Irada Akhundova M.D. Ph.D., Scientific Research Institute of Lung DiseasesBaku, Azerbaijan

14th Annual Congress of Turkish Thoracic Society 13-17 April, 2011, Antalya, Turkey

Follow up of treatment of Drug Resistant TB patients after

release from prison

There was a great need to organize continuation of treatment for DR-TB patients after release from prison

- DOTS-Plus treatment in prison started April 2007 and the patients with more than 2 year sentence were one of the (last but not least) criteria for enrollment.

Start of pilot project for released Drug Resistant TB patients

- April 2009 (upon start of follow up) 135 DR-TB patients were enrolled in prison who were mainly with sentences more than 2 years.

- ...the ICRC started to initiate piloting follow up of released DR-TB patients in cooperation with MoJ and NTP.

- May 2008, when DOTS-Plus project started for civilian patients and there were trained staff in civilian sector regarding MDR management...

March 17 2009, the Memorandum of Understanding on the follow up of released Drug Resistant TB patients to

complete their treatment in civilian anti-TB fasilities was signed between MoH, MoJ and ICRC.

TRIPARTITE AGREEMENT

On the basis of tripartite agreement DR-TB patients released from prison without completing treatment were transferred with transport out to civilian TB facilities.

Start of pilot project for released Drug Resistant TB patients

DR-TB patients continue their treatment after release from prison April 2009 – December 2010

12862

85

135

48

111

98

7240

157

159

208

130

33

119152

154

144

156173

148

194

117

237

265

185180

118

163

155

136

266

228

297

83216

DR-TB patients continue their treatment after release from prison April 2009 – December 2010

12862

85

135

48

111

98

7240

157

159

208

130

33

119152

154

144

156173

148

194

117

237

265

185180

118

163

155

136

266

228

297

83216

4

3

1

2

1

2

1

0

3

1 1

4

1

2

1

5

2

0

2

1

4 4

3

1

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Since April 2009, 50 DR-TB patients were transferred out to civilian sector

2009 -17 patient 2010 – 24 patient 2011 - 8 p.

The number of Drug Resistent TB cases released while being under DOTS-Plus

treatment in prison

Coverage: Whole country

Continuation of treatment is organized for DR-TB patients in civilian sectorTreatment provided regions (city, village, settlement)

Number of cases

Treatment fcilities where released DR-TB patient receive treatment

Treatment (in hospital or ambulatory)

Baku 20 patients Policliniks N10, Binagadi region, TB dispensary N 4 TB dispensary 5, TB dispensary 6, TB dispensary 7,

Buzovna settlement, TB dispensary 2

18 ambulatory + 2 in patient

Gobustan city 1 patient United City Policlinics N17 of Gobustan city Ambulatory

Shirvan city 2 patient City Policlinics N1 of Shirvan city Ambulatory

Sumgayit city 3 patient TB dispensary Ambulatory

Salyan city 2 patient TB dispensary Ambulatory

Masalli city 2 patient PHC unit of the Gizilavar village Ambulatory

Astara city 2 patient TB unit of city hospital 1 ambulatory + 1 in pat.

Sheki city 2 patient TB dispensary Ambulatory

Yevlakh city 2 patient TB dispensary Ambulatory

Aghjabedi city 1 patient TB Unit of Central District Hospital Ambulatory

Tovuz city 1 patient TB department of city hospital Ambulatory

Nakhchevan city 2 patient 1 in TB dispensary and 1 in village medical point Ambulatory

Tartar city 1 patient TB dispensary Ambulatory

Barda city 1 patient TB dispensary Ambulatory

Goychay city 1 patient TB dispensary Ambulatory

Hajiqabul city 1 patient TB dispensary Ambulatory

Bilasuvar city 1 patient City Policlinics Ambulatory

Mingachevir city 1 patient TB dispensary Ambulatory

Goranboy city 1 patient Village medical point Ambulatory

Zerdab city 1 patient TB dispensary Ambulatory

16

1

11

12

712

0

5

10

15

20

25

30

2008(Dec) 2009 (Apr-Dec) 2010(Jan-Dec) 2011(Dec)

Baku Cities and rayons of Azerbaijan

Transfer out patients and their treatment location

33

75

86

108

11

7

11

7

13

8

14

9

17

12

17

12

19

15

23

17

24

17

26

15

27

14

32

19

34

20

34

18

36

14

37

15

41

19

45

22

48

26

50

23

0

5

10

15

20

25

30

35

40

45

50

Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb

Transferred out Under treatment

Transfer out patients and their treatment location

The form is created for each released DR-TB patient to register bacteriological status of the patient every month.

Follow up form

Resistance

3

43

4

0

5

10

15

20

25

30

35

40

45

PDR MDR XDR

PDR

MDR

XDR

MDR CASES WITH CO-INFECTIONS

80,59%

6; 13%

13; 28%

MDR+Hepatitis MDR+Hepatitits+HİV MDR

37

3

12

4

In prison (SS-/CC-), out of prison (SS-/CC-)

In prison (SS- CC+), out of prison (SS-/CC-)

In prison (SS- /CC+), out of prison (SS+/CC+)

In prison (SS- CC+), out of prison (SS+/CC+)

In prison (SS+ /CC+), out of prison (SS+/CC+)

Most of the patients release from prison with culture negative.

Every month sputum specimens are collected from each patients for smear, culture, DST and transported to prison Lab

Any changes in treatment is done by concilium (technical expert commition)

Patients' bacteriological status

Transfer out patients and their treatment outcomes

1 1

18

86

2 1

24

41 2 2 1

14

8

0 0 0 0 0

8

0

5

10

15

20

25

2008(Dec) 2009 (Apr-Dec) 2010(Jan-Dec) 2011(Jan-Mar)

transfer out cured Defaulted Failure Died Transfer in Under treatment

50 patients were released from DOTS-Plus Project in prison

49 of them released after MOU was signed by MOJ,ICRC,NTP

13 cured

8 defaulted

4 failure

2 died

1 Transfer in to prison (re-jailed)

22 under treatment

Interim treatment outcomes

13 8

4

2

1

22

still under treatment CuredDefaulted FailureDied Transfer in

Valuable experience

Implementation mechanism

Project set up

Recording and reporting system

Infrustructure

Trained staff

Resources

Experience and implementation mechanism of the project

Due to the ICRC phase out of health program, the follow up project will be carried out by the NGO – “Health Care Support” who mainly is involved in TB, HIV and other communicable diseases according to its regulation.

The followings were gained during piloting follow up project;

THANK YOU FOR YOUR ATTENTION!