Philippine Standard Time
Friday, April 3, 2020
12:46 am

WHO Corner

Source: End TB News by Rajendra Yadav, MD

  • New WHO Recommendations to Prevent Tuberculosis


    Operational Handbook:

    New WHO guidance will help accelerate efforts to stop people with TB infection becoming sick with TB by giving them preventive treatment.

    A third of Filipinos is estimated to be infected with TB bacteria. These people are neither sick nor contagious. However, they are at greater risk of developing TB disease, especially those with weakened immunity. Offering them TB preventive treatment will not only protect them from becoming sick but also cut down on the risk of transmission in the community. TB preventive treatment in the Philippines has so far been very low.

    More Resources:

    1. Prevent TB Digital Platform (WHO Philippines and DOH are building on this platform to create a full cascade of care app to be released in 2020.)
    2. Visual Q&A
    3. Factsheet on TB Preventive Treatment
    4. Q&A on TB Preventive Treatment
    5. How to Protect Ourselves from TB

  • Join the WHO Live Global Talk Show at 9pm

    Please join us on 24 March at 9:00pm PHT/1:00pm GMT for a special online talk show to mark World TB Day. Come engage with TB survivors and advocates, civil society, high level government representatives, heads of agencies, researchers and partners.
      Read More

  • Stop TB Partnership Launches Special TB and COVID-19 Campaign

    Lucica Ditiu of the Stop TB Partnership and Tereza Kasaeva of WHO along with many others will participate in a virtual town hall, to discuss how the COVID-19 pandemic impacts the work we do on TB. Asia session starts at 4:00pm PHT/8:00am GMT hosted on zoom,

      Read More

  • Cepheid Receives Emergency Use Authorization from US FDA for Fapid SARS-CoV-2 Test on GeneXpert Platform

    The test has been designed to operate on any of Cepheid's automated GeneXpert Systems worldwide, with a detection time of approximately 45 minutes.
      Read More

  • WHO Releases Information Note on Tuberculosis and COVID-19

    This information note addresses questions about COVID-19 for TB patients, sustainability of TB services during the COVID-19 pandemic, and how TB and COVID-19 health workers can unite to save lives.
      Read More

  • DOH Releases Memo on Ensuring Continuous TB Services During Community Quarantine

    TB services will continue but adjusted to avoid frequent exposure of patients and health workers. Most laboratories will stay operational but with major challenge is the restriction in land, air, and sea transportation.
      Read More

  • Lessons learned from TB control can Benefit the COVID-19 Response

    • Many practices in the TB response, such as triaging, cough etiquette, contact tracing in the community, and infection control in health centers and the community would benefit the COVID-19 response
    • People-centred models of care similar to TB, including hospitalisation for those with severe diseases, community-based services, video-supported treatment or home-based care are among the interventions that can be expanded or adapted for COVID-19

      Read More

  • Active or Latent Tuberculosis Increases Susceptibility to COVID-19 and Disease Severity

    • MTB infection likely increases susceptibility to SARS-CoV-2, and increases COVID-19 severity.
      MTB infection status of COVID-19 patients should be checked routinely at hospital admission.

      Read More

  • WHO Announces Forthcoming Changes for the Programmatic Management of TB Preventive Treatment

    In advance of the upcoming guidance on TB preventive treatment, WHO released communication including the following highlights.

    1. Broadened applicability of five of the previous recommendations across all burden settings.
    2. A regimen of one month of daily rifapentine plus isoniazid ("1HP") and another regimen of four months of daily rifampicin ("4R") are now proposed as TPT options for both high- and low- TB incidence settings
    3. Recommendations concerning TPT for people living with HIV.

    In related news, the US CDC recently updated their Guidelines for the Treatment of Latent Tuberculosis Infection including preferred short-course regimens.

      Read More

  • WHO Releases Frequently Asked Questions Document on Recent Key Changes to Treatment for DR-TB


    Rapid Communication Document:

    WHO's Global TB Programme, in collaboration with USAID, Global Fund and the Global Drug Facility have updated the Frequently Asked Questions (FAQs) document on WHO's Rapid Communication: Key changes to the treatment of drug-resistant tuberculosis. The document recommends an all-oral, bedaquiline-containing regimen for MDR-TB patients.

  • The Union Updates Management of Tuberculosis: A Guide to Essential Practice


    Supplemental Materials:

    The 7th edition of the “Orange Guide” has been extensively updated, and includes new information on the management of persons with tuberculous infection, bacteriological diagnosis of tuberculosis, co-management of individuals with tuberculosis and certain comorbidities, treatment of drug-resistant tuberculosis, active use of NTP data by service providers at all levels of the health services and the use of operational research to strengthen the quality of tuberculosis care.

  • Philippine Statistics Authority Estimates the Proportion of Poor Filipinos at 16.6 Percent

    The proportion of poor Filipinos whose per capita income is not sufficient to meet their basic food and non-food needs, was estimated at 16.6 percent. This translates to 17.6 million Filipinos who live below the poverty threshold estimated at PhP 10,727, on average, for a family of five per month in 2018. On the other hand, subsistence incidence among Filipinos, or the proportion of Filipinos whose income is not enough to meet even the basic food needs, was registered at 5.2 percent in 2018. The monthly food threshold for a family of five was estimated, on average, at PhP 7,528.
      Read More

  • WHO Announces Updates on Xpert MTB/RIF, Xpert Ultra and Truenat Molecular Assays for Diagnosis of TB

    Evidence reviewed shows confirmation of high diagnostic accuracy and improved patient outcomes for the Xpert MTB/RIF assay (approved by WHO in 2010) as the initial test to diagnose pulmonary TB (i.e. replacing smear microscopy). Highlights also include the accuracy of a new molecular diagnostic system (called 'Truenat') as an initial test to diagnose pulmonary TB and rifampicin resistance in sequential steps. WHO approval of Truenat increases the competition for rapid diagnostics and thereby may be able to bring down costs.
     Read More

  • WHO Releases The Global TB Report App

    Google Play Store:

    Apple Store:

    Demo Video:

    Discover current statistics and trends, compare countries and regions, and have global TB data right at your fingertips. The free app works offline so you always have access to the data you need.

    For additional Philippines data, you may use the "Race to End TB" mobile apps and web dashboard.

    Race-to-end-TB dashboard:

    Google Play Store:

    Apple Store:

  • The Global Drug Facility Offers IGRA at Reduced Cost

    GDF Catalogue:

    Paper on IGRA:

    The Global Drug Facility (GDF) has added an IGRA (interferon-gamma release assay) test for latent TB infection to its catalog. The products required to run the QuantiFERON-TB Gold Plus (QFT-Plus) IGRA are now available at a GDF-negotiated price of $15.90 per test. This price is offered to any public sector or not-for-profit buyer in low- and middle-income countries when procuring through GDF.

    IGRA provides an alternative to the Tuberculin Skin Test (TST) which is one of the oldest medical tests still in use and many are advocating for an updated option (see the paper The Case for Retiring the Tuberculin Skin Test at the link above). Costs for testing and treating TB infection continue to come down and better and safer treatment options are increasingly available. Removing TB at the infection stage and avoiding the risk of developing TB disease is becoming a more attractive option for ending TB.

  • WHO and DOH Release 2019 Drug Availability Survey

    DOH has been conducting “drug availability surveys” since 2009. The surveys progressively assess the timeliness and sustainability of medicines and vaccines supply to identify opportunities to upscale outpatient care. Physical inventory was conducted in 450 public healthcare facilities across 17 regions in the Philippines as a representative sample. Of the 5 essential drugs listed to treat TB, mean drug availability is 39% across the country. Two out of 5 TB drugs are available in primary healthcare facilities while only a little more than 1 out of 4 are present in higher level hospitals.

  • Stop TB Partnership Opens Applications for Challenge Faclity for Civil Society 2019


      Information Note

    Challenge Facility for Civil Society
    is the Stop TB Partnership (STP) grant mechanism for TB affected community and civil society organizations to transform the TB response so that it is rights-based, gender-transformative, people-centered and accountable. Since 2007 STP has had eight calls for proposals. In that time STP awarded USD 3,540,000 in grants to 131 organizations in 44 countries. The 2019 call is the largest ever with funding available for each proposal between USD 25,000 and USD 150,000.

  • Global Drug Facility Releases Video Showing Progress in Pediatric Drug Formulations for Drug - Resistant TB

    Video (15:20):

    Short version (3:45):

    The Global Drug Facility set up the Pediatric Drug-Resistant TB Initiative aiming to ensure access to the best possible treatments to children suffering from drug-resistant TB. This video shows the impact of the roll out of pediatric-friendly formulations of some second-line drugs for the treatment of RR-TB in children.

  • Philippine Statistics Authority releases the 2018 Philippine National Health Accounts

    Link to report:

    Link to infographic on health expenditure:

    Link to other infographics:

    In 2018, household out of pocket (OOP) was at 53.9%, with more than half of it (50.1%) spent at pharmacies. Every Filipino spent nearly PhP 7,500 for health in 2018 on average. This report includes revised 2016 and 2017 NHA estimates.

  • The Global Laboratory Initiative (GLI) Launches the TB Laboratory Safety Handbook

    Link to the handbook:

    This Handbook focuses on how to work safely in order to reduce the risk of infection or injury and protect the laboratory workforce and the wider community against unintentional exposures or releases of pathogenic biological agents.

  • WHO Aims for Healthy Meetings

    Link to example menu:

    Link to folded brochure:

    A key role for WHO is to convene meetings - gathering together various people passionate about promoting public health. Ironically, the meetings themselves can be less healthy for the participants if not deliberately designed. WHO Western Pacific Regional Office has produced this guidance for when WHO staff organize meetings, to ensure we “walk the talk” of health. You may find them useful for meetings you organize!

  • Philippine Statistics Authority releases the 2018 Philippine National Health Accounts

    Link to report:

    Link to infographic on health expenditure:

    Link to other infographics:

    In 2018, household out of pocket (OOP) was at 53.9%, with more than half of it (50.1%) spent at pharmacies. Every Filipino spent nearly PhP 7,500 for health in 2018 on average. This report includes revised 2016 and 2017 NHA estimates.

  • The Global Laboratory Initiative (GLI) Launches the TB Laboratory Safety Handbook

    Link to the handbook:

    This Handbook focuses on how to work safely in order to reduce the risk of infection or injury and protect the laboratory workforce and the wider community against unintentional exposures or releases of pathogenic biological agents.

  • WHO Aims for Healthy Meetings

    Link to example menu:

    Link to folded brochure:

    A key role for WHO is to convene meetings - gathering together various people passionate about promoting public health. Ironically, the meetings themselves can be less healthy for the participants if not deliberately designed. WHO Western Pacific Regional Office has produced this guidance for when WHO staff organize meetings, to ensure we “walk the talk” of health. You may find them useful for meetings you organize!

  • Comparative Profiles for the World and Philippines (National and Regional)

    Previously, I have sent to you the comparative table for the global and national levels, based on the new 2019 Global TB Report. This new link provides comparative tables and graphs for the global, national and regional levels: Please feel free to provide your comments to me so that we can improve the profiles.

  • Paper: Using Artificial Intelligence to Read Chest Radiographs for Tuberculosis Detection

    Deep learning (DL) neural networks are being used to interpret chest radiography (CXR) to screen and triage people for pulmonary tuberculosis (TB). This research evaluated three DL systems (CAD4TB, Lunit INSIGHT, and qXR) for detecting TB-associated abnormalities in chest radiographs from outpatients in Nepal and Cameroon. When the researchers compared the performance of DL systems and radiologists, all three systems were better than human readers in detecting bacteriologically confirmed TB. Using DL systems to read CXRs could reduce the number of Xpert MTB/RIF tests needed by 66% while maintaining sensitivity at 95% or better. Interesting side-note: Lunit INSIGHT is collaborating with FujiFilm, which has launched a highly portable X-ray machine called "Calneo Xair". You may watch their video here:
     Read More

  • Editorial: TB Consilia and Quality of Tuberculosis Management

    Although the implementation of national TB consilia is highly recommended (to guide the management of all or the majority of 'complex' cases), the existing supranational TB consilia (e.g., the Global TB Consilium; are also useful for a second opinion on challenging cases and as a resource to manage specific cases for which extensive or specific expertise is not available at the national level.
     Read More

  • WHO Releases Global TB Report 2019

    Here are the full report and other related materials:

    Here are some infographics related to the Philippines:

    Here is a comparative table of the World and the Philippines:

  • Paper: Costs and Operation Management of Community Outreach Program for Tuberculosis in Tribal Populations in India

    In 2018, household-out-of-pocket payment (OOP) was 53.9% of the Current Health Expenditures (CHE) in 2018. Health spending financed through government schemes and compulsory contributory health care financing schemes was 34.0% of the CHE. Voluntary health care payment schemes contributed 12.2%. More than half of OOP (50.1%) were spent on pharmacies.  Read More

Massive Open Online Course (MOOC) on Implementation Research

Deadline to register: 4 October 2019

This Massive Open Online Course (MOOC) is a step-by-step online training that will introduce you to designing robust IR projects. You will have access to leading world experts who will take you through the core concepts of IR, including how to: identify the challenges of various health settings; assess the appropriateness of existing strategies; develop new interventions and strategies by working with communities and stakeholders; specify your IR questions; and design rigorous research projects. You will learn how to identify IR outcomes, evaluate effectiveness, and make plans to scale up implementation.

This course is open to all applicants.

No technical or scientific background is required, though a health background will be an advantage.

Language: English with subtitles in English, French and Spanish.

Course starts on 7 October 2019

To register, please contact:

Consult the Course Flyer for more information.

More information about TDR MOOC.

TB Apps and Dashboards of the National TB Programme (Philippines)

You may download the "Race to End TB" mobile apps and visit the "Race to End TB" web dashboards by following the below-mentioned links. The web dashboards have top-level and expert-level indicators. The mobile apps only have the top-level indicators.

These mobile apps and web dashboards are fully linked to the Integrated TB Information System (ITIS) of the Department of Health (DOH). They have real-time data. In the coming months, we will continually support the DOH to enhance the features of these tools based on inputs from all users, including you. We plan to add real-time gamifications, rewarding systems, supervisory modules and artificial intelligence features soon.

 Race-to-End-TB Dashboard

 Google Play Store

 Apple Store

  • Two-pager: HIV Testing and Mortality Among TB Patients in the Philippines

    This interesting two-page analysis was drafted by Yohhei Hamada (RIT/ JATA/ JICA) and Tracy Yuen (WHO Consultant) using the latest ITIS data of the Philippines. It shows that people with TB who were not tested for HIV were significantly more likely to die. The odds ratios were 1.85 (95%CI 1.7-2.0) for drug sensitive TB and 4.21 (95%CI 3.3-5.4) for drug resistant TB. The two-pager has a map on the regional differences. [Therefore, let us please work towards faster and wider coverage of HIV testing among people with TB to save precious lives.]
     Read More

  • Papers: Lancet Publishes a Series of Papers on Tuberculosis

    In this 2019 series, Lancet presents how diagnosis of multidrug-resistant tuberculosis can be improved, how drug regimens could be used to best treat different patient populations, and future perspectives for management of multidrug-resistant tuberculosis. They highlight the gap in knowledge surrounding children with tuberculosis and how testing can be improved. They also present the latest insights into the field of tuberculosis vaccine development, looking at clinical and preclinical trials, the challenges that remain to be overcome, and how controlled human infection models and tools, such as in-vitro functional killing assays, can facilitate vaccine selection.
     Read More

  • Research: WHO Publishes a Call for Research Proposals on Pharmacovigilance

    TDR has announced a call for applications to support research on the challenges and opportunities for pharmacovigilance. The overall objective of the call is to generate understanding of the problematic of underreporting of adverse events in LMICs and how new tools and approaches could improve drug safety monitoring.
     Read More

  • Paper: Lessons Learned from Community-based Tuberculosis Case-finding in Western Kenya

    Relevant findings: Attendance at rural sites where community health volunteers (CHVs) were paid a daily minimum wage was significantly higher than at rural sites where the CHVs were paid a nominal monthly stipend. Conclusion: Mobile units were most effective and efficient when implemented as a single event with community health workers who are paid a daily minimum wage.
     Read More

  • Paper: Costs and Operation Management of Community Outreach Program for Tuberculosis in Tribal Populations in India

    A total of 23 community health workers (CHWs) who already had access to a motorbike were recruited from nearby villages. They were assigned to a defined catchment area to systematically visit homes and communal areas of the villages to provide TB education, screen, collect sputum samples, and deliver results and TB medication. CHWs were given a monthly travel and communication allowance, and performance-based payments. After the program was implemented in the region, there was an increase of over 20% (11.15 to 13.33 tests) in the average number of smear microscopy tests/day. Each CHW supported the treatment of 22 TB patients (on an average) during the year of implementation. The intervention was found to be cost-effective for screening, diagnosis as well as treatment support.
     Read More

  • News: US FDA Approves New Treatment for Highly Drug-Resistant Forms of Tuberculosis

    The US Food & Drug Administration (FDA) has approved Pretomanid. They approved this new drug as part of a three-drug, six-month, all-oral regimen for the treatment of people with extensively drug-resistant TB (XDR-TB) or multidrug-resistant TB (MDR-TB) who are treatment-intolerant or non-responsive. Note: The WHO is currently updating its guidelines on the programmatic management of drug-resistant TB. This drug and regimen may be included in that document.
     Read More

  • Paper: Perceptions of the Private Sector for Creating Effective Public–Private Partnerships against Tuberculosis in Metro Manila, Philippines

    James Sherpa (our ex-WHO intern) has published this research article recently. Abstract: Private providers in Metro Manila perceived their clientele as loyal and their services as distinct from public services, with unique attractions of convenience and quality of service. The private sector saw value in engaging with the public sector for knowledge exchange, access to public-sector commodities, and access to public sector assistance with public health tasks related to tuberculosis. However, their proposed ways of engaging were more centred on the private sector role, in ways that are not currently being pursued by the public sector. It is of the utmost importance to recognize that private provider perspectives are essential to build effective engagement models and, thus, to reach all clients with quality TB care. Note: The WHO retains the copyright to this article. Therefore, please feel free to distribute it to anyone who may benefit from it.
     Read More

  • Paper: National Tuberculosis Patients Cost Survey: Research Findings Lead to Change in Policy and Practice, VietNam

    Abstract: In 2016, the Viet Nam National Tuberculosis Programme (NTP) conducted the first national TB patients cost survey. This survey aimed to identify the main cost drivers to help guide cost mitigation policies and reduce financial barriers to the treatment of TB patients. The survey findings were widely disseminated and the NTP defined a roadmap. The major components of the roadmap included (1) advocating for patients to be covered by social health insurance; (2) creating a charity fund for TB patients; (3) strengthening the collaboration between the Ministry of Health and Ministry of Labour and Social Affairs; and (4) advocating for donor support. The survey findings led to policy changes and new practices in Viet Nam. The Viet Nam NTP plans to conduct a second national TB patients costing study in 2020 to measure the impact of policy change with the help of the multisectoral roadmap. Note: Let us hope that the Philippines can also continue to find similar and/ or other ways and design a roadmap to mitigate the catastrophic costs that over one-third of Filipino TB patients face, as per the 2017 Patients’ Cost Survey of the Philippines.
     Read More

  • Paper: Why Every Word Counts: Towards Patient - and People-Centred Tuberculosis Care

    Here is a paper that I co-authored on people-centred tuberculosis care. In this paper, we emphasise on how the language we use to refer to people with TB often place limits on the care that we provide to them.
     Read More

  • The WHO Launches "Multisectoral Accountability Framework" (MAF-TB)

    Here is a fact sheet on the Multisectoral Accountability Framework on TB that can help support the process of defining who is accountable, what they are accountable for, and how they will be held accountable, at country and local levels, as well as at regional and global levels. MAF has four components: Commitments -> Actions -> Monitoring and Reporting -> Review.
     Read More

  • Stop TB Partnership Supports the Launching of the Declaration of the Rights of People Affected by Tuberculosis

    This declaration mentions 22 rights of people affected by tuberculosis, which includes the rights to life, dignity, health, freedom from degrading treatment, equality, liberty, freedom of movement, privacy, confidentiality, information, informed consent, education, work, food, housing, water and sanitation, social security, freedom of expression, freedom of assembly and association, participation, justice and science.
     Read More

  • The WHO Launches Simple Training Modules on "Capacity-Building of Affected Communities for Accelerated Response to Drug-resistant Tuberculosis"

    This document has the following modules:

    • Module 1: TB/DR-TB Treatment Literacy
    • Module 2: Advocacy
    • Module 3: Barefoot Counselling
    • Module 4: Community Feedback Systems

     Read More

Stop TB Partnership publishes 10 Field Guides on "Finding the People with TB Who Are Missed"

Globally, TB programmes are missing people who: (1) Do not access care, either due to vulnerability, stigma, poverty, remote location, or ongoing conflict; (2) Access care, but are not diagnosed with TB due to deficient screening, diagnostic and referral systems, long waiting times, and overburdened health systems; and (3) Are diagnosed, but may not be started on proper treatment and notified. These 10 Field Guides are organized around these three broad gaps in TB case finding.

Field Guide I: Introduction: Planning and managing interventions to reach more people with TB

Field Guide 1: TB case finding with key populations

Field Guide 2: Strategies for TB case finding in prisons and closed settings

Field Guide 3: Finding missing people with TB in communities

Field Guide 4: Intensified case finding at facility level

Field Guide 5: Scaling up interventions to find children with TB

Field Guide 6: Using contact investigation to find the missing people with TB

Field Guide 7: The role of laboratory systems in TB case detection

Field Guide 8: The role of chest X-ray screening in TB case detection

Field Guide 9: Finding missing people with TB by engaging the private sector

Field guide 10: Strengthening TB information systems and linkages to care

 Read More
  • Paper (Lancet): Tuberculosis

    This is a "seminar" article on A-to-Z about tuberculosis, including many interesting updates.
     Read More

  • Paper (Lancet): Now is the time for shorter all-oral regimens for multidrug-resistant tuberculosis

    Given the new recommendations on the hierarchy of multidrug-resistant tuberculosis drugs, the authors of this article find it surprising that WHO continues to recommend the shorter “Bangladesh” regimen, which includes several drugs that are low in the current hierarchy of multidrug-resistant tuberculosis drugs (e.g., amikacin, ethionamide, and isoniazid). According to them, national tuberculosis programmes must choose between sticking with the obsolete Bangladesh regimen or new, shorter all-oral regimens that are likely to be more effective and safer.
     Read More

  • Paper (WPSAR): Tuberculosis among children, adolescents and young adults in the Philippines: a surveillance report

    This paper analysed patient-based national surveillance data to investigate the epidemiology of reported tuberculosis among children (aged 0–9 years), adolescents (aged 10–19 years) and young adults (aged 20–24 years) to better understand the burden of disease and treatment outcomes in these age groups.
     Read More

  • Paper (JCM): False-positive Xpert MTB/RIF results in retested patients with previous tuberculosis

    The study prospectively retested sputum from 238 patients, irrespective of current symptoms, who were previously diagnosed to be Xpert positive and treated successfully. Patients who retested as Xpert positive and culture negative were exhaustively investigated (repeat culture, chest radiography, bronchoscopy with bronchoalveolar lavage, long-term clinical follow-up). A total of 229/238 (96%) of patients were culture negative. All patients who initially retested as Xpert positive and culture negative ("Xpert false positive") were clinically well without treatment after follow-up. Conclusion: Patients with previous TB retested with Xpert can have false-positive results and thus not require treatment.
     Read More

  • Paper: Mental Health Disorders, Social Stressors, and Health-Related Quality of Life in Patients with Multidrug-Resistant Ruberculosis: A Systematic Review and Meta-Analysis

    Results. The paper included a total of 40 studies that were conducted in 20 countries. The overall pooled prevalence rates of the most common mental health disorders were 25% for depression, 24% for anxiety, and 10% for psychosis. The prevalence of psychosis was 4% before MDR-TB treatment commencement, and 9% after MDR-TB treatment commencement. The most common social stressors reported were stigma, discrimination, isolation, and a lack of social support. Health-related quality of life was significantly lower among MDR-TB patients when compared to drug-susceptible TB patients.
    Conclusion. [We need to screen all MDRTB patients for mental health and social issues using simple and short tools. Then, we need to refer those who require mental health services, social protection and/or social support for appropriate care.]
     Read More

  • Guide: WHO Issues New Guidelines on TB Infection Prevention and Control

    The target audience for these guidelines includes national and subnational policymakers; frontline health workers; health system managers for TB, HIV and highly prevalent non-communicable disease programmes; managers of IPC services in inpatient and outpatient facilities; managers of congregate settings and penitentiary facilities; occupational health officials; and other key TB stakeholders.
     Read More

  • Study: Silica Exposure in the Philippines

    This report of DOLE mentions that more than 35,000 people develop silicosis every year within the Philippines. Exposure to silica dust and silicosis are among the strongest risk factors for TB, with a relative risk of 2.8 – 39 for silicosis, depending on the severity of the disease. Silicosis is common in miners, which is the main reason for the high incidence of TB among them.
     Read More

  • World TB Day: More Materials and Guidance for 24 March 2019 (from the WHO)

    At this website, you can find many materials about WHO TB Day 2019, from the WHO, including an animated logo, social media tiles and posters .
     Read More

  • Guide: Management of Diabetes Mellitus-Tuberculosis – A Guide to the Essential Practice

    This resource provides practical guidance for front line health workers responsible for the diagnosis, management and care of patients with these two diseases. The Union has published this guide in collaboration with the World Diabetes Foundation.
     Read More

  • Guide: Constructing Care Cascades for Active Tuberculosis

    This interesting article describes methods for constructing care cascades for active TB.
     Read More

  • News: People in the Philippines Spend the Most Time Online, Global Report Finds

    A new report has revealed the world\'s heaviest internet users: the Philippines, where people spent an average of 10 hours and two minutes a day online in 2018. Brazil came in second, with nine hours and 29 minutes of internet usage, followed by Thailand with nine hours and 11 minutes, Colombia with nine hours, and Indonesia with eight hours and 36 minutes.
     Read More

  • Call for Proposals: TB REACH Wave 7 has been Launched (deadline: 2 April 2019)

    The Stop TB Partnership’s TB REACH has launched its Wave 7 round of funding to improve TB case finding and treatment outcomes with an emphasis on the empowerment of women and girls to lead key approaches in TB response. Interested agencies may apply. The WHO Country Office (Philippines) would be happy to provide technical assistance during the writing of the concept note.
     Read More

  • Paper: Interventions to Improve Retention-in-Care and Treatment Adherence among Patients with Drug-resistant Tuberculosis: A Systematic Review

    Results. This systematic review included 25 studies published between January 2000 and December 2017. Individual counselling support and home visits by health workers, provided throughout treatment, were associated with fewer losses to follow-up than when they were provided only at the start of treatment, or not at all. The findings are consistent with those reported in a recent Cochrane systematic review (link:, which found that daily DOT did not improve TB cure rates, compared to self-administered therapy, when the frequency of contact with providers during self-administrated therapy was every 2 weeks or more frequently than that. This review also provides evidence to support the effectiveness of financial compensation for rent or travel expenses, as well as lost wages, but not of group counselling, involvement of family in counselling sessions or nutritional support, on improving retention in care.
     Read More

  • Paper: Finding the Missing Cases in Primary Health Clinics of South Africa

    During this study, the researchers used "any-one-of-four" symptom screening. But they used Xpert test for all visitors of the primary health clinics. They found that about 5% of those who had at least “any-one-of-the-four TB symptoms” had Xpert positive TB. They also found that about 2% of those who were visiting the clinics for other reasons had Xpert positive TB. The research findings suggest that the primary health clinics of South Africa used to miss 62.9–78.5% of TB patients attending primary health clinics for TB-related symptoms. The clinics also used to miss 89.5–100% of TB patients attending the clinics for other non-TB symptoms. [Now, South Africa has started using "screen all" policy in all clinics of the country. To find all TB patients among clinic visitors, X-ray screening may be done, if available. If X-ray is not available, "any-one-of-four" symptom screening will also find many missing TB patients.]
     Read More

  • Advisory: National Privacy Commission Responds to the Department of Health regarding Collection of Health Information

    In this advisory, the National Privacy Commission has clarified to the DOH that "the Data Privacy Act does not prohibit the DOH from collecting and processing personal data for purposes necessary to its mandate". This advisory is useful for facilitating mandatory notifications by the private providers.
     Read More

WHO Publishes the 2018 Global TB Report

This new report shows that the incidence rate of the Philippines did not change between 2016 and 2017. The main reason for the no-change is that the treatment coverage rate fell from 58% in 2016 to 55% in 2017. To achieve the SDG target of 80% reduction of incidence rate by 2030 (compared to 2015), we need to increase our treatment coverage rate to over 90% within the next 2-3 years, rapidly.

Here is the full 2018 Global TB Report:
View Report

Here is a one-page comparative global and Philippines data based on the report:
View Report

Here is a one-page extract for the Philippines from the report:
View Report

Here is a one-page infographic for the Philippines based on the report:
View Report

  • President Duterte Signs the Occupational Safety and Health Standards Act (Republic Act 11058)

    For the health aspects of the Act, the focus is on tuberculosis, hepatitis and HIV. Here is a nice DOLE-primer, although a little outdated: is now in the process of writing the “implementing rules and regulations” for this Act. Engaging DOLE and the formal sector for health in the context of this new Act will help us to reach out to almost 26% of the general population who are in the formal sector.
     Here is Republic Act 11058, drafted in 2017 and signed in 2018

  • The Global Laboratory Initiative (GLI) Announces the Launch of the Specimen Referral Toolkit

    This toolkit is for developing, strengthening and integrating specimen referral networks globally.
     Read More

  • WHO Bulletin: Patient-led Active Tuberculosis Case-finding in the Democratic Republic of the Congo

    Volunteers, mostly ex-TB patients, screened 650,000 people at the cost of US$0.29 per person screened and US$ 44 per person diagnosed. The intervention resulted in an additional 4,300 sputum-smear-positive pulmonary tuberculosis diagnoses, 42% (4,300/10,247) of the provincial total for that period.
     Read More

  • WHO Publishes Updated and Consolidated Guidelines on Latent TB Infection

    This new guideline mentions that National TB Programs need to focus on TB contacts who are above five-year of age too, and not just under-five contacts and PLHIV. It recommends shorter regimens to treat Latent TB Infection, e.g., INH + Rifampicin daily for three months and INH + Rifapentine weekly for three months.
     Read More

  • Lancet: Chest Radiography may be Offered to People living with HIV who are on ART in Addition to Four-symptom Screening

    The systematic review suggests that the WHO’s four-symptom screening rule has lower sensitivity among people with HIV (PLHIV) who are on ART. Hence, chest radiography may be offered to PLHIV who are on ART to improve the sensitivity of the four-symptom screening rule, provided it does not pose a barrier to preventive treatment. The WHO guideline on Latent TB Infection (above) mentions this too.
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  • USAID/CTB Publishes TB Stigma Measurement Guidance

    This is a technical guide to help TB programs and partners measure levels of TB stigma in specific settings and populations.
     Read More

The WHO Announces Landmark Changes in MDR-TB Treatment Regimens

17 August 2018 | GENEVA - Major improvement in treatment outcomes and quality of life of patients with multidrug-resistant tuberculosis (MDR-TB) are expected, following key changes in MDR-TB treatment announced by WHO today.

The first important change is a new priority ranking of the available medicines for MDR-TB treatment, based on a careful balance between expected benefits and harms. Treatment success for MDR-TB is currently low in many countries. This could be increased by improving access to the highest-ranked medicines for all patients with MDR-TB.

The second important change is a fully oral regimen as one of the preferred options for MDR-TB treatment, with injectable agents proposed to be replaced by more potent alternatives such as bedaquiline (the first-ever medicine to be developed specifically for the treatment of MDR-TB). Injectable agents cause pain and distress to patients, with many experiencing serious adverse effects that often lead to treatment being interrupted.

"The treatment landscape for patients with MDR-TB will be dramatically transformed for the better with the announcement today," said Dr Soumya Swaminathan, WHO Deputy Director-General for Programmes. "Building on the available new data, and with the involvement of a large number of stakeholders, WHO has moved forward in rapidly reviewing the evidence and communicating the key changes needed to improve the chances of survival of MDR-TB patients worldwide. Political momentum now needs to urgently accelerate, if the global crisis of MDR-TB is to be contained."
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  • WHO Publishes a New Compendium of Guidelines and Associated Standards to End TB (June 2018)

    This is the latest version of the End TB Compendium, with many new things that are relevant for the Philippines. If you are too busy to read the whole document, then please just try to skim through the WHO’s 33 standards of care (words in bold letters) – from page # 9 to 39.
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  • DOH Publishes the Admin Order on "FOURmula One Plus for Health"

    This is a great policy, with a potential to revolutionise the health sector in the Philippines. Everyone needs to read and adopt it in their work.
     Read More

  • 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.     Read More

  • 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.     Read More

  • 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.     Read More

  • 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).     Read More

  • USAID announces new request for applications

    “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: January 03, 2018 Estimated total program funding: $20,000,000.     Read More

  • 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)

  • 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’:     Read More

  • 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.     Read More

  • 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.     Read More

  • 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.     Read More

  • 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 to 80-90% rapidly. The most critical sections that you need to read are about the 3Ps:

    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-centered caring through community-based care on page 76
        Read More

  • 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) for eligible U.S. non-profit non-governmental 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:     Read More

  • Estimating the Future Burden of MDRTB and XDRTB in India, 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.     Read More

  • The Cascade of Care in Diagnosis and Treatment of Latent Tuberculosis 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).     Read More

  • 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 for treatment adherence.     Read More

  • 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.     Read More

  • 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.     Read More

  • WHO Video: People-Centred Care

    Shift away from (just) asking: What is the matter with you? What matters to you? In other words, ask your patients this one question: How can I improve your care?.     Read More

  • 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.     Read More

  • USAID Philippines Issues Request for Applications for a New TB Project on Patient-centered Care

    The Patient-centred TB Care project will focus on improving patient-centered 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.     Read More

  • WHO Publishes New Guidelines for Treatment of Drug-susceptible 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.     Read More

  • 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, pediatric specimens, extra-pulmonary specimens (notably cerebrospinal fluid), and especially for HIV positive individuals whose specimens are frequently paucibacillary.     Read More

  • 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.     Read More

  • 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.     Read More

  • 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.     Read More

  • 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.     Read More

  • 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.     Read More

  • 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.     Read More

  • 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).     Read More

  • Quality of Tuberculosis Care Addresses 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.     Read More

  • 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.     Read More

  • 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.     Read More