National TB Prevalence Survey in Lao PDR - World TB Prevalence Survey in Lao PDR Regional Surveillance workshop HCM City, 1 -4 June 2010 Lao PDR National Tuberculosis Control Programme National TB Centre ... TB burden in Lao PDR LAO PDR NTC 2010 1 1990 ...

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<ul><li><p>National TB Prevalence SurveyNational TB Prevalence Survey</p><p>in in Lao PDRLao PDR</p><p>Regional Surveillance workshop HCM City, 1Regional Surveillance workshop HCM City, 1--4 June 20104 June 2010</p><p>Lao PDR National Tuberculosis Control Programme</p><p>NationalNational TB Centre, VientianeTB Centre, Vientiane</p></li><li><p>TB burden in Lao PDRTB burden in Lao PDR</p><p>LAO PDR NTC 2010 1</p><p>1990 2007*</p><p>Population 4.08 M 5.85 M</p><p>Prevalence TB all forms 428 (17,449) 289 (16,906)</p><p>Incidence TB all forms 179 (7,278) 151 (8,851)</p><p>Incidence new S+ PTB 80 (3275) 67 (3954)</p><p>Mortality due to TB 38 (1,538) 24 (1,410)</p><p>WHO 2009 Report, Global Tuberculosis Control</p><p>National average of ARIT: 1.2 - 1.3% in 1995 (Arnadottir and Coll.) </p></li><li><p>TB case detection, 1995-2009</p><p>* revised WHO estimates in 2010</p></li><li><p>LAO PDR NTC 2010 4</p><p>Prevalence Survey objectivesPrevalence Survey objectives</p><p> Primary objective is to determine the prevalence of bacteriologically confirmed pulmonary TB (smear and/or culture positive)</p><p> Two secondary objectives are to determine:</p><p> the prevalence of smear positive PTB</p><p> the prevalence of radiologically active PTB</p></li><li><p>LAO PDR NTC 2010 5</p><p>Screening algorithm*Screening algorithm*</p><p>*Assessing tuberculosis prevalence through population based survey, WHO 2007</p></li><li><p>LAO PDR NTC 2010 6</p><p> PTB suspect </p><p> TB Symptoms: cough 14 days AND/OR blood in cough </p><p> Abnormal chest X-ray consistent with TB at first reading (on site) </p><p> PTB case</p><p> Bacteriology positive (smear AND/OR culture)</p><p> CXR suggestive at second reading (central)</p><p>DefinitionsDefinitions</p></li><li><p>LAO PDR NTC 2010 7</p><p>Sampling (detailed in protocol)Sampling (detailed in protocol)</p><p> estimated prev. 251 S+ PTB/100,000 pop. 15y old, precision: 25%, participation: 80%, design effect: 1.3 (in protocol)</p><p> sample size 40,000 persons 15y old or more</p><p> 50 clusters of 800 subjects (no strata)</p><p> random selection of 50 districts (in population 15 years old, National Census)</p><p> random selection of 1st village of each cluster in list of all villages of district</p><p> randomisation rules in protocol for selection of more villages and household groups</p></li><li><p>LAO PDR NTC 2010 8</p><p>TBPS Organisation (1)TBPS Organisation (1)</p><p> Survey Committee (SC) chaired by Minister and Vice Minister of Health</p><p> Executive Committee (EC) chaired by NTC: Chairman (NTP director), Vice Director, 1 coordinator, 9 team leaders, 6 chiefs of sub committees</p><p> The Technical Committee (TC) supports the EC and includes 6 sub committees: Census &amp; interview (5), X-ray (5), Lab (5), Statistics (3), Admin &amp; Logistic (4), Finance (2)</p></li><li><p>LAO PDR NTC 2010 9</p><p>TBPS Organisation (2): Central teamTBPS Organisation (2): Central team</p><p> Central CXR unit (2 radiologists): training/supervision of 3 field readers and second reading and final diagnosis</p><p> NRL: training and supervision of 2 regional labs, primary culture and ID for all positive culture </p><p> Two regional laboratories: primary culture only</p><p> Optional: DST (solid media in NRL), Molecular testing (Merieux Foundation)</p><p> Data Management unit NTC, TA for data processing and analysis</p><p> Administration &amp; logistic and finance: NTC</p></li><li><p>LAO PDR NTC 2010 10</p><p>TBPS organisation (3): Field TeamTBPS organisation (3): Field Team</p><p> 2 teams in field and 1 team in standby in rotation. </p><p> Each team has one team leader and 12 permanent staffs (3 census and interview, 4 CXR, 2 laboratory, 3 drivers)</p><p> 8-10 local staffs including PTC, DTM, HC staff, VHVs, village volunteers</p></li><li><p>LAO PDR NTC 2010 11</p><p> Establish culture capacity with proficiency review in 3 labs (started Sep-09)</p><p> Field test operations (November 2009)</p><p> Field assessment: selection and mapping of villages and household groups, description of conditions, roads, time for transport of sputum specimens</p><p> 2d visit in cluster 2 weeks before survey: to complete household register forms and prepare arrival of survey team</p><p> Ethic: Signed informed consent from each survey participant is needed</p><p>PreparationPreparation</p></li><li><p>LAO PDR NTC 2010 12</p><p>TrainingTraining</p><p> Census &amp; interview unit: sampling rules, conducting interview and filling questionnaires</p><p> CXR unit on first reading on site and reporting</p><p> Laboratory unit: </p><p> collection, conservation, packaging, sending of specimens and reporting</p><p> Training on inoculation and primary culture of lab technicians from the 2 regional labs (Savannakhet and Luangnamtha) </p></li><li><p>LAO PDR NTC 2010 13</p><p>Field operationsField operations</p><p> 50 clusters in 8 months (one cluster per week) by 2 teams (+ 1 in standby) </p><p> 1 team has 13 staffs: 1 team leader, 3 census and interview, 4 CXR, 2 laboratory, 3 drivers</p><p> local staff: province and district TB staff, HC nurse, village volunteers, chief of villages, police, mass organisation</p><p> 1 cluster requires: </p><p> up to 800 interviews and CXR, </p><p> 120 TB suspects identified (~15%), </p><p> 240 sputum specimens collected send to labs (preferred) or on site inoculation if delay to process specimen &gt;72 h</p></li><li><p>LAO PDR NTC 2010 14</p><p>Central level operationsCentral level operations</p><p> Primary culture (in NRL and 2 regional culture labs):</p><p> 6000 TB suspects x 2 = 12,000 specimen and smear slides</p><p> X 2 = 24,000 culture tubes (in 3 labs)</p><p> Identification of positive cultures in NRL</p><p> CXR unit: second reading of all films</p><p> Data management unit in NTC: one international expert in epidemiology for data collection and analysis</p></li><li><p>LAO PDR NTC 2010 15</p><p>PS field testPS field test</p><p> Test survey in one Naxaithong district in </p><p>Vientiane Municipality (22-28 Nov 09)</p><p> Preparation visit 2 weeks before</p><p> D0 = plan census day and give appointments to </p><p>chiefs of villages</p><p> D1= Census in 3 villages, 244 households, 826 </p><p>eligible subjects</p><p> D2 to D6: 732 Interviews (88.6%), 722 CXR, 121 </p><p>TB suspects provided 2 sputum specimens</p></li><li><p>LAO PDR NTC 2010 16</p><p>Next stepsNext steps</p><p> Second laboratory review by KIT in NRL and 2 primary culture laboratories (16-22 May 2010) </p><p> 23 /50 clusters assessed by end May-10</p><p> Ongoing testing data collection and data analysis software</p><p> Organise second CXR reading (central level)</p><p> Possible to start survey in June-July 2010 in clusters located in South and centre regions (accessible by road during rainy season)</p></li><li><p>LAO PDR NTC 2010 17</p><p>Items US$</p><p>1</p><p>Lab equipment (including NRL </p><p>upgrade) 462 000</p><p>2 CXR equipment 111 128</p><p>3 Vehicles 89 000</p><p>Sub total 662 128</p><p>4 Screening of clusters 465 941</p><p>Total 1 128 069</p><p>Budget Needed for Prevalence SurveyBudget Needed for Prevalence Survey</p></li><li><p>LAO PDR NTC 2010 18</p><p> Dr Bounlay Phommasack for making possible field test in Vientiane</p><p> Naxaithong district authorities, chiefs of village and population</p><p> NTC team leaders and NTP team from Vientiane municipality and Naxaithong district for field test</p><p> Dr Oroth: Radiology central hospital Mahosot and radiologists and technicians</p><p> Dr Satha (CENAT, Cambodia) for radiology expertise and field testing of operations</p><p> F. Nzabintwali and lab technicians of NRL and regional lab team</p><p> Survey design reviewers: SJ. Kim, P. Glaziou, I. Onozaki, C. Sismanidis, D. Sagebiel</p><p> Laboratory support and reviews: SJ Kim and CK Kim (KIT)</p><p> Data management software design: I Law</p><p>AcknowledgementsAcknowledgements</p></li><li><p>LAO PDR NTC 2010 19</p><p> Assessing tuberculosis prevalence through population based survey, ISBN 978 92 9061 314 5 World Health Organization 2007</p><p> The Public Health Service National Tuberculosis Reference Laboratory and the National Laboratory Network, Minimum Requirements, Role and Operation in a Low-Income Country, ISBN2-9504238-7-6 International Union Against Tuberculosis and Lung Diseases 1998 </p><p>ReferencesReferences</p></li></ul>