Philippine Standard Time
Wednesday, November 21, 2018
8:28 am

WHO Corner

Source: End TB News by Rajendra Yadav, MD

  • 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 Here is a nice DOLE-primer, although a little outdated: is now in the process of writing the “implementing rules and regulations” for this Act.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.
     Read More

  • 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."
  Read More

  • 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.
     Read More

  • 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