Impact of DOTS on Case Fatality: India

Source: RNTCP India: quarterly and annual cohort analysis published as quarterly and annual reports at www.tbcindia.org NTP deaths: Datta M, Radhamani MP, Selvaraj R, et al. Critical assessment of smear-positive pulmonary tuberculosis patients after chemotherapy under the district tuberculosis programme Tubercle and Lung Dis 1993;74:180-186

RNTCP in India has reduced case fatality among registered TB patients by 7-fold

* |Country office for Bangladesh

Reduction in TB prevalenceModel DOTS Project (Thiruvallur, South India)Source: TRC, Chennai

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Title: Model DOTS project: Reduction in TB prevalence in South-India (source: TRC, Chennai)

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* |Country office for Bangladesh

BangladeshSource: WHO Report 2007, Global Tuberculosis Control Surveillance, planning, financing

* |Country office for Bangladesh

Assessment of vital registration systemsin South-East Asia

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Assessment of vital registration systemsin South-East Asia

* |Country office for Bangladesh

Lessons learned and challenges aheadSustaining current success and progress: ensuring resources and quality implementationWeak laboratory networks and surveillance mechanismsDifficulties in addressing TB/HIV and drug-resistant TBLow community awareness and utilization of servicesNational public health services overstretched: limited management capacity, infrastructure

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Measuring progress against MDGsHigh importance:Strengthen routine surveillance systems for routine TB cases; to be extended with testing for HIV and drug-resistanceStrengthen death registration systems; evaluate the reliability of methods for classifying TB deathsModerate importance:Undertaking disease prevalence surveys (where information is scarce)Evaluate the reliability of treatment outcomes in patient cohortsLow importance: Conducting two or more tuberculin surveys, mainly to measure change in risk of infection

* |Country office for Bangladesh

Conclusions: opportunities for meetingthe TB-related MDGs Good progress so far achieved in the RegionEnhanced resources for TB control:Sustained/increased funding for national budgetsAdditional support through bilateral and international initiatives (GFATM, GDF, Stop TB Partnership)Growing partnershipClear plans with set targets (what gets measured, gets done!)Intensified technical support to maintain quality and to implement and sustain necessary, additional interventions

* |Country office for Bangladesh

Thank you!

However,Even at maximum DOTS coverage, case detection seems to remain below the 70% target level in most settings (Dye et al 2002)

So we need innovative approaches to case detection.

The DEWG is a mechanism to do whatever it needs to be doneWe need to ensure we make good use of it.The 2nd ad hoc Committee produced some recommendations for action, the DEWG is a tool to facilitate/implement some of them.14