Ensuring High

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Ensuring High Quality TB Care Utilization of
ISTC Rio de Janeiro March 25, 2009
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Organizations Responsible for ISTC
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J.W. Lee, Director General, World Health
Organization March 24, 2006
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ISTC Key Points

• Differs from existing guidelines standards
  present what should be done guidelines describe
  how to do it
• Evidence-based, living document
• Developed in tandem with Patients Charter for
  Tuberculosis Care
• Handbook for using the International Standards
  for Tuberculosis Care developed
• Training modules based on ISTC available

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How is ISTC being used?

• Providing a focus for a global campaign to
  improve TB Care and control
• As a tool to apply peer pressure via professional
  societies to improve TB care globally
• As a core for medical and nursing school
  curricula
• As a focus of continuing medical education
  programs
• As a guide for funders
• As a focus for advocacy

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Professional Society Endorsements Indonesia
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ISTC in Indonesia

• Indonesian Society of Respirology
• Two day workshops in 13 provinces in coordination
  with local chapters of professional societies
  Provincial/District health authorities
• ISTC Short version delivered to all participants
• Indonesian Medical Association
• Develop National Task Forces.
• Provincial TF in 14 provinces to ensure local
  ownership
• Development of guidelines for implementation by
  private practitioners
• Planning to have ISTC in certification and
  accreditation scheme
• Improving Indonesia Training Module based on ISTC
• Situation analysis in hospitals and at provincial
  level

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ISTC in Myanmar

• Situation analysis conducted by NTP/WHO/MMA
  using ISTC as framework.
• Two day workshop held in Yangon March 2009 MOH,
  NTP, WHO, MMA, academic institutions attended (68
  attendees.
• Objectives
• Review Tuberculosis care and control in Myanmar
  and the involvement of the private sector
• Review the International Standards for TB Care
• Discuss ISTC adaptation and implementation
  strategies in the Myanmar context and
• Develop adaptation strategies and approaches to
  implementation of the ISTC.

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ISTC in Myanmar
Situation analysis Diagnosis
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ISTC in Myanmar
Situation analysis Diagnosis EP TB
microscopy
culture
histology
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ISTC in Myanmar

• Problems identified in situation analysis
• Identification of TB suspects in the hospital
• Biopsies in extra-pulmonary TB
• Diagnosis of sputum smear negative TB
• Asking about exposure as part of evaluating
  children for TB
• Follow-up sputum examination
• HIV testing for TB patients
• Risk assessment for drug resistant TB
• Lack of contact examination

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ISTC in Myanmar Recommendations

• The MOH should endorse ISTC together with an
  annex stating the points for adaptation for the
  Myanmar context.
• The NTP should advocate to the MOH to officially
  launch ISTC during the World TB Day activities.
• The MOH should establish an ISTC Task Force.
• The NTP, in collaboration with relevant partners
  should develop a work plan for implementation,
  and monitoring and evaluation of the ISTC in
  Myanmar.
• Based on the above work plan, a resource
  mobilization plan should be presented to relevant
  donors
• The MMA should endorse the ISTC with limited
  adaptations for the developed in the National
  Workshop on the ISTC.

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ISTC Training Modules
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Kerala Health Minister Launching Patients
Charter For Tuberculosis care

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ISTC Implementation Role of Professional
societies

• Professional societies can serve as valuable
  collaborators with public health programs
• Serving as conduits to their private sector
  members
• Giving credibility to public health programs
• Providing technical assistance to programs
• Conducting training activities
• Exerting peer pressure
• Advocating for appropriate resources and
  policies.

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ISTC Pilot Sites

• Indonesia
• Situation Analysis of the constraints to full
  implementation at provincial level in
  collaboration with PDPI
• Coordinated professional society campaign with
  Indonesian Med. Soc.
• Dissemination Education Activities
• Patients Charter Activities

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ISTC Pilot Sites, India

• Used for PPM training by RNTCP/IMA

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ISTC India

• IMPACT Indian Medical Professional Associations
  Coalition against Tuberculosis
• Indian Medical Association
• Association of Physicians of India
• Indian Chest Society
• National College of Chest Physicians (India)
• Indian Academy of Paediatrics
• Federation of Family Physicians Associations of
  India

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ISTC Pilot Sites

• Kenya
• Coordinated professional society campaign with
  KAPTLD
• Dissemination Education Activities
• Tanzania
• Developing coordinated curriculum for medical
  students at all schools in the country
• Mexico
• Adaptation at state level via professional
  societies and national/local control programs

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Editorial, Lancet Infectious Diseases Nov, 2006

• In this month's issue of The Lancet Infectious
  Diseases we publish the International Standards
  for Tuberculosis Care. When national tuberculosis
  control programmes and individual clinicians
  apply these standards correctly,
  multidrug-resistant tuberculosis andthe recently
  definedextensively drug-resistant (XDR)
  tuberculosis should not develop---.

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Why do we need a new document ?

• There are many guidelines, recommendations, and
  manuals, but
• few, if any, focus on TB care rather than
  control
• none are supported by a broad international
  consensus
• most present the how of TB control rather than
  the why (evidence base is lacking)
• most are viewed as government documents and,
  therefore not relevant to the private sector
• none can serve as the focus of a global campaign
  to improve TB care and control globally through
  effective private sector involvement

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ISTC India
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ISTC Indonesia
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Editorial, Lancet Infectious Diseases Nov, 2006

• The International Standards for Tuberculosis Care
  are designed to ensure that patients receive
  proper diagnosis, therapy, and support to
  complete their treatment regimens. The emergence
  of XDR tuberculosis shows that proper standards
  of tuberculosis care are far from being
  universally applied, and is a timely reminder
  that governments must provide the support
  necessary to treat properly what is essentially a
  curable disease.

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ISTC Languages

• English
• French
• Spanish
• Russian
• Chinese

• Indonesian
• Vietnamese
• Japanese
• Khmer
• Thai