TB infection control and prevention of XDR

1
TB infection control and prevention of XDR

• Group II

2
Barriers I

• Huge workload of staff prevents them from taking
  TB infection control as an issue
• Health workers (including home based carers) are
  ignored
• Poor infrastructures and dilapidated facilities.
  Closed areas and crowded inpatients.
• TB wards are now integrated into general medical
  wards. Revisit is needed. Dilemma is how to deal
  with the subsequent stigma. Improved
  communication between health worker and patient
  may help. It might not be a good problem

3
Barriers II

• Parallel structures (of TB and HIV programs and
  also those responsible for IC such as the Nursing
  Departments)
• Lack of clear guidelines, training and resources
  for infection control in hospitals
• Health Workers are reluctant to care for TB
  patients
• Lack of information to patients on the risks
  of/need for TB infection Control

4
Enablers for TB Infection Control

• Advocacy fro Commitment and Financing
• Policy Changes and Joint TB/HIV Action
  Planning/Implementation
• Capacity Development of Personnel
• Infrastructural Adjustments to enhance Infection
  Control
• Coordination of Joint TB/HIV Plan and Integration
  of services at Facility levels
• Efforts to avoid and reduce stigma
• Identify focal point for infection control

5
Critical national level policy changes

• Enhanced political commitment and funding
• Adaptation of global TB IC guidelines
• Development of a country-specific plan of action
  for TB IC
• Reflection of key TB IC elements in programme
  strategic plans
• Active engagement of all stakeholders and levels
  of care

6
Critical activities to assess magnitude of MDR
XDR TB

• Establish presence of MDR XDR TB
• Disease mapping (extent and geographic spread)
• Strengthening the infrastructure for diagnosis
  and management
• Strengthen infection control measures
• Establish surveillance system for MDR XDR TB

7
Actions

• Coordination with National infection control
  committees wherever they are available (e.g.
  Malawi)
• Emphasise the importance of TB IC as one key
  activity for national TB/HIV coordinating bodies
• Focus on facilities and have focal point for IC
• Promote award schemes for best performers in IC
  (including TB IC)
• M and E is important (continuous evaluation)
• Emphasise the importance of TB IC into national
  IC policies.
• Joint plan on TB IC with TB, HIV and other
  stakeholders such as Nursing Divisions and strong
  national advocacy for their implementation

8
Actions

• Encourage the use of funding available for TB and
  HIV to TB IC.
• National trainings for IC and training manuals
• Information and education for patients
• Communication to patients to avoid stigma
• Triage of patients should be started as early as
  possible depending on country context.
• Expand availability of culture facilities and
  decentralisation.
• Provision of free MDR treatment and ensuring
  treatment adherence.
• Establish minimum standards for IC
• GLC more proactive in technical assistance to
  countries
• GDF to provide backup support for MDR and XDR
  diagnostic and treatment commodities