MDR (Multi Drug Resistance) interventions in 2012 to reduce the burden of drug resistant TB in the province.
Provincial MDR TB Coordination Committee is formulated and notified. TB Reference Laboratory provides Acid Fast Bacillus Diagnostic Sensitivity Testing (AFB DST) and cultures.
GeneXpert machines are installed for diagnosing MDR-TB at Leading Reading Hospital, Khyber Teaching Hospital, Provincial TB Reference Laboratory Peshawar, Ayub Teaching Hospital Abbottabad, Mardan Medical Complex, DHQ Hospital Battagram, DHQ Hospital Swat, DHQ Hospital Bannu and DHQ Hospital D.I. Khan.
The Xpert MTB/RIF assay can detect both TB resistance to Rifampicin in two hours and currently is the only full automated cartridge based real-time DNA test.
Programmatic Management of Drug Resistant TB (PMDT) Units have been established in 4 major teaching hospital of the province i.e. Lady Reading Hospital Peshawar, Ayub Teaching Hospital Abbottabad, Mufti Mehmood Memorial Teaching Hospital D.I,. Khan and Saidu Group of Teaching Hospital, Swat.
Multi Drug Resistant /XDR TB wards/OPDs are renovated under infection control measures at Leady Reading Hospital (Pesahwar), Ayub Teaching Hospital (Abbottabad), Mufti Mehmood Memorial Teaching Hospital (D.I. Khan) and Saidu Group of Teaching Hospital (Swat).
838 DR-TB patients have been enrolled till December 2014, out of which 634 are supported by (NTP/ACD and 204 by (EPOS/KfW). So far, 2013 MDR TB patients are successfully cured and 488 DR-TB patients are under treatment.
Sputum transportation mechanism is ensured through courier services in all PMDT units.
492 doctors (DTOs/NPOs/Professors at tertiary care hospital and BMUs) and 1103 paramedics, technicians, DOTS facilitators, LHVs, LHWs have been trained on programmatic management of MDR TB across the province.
Training and orientation sessions have been conducted with all health care providers on ambulatory based model of care in MDR TB management.
Public Private Partnership (PPP) is an important component of the programme.
The primary objectives of PPP DOTS are:
* To increase case detection by enhancing the ability of private health providers to identify and diagnose TB cases.
* To increase treatment success rate by improving the quality of TB care received by patients attending private facilities.
* Provision of free of cost anti-TB drugs to the patients receiving treatment from private sector.
PPP clinics and laboratories are established in 18 districts of the province with support of EPOS/KfW and Mercy Corps through its implementing partners organization (ACD, Greestar, ASD, AKHSP, MALC and SHINe).
PPP activities are outsourced to partners organization ((ACD, Greenstar, ASD, AKHSP, MALC and SHINe) to further potentiate the efforts to find out maximum missed TB cases in community.
The key strategies involve:
Active case detection through directly reaching the high risk communities an a tracing the contacts of current and previously treatment patients.
To create awareness in the target population and referral of TB suspects through community based communication and social mobilization activities.
Through PPP, the programme has registered in 11,621 TB cases in private sector and has contributed 25% to the total case detection rate of the province rate of the province in 2014.
The Advocacy, Communication and Social Mobilization (ACSM) strategy is being implemented to influence behaviors and mobilize communities to create long term normative shifts toward desired behaviors.
The social mobilization strategy includes six uniform activities: Interpersonal communication workshops for healthcare providers, community coalition meetings, TB patient empowerment sessions, orientation session for key advocates, journalists and community awareness sessions.
During 2014, the social mobilization strategy was implemented in 15 districts of the province.
Advocacy and Communication strategy includes orientation sessions with parliamentarians, advocacy seminars at provincial and district level, printing of education material on TB, newspaper supplements on World TB Day, TB ads, TB calendars and dairies, recorded television and radio programmes and TB billboard displays.
EPOS Health Management in collaboration with GOPA consultants is supporting TB Control Programme through German Development Bank, KfW.
GLOBAL FACTS ABOUT TB
- In 2013, 9 million feel ill with TB.
- A total of 1.5 million people died from TB in 2013 (including 360000 people with HIV)
- 80000 HIV negative child died due to TB globally in 2013.
- TB is the leading killer of people living with HIV.
- The number of people falling ill with TB is declining and the TB burden rate dropped 45% since 1990.
- About 80% of reported TB cases occurred in 22 countries in 2013.
- Multidrug Resistant TB (MDR-TB) does not respond to standard treatments and is difficult and costly to treat.
- An estimated 480000 people developed MDR-TB in 2013.
- About 37 million lives were saved worldwide between 2000 to 2013 through TB diagnosis and treatment.
- The world is on track to achieve the global TB target set for 2015 in the Millennium Development Goals.