The implementation of the National Tuberculosis Control Program at a regional level:

Voronezh TB Service

JULY 13, 2015 Dr. Kornienko, Sergey

• The biggest region in the central belt of the

European part of Russia

• Distance from Moscow - 587 km

• The area 52,400 sq. km

• Area Population (2014) 2,328,959

• Administrative center –

the city of Voronezh with a population 1,014,600

Voronezh Region

Measures to optimize the TB service of the Voronezh Oblast

2005-2015

TB Site Number of beds2005-2010

2012-2014

From 2015

Total- Inpatient beds- Day Hospital- Hospital-at-Home

1590--

1005105

-

8108565

Oblast Dispensary- Inpatient beds- Day Hospital- Hospital-at-Home

1125--

82050-

7003040

District Dispensary (DD)- Inpatient beds- Day Hospital- Hospital-at-Home

9 DD465

-

4 DD22555-

4 DD1105525

Children Sanatorium -- 2 490 470 470

Adults’ Sanatorium -- 1 160 160 160

Up to 2012

From 2012г.

4

FSG.ORG

© 2012 FSGLilly 7 Team Meeting

Main TB epidemiological indicators in the RegionMain TB epidemiological indicators in the Region

Indicators, per 100 000Indicators, per 100 000 20002000 20052005 20102010 20122012 20132013 20142014

Territorial incidence of Territorial incidence of tuberculosistuberculosis

VRZVRZ

RFRF

7373..99

9090..77

7070..11

8383..88

5656..55

7777..22

4545..11

6868..11

3636..77

6363..00

3333..00

5959..55

TB incidence of residential TB incidence of residential populationpopulation

VRZVRZ

RFRF

4949..00

6565..55

5353..77

6767..99

4545..11

6969..66

3535..33

5757..66

2828..11

5353..44

2525..44

5050..77

TB incidence in childrenTB incidence in children VRZVRZ

RFRF

66..44

1717..99

77..11

1616..44

44..11

1515..22

44..66

1616..44

33..99

1414..55

33..55

1313..22Territorial TB mortalityTerritorial TB mortality VRZVRZ

RFRF

1111..99

2020..44

1414..88

2121..11

1111..00

1515..44

77..99

1212..44

66..00

1111..33

55..22

1010..00

TB mortality of residential TB mortality of residential populationpopulation

VRZVRZ

RFRF

99..66

1616..00

1010..99

18.218.2

88..77

1212..55

66..11

1010..11

44..99

99..22

44..00

88..33

7270,5

67,3

63,361,8

58,6

54,552,8

49,6

47,647,346,4 45,3 45,445,5

45,143,6 42,6

40,7

37,634,2 35,8

42,9

57,8

67,5

73,976

85,2

90,7

86,188,2

83,283,382,7

83,583,2 82,6

77,4

73,6

68,1

63

59,5

65,363,6

55,9

50,849,4

44,7

41,340,641,1

48,7 48,748,149,8

52,7

49,5

41,139,9 38,5

36,7 37,237,7

46,748,3

62,2

69,4

66

70,969,2

73,9

69,972

66,9

71,1

64,9

69,3 68,9

63,2

56,5

50,5

45,2

36,7

33

20

30

40

50

60

70

80

90

Заболеваемость РФ Заболеваемость ВО

TB Incidence (per 100 000 population)In 2014, the first time in 50 years, it has been achieved a reduction in TB Incidence 33.0 per 100 000 population

2005 2010 2014 Dynamics

RF 83.3 77.2 59.5 - 28.6%

CFD 60.6 55.4 39.0 - 35.6%

VRZ 70.1 56.5 33.0 - 52.9%

0

5

10

15

20

25

30

15.9

59.0

24.3 24.2 24.8

27.5

31.7

24.722.9

18.8

RF VRZ

Reducing the reservoir of MDR TB in Voronezh region

201420132012

TB/HIV situation

Reducing the burden of TB:Patient-Centered Service

Active TB Case Finding Strategy (operational data)Active TB Case Finding Strategy (operational data)

IndicatorsIndicators 20002000 20052005 20102010 20122012 20132013 20142014

Coverage with all types of screening methods

VRZVRZ

RFRF%%

63.4

57.1

66.1

57.9

89.0

63.6

89.1

65.7

86.6

65.8

85.6

66.5

Coverage with a chest radiography for population over 15 years old

VRZVRZ

RFRF %%

55.7 75.1 87.1

55.6

85.6

58.3

84.6

59.0

83.5

Detection per 1000 screened

VRZVRZ

RFRF

0.6

0.6

0.76

0.6

0.42

0.58

0.34

0.61

0.28

0.56

0.25

Passive TB detection (doctors’ visits)

VRZVRZ

RFRF %%

42.2

47.2

29.9

46.6

28.6

40.3

26.6

39.3

25.0

39.7

26.5

Detected “Post mortem” VRZVRZ

RFRF %%

0.4 0.8

2.8

0.8

1.8

0.9

1.6

0.7

1.6

0.7

1.7

International projects

2010 – 2012: Green Light Committee (World Health Organization)

2011 – Present: “Partners in Health” Eli Lilly MDR-TB Partnership– Major Initiative I: Improving tuberculosis

infection/transmission control in the Russian Federation

– Major Initiative II: Building a sustainable model for high-quality ambulatory MDR-TB care delivery

F-A-S-T:Improving tuberculosis transmission control

Administrative control new approach• Find cases • Actively (identifying MDR-TB patients)

GeneXpert MTB/RIF assay• Separate patients safely to reduce exposure to

drug-resistant strains (stopping nosocomial transmission), and

• Treat effectively with second-line drugs

Rapid Rif-susceptibility testing during the process of hospitalization, 2013 - 2015

Patient-Centered Approach (PCA)

Support Vehicles

2011 One PCA Team

2 nurses, designated TB doctor,

PCA Coordinator (deputy chief TB physician), social worker

Daily food packages, Mobile plans

One vehicle

2012 Two PCA Teams

2 nurses, 2 designated TB doctors,

PCA Coordinator (deputy chief TB physician), social worker, addiction specialist

Daily food packages, Mobile plans, symptomatic medications, в т.ч. АЗ

Two vehicles

2013 Three PCA Teams

2 nurses, 2 designated TB doctors,

PCA Coordinator (deputy chief TB physician), social worker, addiction specialist

Daily food packages, Mobile plans, symptomatic medications

Three vehicles

Treatment outcomes for PCA patients, 2011 - 2015

Advancing strategies for quality outpatient TB services

Main components to sustain effective TB program

PCA team

Social support: public transportation passes, daily food sets, monthly hygiene sets

Substance abuse specialist, psychologist and social worker

Rapid diagnostic methods, early start of treatment

Sufficient supply of TB drugs, second line drugs and side effect medications Treatment TB according to the national standards of care

DOT network: TB inpatient hospital, day-care TB hospital, TB policlinic, “Hospital at Home”, Patronage nurses,

TB DOT points at the city general medical service

Challenges Plans

• Strengthening of the default retrieval system

• Sustain the success of the regional TB Control Program

• Expanding intensified patient-centered care with prioritization of vulnerable populations, such as children and adolescents -- to create the family-centered accompaniment (FCA) model of care (oversee families with TB patients with children)

For the sake of children's health we still have so much to do !!!

THANKSContact details: vokpd@vmail.ru

The Lilly MDR-TB Partnership is funded by the Lilly Foundation