National TB control program Flashcards

Question

TB treatment outcome definitions - **for drug-susceptable TB** - for drug-resistant TB | Mnemonic: CCF-DuLu-NaS

Answer 1

Only applicable in drug-susceptable TB: 1) Cured: - a **PTB** case with bacteriologically confirmed TB at the beginning of Rx - who was smear or culture **negative** in the **last month of Rx ** and on at least one previous occasion 2) Rx completed: - TB pt who completed Rx **without** evidence of failure, - but with **no record** to show that sputum smear or culture results in the last month of Rx and on at least one previous occasion were negative, - either because tests were not done or because results are unavailable 3) Rx failed: - TB pt whose sputum smear or culture is positive at month 5 or later during Rx 4) Died: - TB pt who dies for any reason before starting or during the course of Rx 5) Lost to f/up: - TB pt who did not start Rx, or - Rx was interrupted for two consecutive months or more 6) Not evaluated: - No Rx outcome is assigned. - Includes cases 'transferred out' to another Rx unit - as well as cases for whom Rx outcome is unknown to the reporting unit 7) Treatment success: - the sum of cured and treatment completed | **CCF-DuLu-NaS**

Answer 2

Only applicable in drug-resistant TB: 1) Cured: - Rx completed as recommended by national policy - without evidence of failure - **AND** ≥3 consecutive cultures taken at least 30d apart are negative after the intensive phase 2) Treatment completed: - Rx completed as recommended by the national policy - without evidence of failure - **BUT** no record that ≥3 consecutive cultures taken at least 30d apart are negative after the intensive phase 3) Treatment failed: - Rx terminated or need for permanent regimen change of at least two ATT drugs because of: i) lack of conversion by the end of the intensive phase, or ii) bacteriological reversion in the continuation phase after conversion to negative, or iii) evidence of additional acquired resistance to fluoroquinolones or second-line injectable drugs, or adverse drug reaction 4) Died: - pt who died for any reason during the course of Rx 5) Lost to follow-up: - treatment was interrupted for 2 consecutive months or more 6) Not evaluated: - No Rx outcome was assigned - incl cases transferred-out to another treatment unit and whose Rx outcome is unknown 7) Treatment success: - the sum cured and treatment completed | **CCF-DuLu-NaS** **C**ure **C**ompleted **F**ailed **D**ied **L**oss to

Answer 3

TBIS-10(place the letter here) A: Awal - To be filled up upon Dx B: Buku - The book documenting pt's personal info, Rx & progress. When pt move to different Rx unit, fill up TBIS-10K and send this TBIS-10B together to the new PR1 C: Contact - List of close contacts & doc's Ax of contacts D: Default - To report pt & close contact who defaulted - fill up this TBIS-10D form for pt who failed to attend treatment on 3rd day consecutively - fill up this form weekly for at least 8 times , for pt who failed to attent Rx for ≥2 months consecutively E: Electronic - the DOT book F: Follow-up - To inform PR2 about DOT, when is PR1 next TCA and completion of Rx G: Gagal - to find out factors for Rx failure H: Harian - put in front of folder - Appointment dates for PR1 - ATT regimen - sputum conversion date - PR2 location I: Information - overview of pt's Rx, smear conversion, DOTs & Rx outcome J: Jalan - pt's death and reason K: Keluar - For TB cases transferred out to other PR1

Answer 4

PR1: Treatment unit that - diagnose the pt with TB - started pt on TB Rx - Do on-going appointments and reviews of the pt, - Stop the TB Rx PR2: Treatment unit that - continue the TB Rx (DOTs), - **BUT** does not started the TB Rx or do on-going appointments and reviews - this facility may diagnose the TB

Answer 5

_Definition_: = The number of TB cases detected in a given year. - the TB case reported within the **national surveillance system**, then to WHO _Aim_: 1) Ensure high quality pt care 2) Aid staff providing adequate services 3) Allows managers in national TB program to monitor program performance 4) Basis for program and policy development

Answer 6

_Def of Systematic screening for TB disease_: - systematic identification of ppl at risk for TB disease, - in a predetermined target group - by assessing Sx and - using tests, examination, or other procedures - that can be applied rapidly. _Types_: 1) Active case finding - **provider-initiated screening** - systematic screening - systematically target ppl high risk of exposure or developing TB - Screens them by assessing Sx, test, examination/ other procedures - high risk exposures: contacts of TB, PLHIV, high TB burden population (e.g. prisons, miners with silica exposure) 2) Passive case finding - **Pt-initiated pathway** - person with TB who experienced Sx - person having access and seeking care, and present spontaneously at a health facility - Health worker correctly assessing criteria of TB

Answer 7

3 pillars underpinned by 4 key principles: Pillars: 1) Integrated, pt-centred TB care and prevention 2) Bold policies and supportive system 3) Intensified research & innovation Key principles: 1) Government stewardship and accountability, with monitoring and evaluation 2) Building a strong coalition with civil society and communities 3) Protecting and promoting human rights, ethics & equity 4) Adaptation of the strategy and targets at country level, with global collaboration **Pillars**: - bring together critical interventions - to ensure all ppl with TB have equitable access to high-quality Dx, Rx care and prevention, - without facing catastrophic expenditure or social repercussion **Principles**: - The success of the strategy in driving down TB deaths and illness will depend on - countries respecting the key principles - as they implement the interventions outlined in each pillar

Answer 8

All countries should aim to reach these targets by 2025: 1) Rx coverage ≥90% 2) Rx success rate ≥90% 3) Preventive Rx coverage ≥90% - PLHIV & children who are contact of cases started on LTBI Rx 4) TB affected households facing catastrophic costs 0% 5) Uptake of new diagnostics and new drugs ≥90%

Answer 9

TB pts with the following characteristics: 1) bacteriologically confirmed PTB 2) Proven or presumed MDR TB or XDR TB 3) PLHIV 4) Child <5y

Answer 10

1) Contact with DM 2) Index case with cavitation 3) Index case with >100AFB/field 4) Being household contact at night 5) Being a contact who is actively smoking

Answer 11

No uniform definition, so depends on local context. - Some definitions: i) Family members living in the same room with index case for >30d ii) family members or other ppl living with index case for >6m

Answer 12

1) Pt failed to attend TCA --> 2) Call pt on Day 1 & advise to attend TCA --> 3) If pt uncontactable, issue the first TBIS-10D on Day 3 --> 4) PR needs to issue TBIS-10D every week until 8 weeks, to allow further legal action to be taken

Answer 13

1) Prevention and Control of Infectious Diseases Act 1988 (Act 342) 2) Mental Health Act (Act 615) 3) Child Act 2001, amended 2016 (Act 611)

Answer 14

_Vision_: A world free of TB Zero deaths, disease and suffering due to TB _Goal_: End the global TB epidemic _Targets_: 1) Reduction in number of TB deaths by 90% (2030) and 95% (2035), compared with 2015 2) Reduction in TB incidence rate by 80% (2030) and 90% (2035), compared with 2015 3) TB-affected families facing catastrophic costs due to TB 0% (2030 and 2035)