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THE EXPERIENCES AND PROBLEMS OF MULTIDRUG RESISTANT TUBERCULOSIS PATIENTS AT DISPENSARIES IN TURKEY. Dr. Suha ÖZKAN Ankara Provincial Tuberculosis Coordinater. The Research of Treatment with Second-line TB Drugs in Teaching Hospitals, 2005. In National Surveillance 25 %40 24 %35 - PowerPoint PPT Presentation
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11
THE EXPERIENCES AND PROBLEMS
OF MULTIDRUG RESISTANT
TUBERCULOSIS PATIENTS AT
DISPENSARIES IN TURKEY
Dr. Suha ÖZKANAnkara Provincial Tuberculosis Coordinater
22
The Research of Treatment with Second-line TB Drugs in Teaching Hospitals, 2005
Number of patients
Ankara Atatürk H. 63
İstanbul Süreyyapaşa H. 68
İstanbul Yedikule H. 34
İstanbul Heybeliada H. 14
İzmir Suat Seren H. 18
TOTAL 197Source: TB Control Department, MoH
In National Surveillance
25 %40
24 %35
16 %47
6 %43
14 %78
85 %43
33
155 (79%) of 197 patients were male.
126 had history of treatment failure.
19 had defaulted previously.
MDR had found in 172 patients.
63 patients from İstanbul, 11 from İzmir, 5 from Ankara . (Bursa 10, Adana 8, Mersin 6, Trabzon 6)
Source: TB Control Department, MoH
The Research of Treatment with Second-line TB Drugs in Teaching Hospitals, 2005
44
The Process of Diagnose and Treatment of MDR-TB Patient
DIA
GN
OSE
BEFORE DIAGNOSE STAR
T TR
EATM
ENT
HOSPITAL OUTPATIENT FOLLOW UP
DISPENSARY
THE CONTROLS IN HOSPITALS AND DISPENSARIES
CO
MPLE
TIO
N
OF
TREATM
ENT
DISPENSARY
55
The Diagnose of MDR-TB in Dispensaries
In pulmonary tuberculosis;
Mycroscopy of smear
Culture
Drug Susceptibility Test
The Type of Bacillus
Quality Controlled
66
The history of treatment out of order
No bacteriological conversion during treatment
No improve in signs and symptoms
The history of contact to MDR-TB patient
Going to fail in treatment
With DOT
MDR in which patient ?
77
The bacteriology in diagnose and follow up
Directly Observed Treatment
Not to add any new drug during treatment
To transfer the patient to hospital which is specialized on MDR-TB treatment
To send history of patient and information about diagnose and treatment, to hospital with patient
The Obligations of Dispensaries
88
The Problems about Diagnose of MDR-TB in Dispensaries
The deficiency of bacteriology
Treatment out of order (DOT ?)
Non-Standardize regimens
Not to understand treatment failure
The mistake of adding new drugs
The doctors and hospitals who had no experimentation on MDR-TB
The echonomics and social problems in management
99
Recording MDR-TB Patient in Dispensary
All MDR-TB patients must be recorded in Dispensary
Previous record must be closed, and the patient must be re-recorded with appropriate case defination in treatment failure
The history of disease, bacteriological results and knowledge about treatment must be recorded in patient files
The notes about follow up
1010
The prescriptions and the health report for drugs
Inadequancy transfer Dispensary from hospital
Inadequte knowledge in Discharge Report
The Problems in MDR-TB Registrations
Non registration and out of National Surveillance
No DOT
The deficiency in drugs
No compliance, problems about side-effects
1111
The Follow up MDR-TB Patient in Dispensary
Daily DOT with health staff
Bacteriology in every control
To ask side-effects of second-line drugs during examination
To agree the orders of hospital about treatmen, not to make any change
To advise patient to be controlled in hospital
1212
The Problems in Pursuit and DOT of MDR-TB Patient
Shortages of drugs (sometimes)
Long treatment duration and disgust
Difficulties in DOT because of applying 2 or 3 times in a day
Prevention of health staff and public from transmission
Inadequate knowledge about side-effects
No limitation to drugs in Pharmacies
What to do for contacts ?
1313
The Support of MOH for Second-line Drugs
MOH had supplied second-line drugs since 2003. Ankara Dispensary had delivered with the request of all dispensaries in Turkey, from 2003 to 2008.
The repuests from dispensaries are increasing.
But some patients are still taking drugs from pharmacies with prescription.
The second-line drugs for two or three months were sent to dispensary with the prescription and referral report of patient from hospital.
1414
The Second-line Drug Supply
2006
• 615 request
• Total 212 patients
• 188 of them are MDR/failure
Treatment start year
31 patients before 2005,
89 patients in 2005,
66 patients in 2006.
2 unknown.
2007
• 747 request
• Total 212 patients
•187 of them are MDR/failure
•Treatment start year
49 patients before 2006i,
68 patients in 2006,
68 patients in 2007,
2 unknown.Source: The records of second-line drug supply
1515
The total number MDR/treatment failure patients were 272 in txo year.
92 patients from 2005, 79 from 2006, 68 from 2007.
Most of the patients diagnosed in Ankara Atatürk C.D. Hospital(164). 46 in Süreyyapaşa H, 27 in İzmir Dr. Suat Seren H, 17 in Yedikule H, 6 in Heybeliada Hospital.
Treatment of 12 patients were started in other hospitals.
Nearly the drugs of half of the patients were requested systematicly.
The Records of second-line drug supply
in 2006-2007
Source: The records of second-line drug supply
1616
MDR
Treated with second-line drugs
Treatm
ent failu
re
Recorded in Dispensary
The drug supply from MOH
Dispensary and MDR-TB Patient
1717
THE RESEARCH OF TREATMENT WITH SECOND-LINE DRUGS IN TURKEY-2009
Directorate of Tuberculosis Control in MOH.
The patients of 2007 and 2008 are in study.
The data of the patients who were treated with second-line drugs are collected and recorded systematicaly.
Study covered all Turkey.
1818
Recorded and analized in MOH
Chest Diseases Teaching Hospital
Tuberculosis Control Dispensary
Records of Drug Supply
The records of Pharmacies (Social Security)
THE RESEARCH OF TREATMENT WITH SECOND-LINE DRUGS IN TURKEY-2009
1919
MDR-TB Registries in Ankara TB Dispensaries, 2006-2007-2008
8 patients in 2006, 3 patients in 2007, and 13 patients in 2008 were registered in dispensaries (Total 24).
All of them are diagnosed in Atatürk C. D. Hospital.
17 of them are MDR. 10 of MDR caes had previously treatment failure history.
4 patients were treated because of treatment failure.
2 patients were treated because of mycobacterium other than tuberculosis.
There is 1 XDR case.
2020
14 patients are male.
9 patients had SSK, 6 had greencard, 4 patients had no health insurance.
18 had treated under DOT (16 them with health staff)
21 patients drugs were supplied from MOH.
12 patients are still under treatment, 6 patients are cured, 4 patients are defaulted, 1 patient is treatment failure, 1 patient was transfer out.
MDR-TB Registries in Ankara TB Dispensaries, 2006-2007-2008