End TB News

Uploaded: December 7, 2017
• The WHO publishes a Compendium of all TB Guidelines and Associated Standards.

The Compendium has been developed as a clear and concise instrument to facilitate the understanding and planning of delivery of high-quality care for everybody affected by TB. It incorporates all recent policy guidance from WHO; follows the care pathway of persons with signs or symptoms of TB in seeking diagnosis, treatment and care; and includes key algorithms and cross-cutting elements that are essential to a patient-centred approach in the cascade of TB care. The Compendium is structured into 33 WHO standards. It consolidates all current WHO TB policy recommendations into a single resource, with electronic links to the individual, comprehensive WHO policy guidelines. This Compendium will be updated annually, including in its digital format, to allow incorporation of new evidence emerging from the rapidly evolving TB diagnostic and treatment landscape.

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• The WHO Recommends Three Approaches to Find the Missing TB Cases in the Philippines.

A team of officers from all three levels of the WHO (headquarters, regional office and country office) conducted a “screening-diagnosis” review mission along with key partner agencies on 02-06 October 2017. The mission recommended three approaches to find the missing cases: (1) ‘Screen all’ at all public health facilities and congregate settings, irrespective of their symptoms (2) ‘Screen high risk groups’ in communities and (3) ‘Link all’ who already have chest X-rays in private and corporate sectors to Xpert MTB/RIF, as required. For more details, please read the report by following the above-mentioned link.

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• Learning opportunity: Institut Pasteur launches an open online course on Tuberculosis.

This course will provide a knowledge base that goes from the basics of TB to the current state of knowledge on various aspects of tuberculosis: the clinical picture, epidemiology, paediatric TB, factors affecting susceptibility to the disease, including HIV, diabetes and human genetics, immunology, vaccines, diagnosis, current and future ways to detect drug resistance, and how to treat drug sensitive and multi-drug resistant strains. This online course is organized over six weeks. Each week is composed of 4 to 6 sequences. In each sequence, you will find a 10 minute video and two multiple choice questions (MCQ) to help students check their understanding. A weekly evaluation is performed using about 10 MCQs and, at the end of the course, a final evaluation is performed with 30 MCQs. Classes will start on Jan 29 2018 and end on Apr 02 2018. Estimated effort required: 02:30 hours per week.

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• Funding opportunity: Stop TB Partnership launches Challenge Facility for Civil Society Round 8.

Stop TB Partnership’s CFCS is a unique small grants mechanism that, since 2007, supports innovative community responses to fight tuberculosis (TB). The theme for this latest round of funding is “Communities for Impact”. The overall aim of CFSC Round 8 is to contribute to expanding access to quality TB prevention and care services to community- and hard-to-reach settings. The application period has started on 4 December 2017. Applications should be completed by Friday, 12 January 2018 (18:00 hrs Geneva time).

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Uploaded: November 9, 2017
• USAID announces new request for applications.

Then look for “Opportunity: 72049218RFA00001 - TB Platforms for Sustainable Detection, Care and Treatment Activity” This funding opportunity is open to all US and non-US organizations. Closing date for applications: Jan 03, 2018 Estimated total program funding: $20,000,000

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Uploaded: November 2, 2017
• WHO launches the Global TB Report 2017.

The report shows no significant progress against all important indicators. If we want to end TB by 2030, we need to launch historically unprecedented efforts against TB, starting now. Here are the full and extracted reports.

One-page comparative analysis of the Philippines vs the World.

Two-page extract report of the Philippines including SDGs.

;Global TB Report 2017 (a link to the WHO website).

Uploaded: October 18, 2017
• Stop TB Partnership announces TB REACH Wave 6 funding.

Deadline for Stage 1 application: 28 November 2017

Stop TB Partnership wants to fund innovative and out of the box ideas, strategies, initiatives, and technologies, which aim to increase the number of people diagnosed and treated for TB, to decrease the time to appropriate treatment and to improve treatment success rates. The Philippines is one of the 12 countries that they will prioritise for this funding. Applicants from the Philippines are encouraged to submit proposals that link to, inform or support their country’s case detection or notification activities funded under their Global Fund grants. Please read this dedicated information note to understand how TB REACH funding needs to be linked to Global Fund Catalytic Funding on ‘finding the missing cases’: http://bit.ly/2zv31PN
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Uploaded: October 17, 2017
• GLI guide to TB Specimen Referral Systems and Integrated Networks.

Specimen referral systems can reduce catastrophic costs and treatment delays. Besides they can help to engage the private sector more easily by providing them the incentive of quality-assured laboratory services. This guide has many interesting indicators, formats and nine case-studies..
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• Community-based Care for DRTB: Guide for Implementers.

Community-based care for drug resistant TB patients is superior to facility-based care. This guide provides practical, step-by-step guidance on how to organize, implement, and monitor community-based care for DR TB. It is equally useful for program planning or supervision.
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• GLI Training Package: Programme Modules for Diagnostic Network Strengthening.

This modular training package has been developed to guide programme and laboratory managers and their implementation partners on key topics for diagnostic network strengthening. The modules are in PowerPoint format for country customization, and are accompanied by facilitator guides and worksheets for participants.
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Uploaded: August 12, 2017
• DOH Releases Implementing Guidelines for Multi-Drug-Resistant Tuberculosis (MDRTB).

This is an excellent document. Please read it carefully. If we implement what is mentioned in the document, and keep the interest of the patients as paramount, the treatment success rate will rise 80-90% rapidly. The most-critical sections that you need to read are about the 3Ps (as I call them):.
  1. Preventing (and treating) nausea and vomiting on page 53
  2. Paying home-visits to prevent and manage treatment interruptions on page 72
  3. Patient-centred caring through community-based care on page 76
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• USAID issues Request for Applications for a new project on TB innovations and health systems strengthening.

USAID/Philippines has posted a Request for Application (RFA) to seek applications from eligible U.S. non-profit nongovernmental organization (NGOs) for-profit NGOs willing to forego their fee, private voluntary organizations (PVOs), Philippine-based NGOs, universities, foundations, consortiums, and international organizations for a Cooperative Agreement to implement a $30 million, five-year activity entitled, “Tuberculosis Innovations and Health Systems Strengthening.” To see details regarding this RFA, click the link below:
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Uploaded: June 26, 2017
• Estimating the Future Burden of MDRTB and XDRTB in India, the Philippines, Russia, and South Africa: A Modelling Study.

MDR and XDR tuberculosis were forecasted to increase in all four countries [including the Philippines]. Additional control efforts beyond improving acquired drug resistance rates are needed to stop the spread of MDR and XDR tuberculosis in countries with a high burden of MDR tuberculosis. [A “comment” article on this paper in the same issue of the journal mentions that the main efforts ... should be aimed at using rapid diagnostic methods for all patients, implementing the short-course regimens for MDRTB and using new drugs as per WHO recommendations. http://bit.ly/2sTkwqg].
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• The Cascade of Care in Diagnosis and Treatment of Latent Buberculosis Infection (LTBI): A Systematic Review and Meta-Analysis.

Factors associated with fewer losses [in the cascade of care for LTBI] were immune-compromising medical indications, being part of contact investigations, and use of rifamycin-based regimens [e.g., Rifapentine].
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• Barriers and Facilitators to the Uptake of Tuberculosis Diagnostic and Treatment Services by Hard-to-Reach Populations: A Systematic Review.

Stigma and challenges regarding access to health care were identified as barriers to tuberculosis diagnosis and treatment uptake, whereas support from nurses, family, and friends was a facilitator fortreatment adherence.
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• Effectiveness of Interventions for Diagnosis and Treatment of Tuberculosis in Hard-to-Reach Populations: A Systematic Review.

The analysis showed that tuberculosis screening by (mobile) chest radiography improved screening coverage and tuberculosis identification, reduced diagnostic delay, and was cost-effective among several hard-to-reach populations... Monetary incentives improved tuberculosis identification and management among drug users and homeless people.
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• Diabetes Mellitus and the Risk of Multidrug Resistant Tuberculosis: A Meta-Analysis.

The pooling analysis indicated that diabetes mellitus was an independent risk factor for MDR-TB, especially for primary MDR-TB.
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• WHO Video: People-Centred Care.

Shift away from [just] asking: “What is the matter with you?” to “What matters to you?” [In other words, ask your patients this one question: “How can I improve your care?”].
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Uploaded: May 5, 2017
• GLI Releases a New Guide on Xpert® MTB/RIF Ultra Cartridges.

The Global Laboratory Initiative (GLI) has released a guide on the new Xpert® MTB/RIF Ultra cartridges based on recommendations of the WHO. The sensitivity of these Ultra cartridges is about 5% higher than that of Xpert MTB/RIF (87.8% vs 82.9%). However, as expected, this increase in sensitivity is at the cost of specificity, which is about 3.2% lower (94.8% vs 98%). Hence, the GLI has suggested a revision of the algorithm. You may refer to the revised algorithm on page 11 of the document. This revised algorithm would be useful only after the Philippines starts procuring and supplying these new Ultra cartridges.
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• USAID/Philippines Issues Request for Applications for a New TB Project on Patient-Centred Care.

The Patient-Centred TB Care project will focus on improving patient-centred TB care by bolstering tuberculosis services at the regional, provincial, local government unit and community levels. It is a five-year project (September 2017 – August 2022) under a cooperative agreement award that is estimated at $20 million. Applications will close on June 15, 2017.
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Uploaded: April 30, 2017
• WHO Publishes New Guidelines for Treatment of Drug-Dusceptible Tuberculosis and Patient Care

The main highlights of the guidelines are:

Treatment of drug-susceptible tuberculosis

•The category II regimen is no longer recommended for patients who require TB retreatment and drug-susceptibility testing should be conducted to inform the choice of treatment regimen. Patient care and support [for drug susceptible and drug resistant tuberculosis]
Community- or home-based directly observed treatment (DOT) is recommended over health facility-based DOT or unsupervised treatment.

Decentralized model of care is recommended over centralized model for patients on MDR-TB treatment. The revision is in accordance with the WHO requirements for the formulation of evidence-based policy.
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Uploaded: April 2, 2017
• The WHO recommends Xpert MTB/RIF Ultra assay as an alternative to the existing Xpert MTB/RIF tests.

The Technical Expert Group of the WHO agreed that the Ultra is non-inferior to the Xpert MTB/RIF assay. The group agreed that the greatest benefit was in the increased yield for the detection of MTB in smear-negative culture positive specimens, paediatric specimens, extra-pulmonary specimens (notably cerebrospinal fluid) and especially for HIV positive individuals whose specimens are frequently paucibacillary
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• The WHO and UNICEF recommend use of the child-friendly fixed-dose combinations.

The WHO and UNICEF have urged all national TB programmes to discontinue and replace the previously used medicines for children weighing less than 25 kg with the child-friendly dispersible TB FDCs as soon as possible.
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• GLI Practical Guide for TB Laboratory Strengthening.

This Guide includes the use of four new WHO-recommended model TB diagnostic algorithms. In addition, it describes the most recent guidance in key technical areas, including quality assurance and quality management systems, specimen collection and registration, procurement and supply-chain management, biosafety, diagnostics connectivity, data management, human resources, strategic planning and other topics.
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• GLI Handbook on Four Model TB Diagnostic Algorithms.

This handbook provides four model diagnostic algorithms. (These are the same algorithms as in the above-mentioned GLI Practical Guide). These algorithms graphically depict the most up-to-date WHO recommendations on use of TB diagnostics. The algorithms include the use of Xpert MTB/RIF, line probe assays for 2nd line drugs, the lateral flow urine lipoarabinomannan (LF-LAM) assay and the loop-mediated isothermal amplification (TB-LAMP) test, together with conventional tools including microscopy and phenotypic culture and DST.
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• Engaging the private sector to increase tuberculosis case detection: an impact evaluation study.

A year-long mass communications initiative was deployed in a section of Karachi, Pakistan (the intervention area). This initiative encouraged people with prolonged cough (>2 weeks) to seek care at local family clinics or Indus Hospital – a 150-bed, private hospital. The initiative included billboards, local cable television ads, posters, and flyers, as well as deployment of local residents as TB screeners in over 50 local private sector family clinics. Screeners were provided a mobile phone, then given a monthly stipend and small conditional cash transfers via phone bank transfer for such activities as submitting a daily report, procuring an acceptable sputum sample, and identifying a smear-positive case. Between 2010 and 2011, pulmonary tuberculosis notifications increased by about four times for adults and about seven times for children.
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Uploaded: March 1, 2017
• An Activist Guide to TB Diagnostic Tools 2017.

This short guide is for activists as well as others who want to know about TB diagnostics in a very simple language.
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• Contact investigation for tuberculosis: a systematic review and meta-analysis.

In 95 studies from low- and middle-income settings, the prevalence of active TB in all contacts was 3.1%, microbiologically proven TB was 1.2%, and latent TB infection was 51.5%. The prevalence of TB among contacts of patients with multidrug-resistant or extensively drug-resistant TB was 3.4%. Incidence was greatest in the first year after exposure.
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• The Use of a Mobile Screening Unit in Active Case Finding for tuberculosis in Palawan, the Philippines.

In Palawan (Philippines), the DetecTB project implemented an active case finding strategy that offered a one-stop diagnostic service with a mobile unit equipped chest X-ray and Xpert. The highest yield (in percentage) with lowest number needed to screen (NNS) to get one TB patient was found in prison (6.2%, NNS: 16), followed by indigenous population (2.9%, NNS: 34), the rural poor (2.2%, NNS: 45), and the urban poor (2.1%, NNS: 48).
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• Quality of tuberculosis care – address gaps in the care cascade.

This paper describes how to use analysis of cascades of care to address quality of TB care. Please check the diagrams within it.
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• WHO Framework: Indicators and targets for laboratory strengthening under the End TB Strategy.

The Framework has 12 core indicators to measure programmes’ capacity to detect TB accurately and rapidly using new diagnostics, provide universal DST, and ensure the quality of testing. These indicators will be monitored globally by WHO as countries progress towards reaching the targets, and they complement the broader top 10 indicators for monitoring the End TB Strategy. Please refer to a link at the bottom of that webpage for a downloadable MS Excel file.
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• Quezon City backs ‘prescription for TB meds’ law.

Residents of Quezon City can no longer self-medicate for tuberculosis, after Mayor Herbert Bautista recently signed into law an ordinance preventing drugstores from selling anti-TB drugs without a doctor’s prescription. District 3 Councilor Eufemio Lagumbay authored Ordinance No. 2545, titled the “No Prescription, No Dispensing of Anti-TB Drugs Policy,” to enforce locally a national policy in dispensing prescription medication, which includes anti-TB drugs, over the counter. The measure also makes it imperative for pharmacies “to equip their personnel with the necessary skill and competence to help TB patients get access to the correct and complete TB treatment.”
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