- Email: [email protected]
213-PC11 A cohort evaluation of tuberculosis treatment results in Mexico
Abstracts
77
is: NATIONAL, spreading all over the country, divided into 9 operational zones, composed in turn of 38 districts altogether. SEMI-VERTICAL, from the Programme Manager (Ministry of Health's Central Unit) down to the Zonal Supervisor (a Medical Officer, ZTLS) and the District Supervisor (generally a Medical Assistant, DTLS): INTEGRATED, at grassroots level, into the ordinary health delivery system (horizontal component), to jointly fight against'the two diseases. Main sponsoring agencies: the German Leprosy Relief Association and the Italian Co-operation. TB diagnosis is based on direct microscopy by Z-N method. Patients' detection is generally made by passive case-finding; correct case-holding's implementation is a current priority. Treatment regimens are: 2STH/10TH for sputum -ve, both pulmonary and extra-pulmonary TB (standard course); 2SRHZ/6TH (or 6EH in case of HIV +ve patients) for sputum +ve pulmonary TB and severely ill patients (short course); re-treatment: 2S3RHZE/5TH (or 5RHE in case of H resistance) three times a week.
diabetes mellitus, 7 were alcohol abusers, 1 was HIV+ and 1 had steroid-dependent asthma. All cases were diagnosed at our specialized health facility; 20 received treatment there and 80 of them were sent to their community health center. 98 patients received short-term regimen with 2HRZ/4HR, one patient with 1S2HRZ/4HR, and another one 2ER/2HRZ/4HR. 57 patients were considered cured, 29 were defaults, 3 failures, 5 died and 6 were transferred. Treatment was directly observed in just 37 patients (35 cured, 1 transfered, 1 died). We conclude that more emphasis should be given to resolve the shortcomings of the TB control program in our country through more extensive directly observed treatment, along with better patient education.
In 1994 a total number of 24,657 new cases were registered with the following breakdown: new AFB+: 12,958 (52.5%, M = 59.1% and F = 40.9%); relapses AFB+ 4.5%; new A F B - 21%; relapses A F B - 2%; clinical diagnosis 11%; extra-pulmon. TB 9%. Case-finding indicators are as follows: case detection rate all forms = 137/100,000; case detection rate AFB+ = 72/100,000 (37.5% of expected incidence with the M.o.H. currently estimated A.R.I. of 3.5%). Treatment outcome indicators (52.6% reports submitted):
This pilot district to implement TB SCC in Kenya has a population of about 400,000 people living in an area of 2,800 sq kin. The population density is 132/sq kin. and TB CDR is 89:100,000 pop. The 8 month regimen - 2SRHZ/6TH (6EH) was introduced in the district in April 1993. The first two months are supervised usually under admission while the continuation phase was self administered from the nearest health centres or dispensaries. Evaluation of the first cohort of 69 smear sputum positive patients reveals:- SCCT coverage of 82.1%, sputum negative rate at 2 m of 85.2%, 5 m of 80%, 8 m of 80%. Mortality 10% and out of control rate of 2.9%. No failure cases were recorded from this cohort. The mortality rate was highest within the 1st two weeks of treatment. This programme based evaluation shows that the implementation of shortcourse chemotherapy in Embu District has been successful and compares to the WHO/ IUATLD standards.
%
Sh. C.
St. C.
Re-treat.
Cure rate Treat. Compl. rate Overall Death rate Failure rate Defaulting rate
31.3 28.2 59.5 9.9 0.2 13.2
22.7 31.8 54.5 12.0 0.9 23.9
37.6 20.5 58.1 7.4 2.4 22.0
In some sample serosurveys, 60% of the newly diagnosed patients are HIV +ve. A multicentric epidemiological study is now in progress to assess the overall HIV positivity rate in TB patients countrywide.
213-PCll A cohort evaluation of tuberculosis treatment results in Mexico Garcia-Cruz, A., Olvera Castillo, R., Espinosa, C. Instituto Nacional de Enfermedades Respiratorias, Mexico DF, Mexico
As a part of an international multicentric study aimed at evaluating the practicability of the standard definitions of the IUATLD and the WHO in the assessment of treatment results of infectious TB cases, we selected a randomised cohort of 100 newly diagnosed, smear positive cases, identified from January 1 to December 31, 1992. 62 patients were male. Age ranged from 16 to 79 years old with an average of 43 + 16.15 years. Coexisting illnesses were found in 29 patients of which 21 had
225-PCll Shortcourse chemotherapy implementation in Embu District Kangangi, J., Kibuga, D. National Leprosy~Tuberculosis Programme, Kenya
2 3 6 - P C l l Outcome of tuberculosis treatment: a comparison of Alberta, Canada and Nicaragua Kassam, N., Cruz, R., Fanning, A. University of Alberta, Edmonton, Canada
Worldwide, tuberculosis is the commonest cause of mortality from a single pathogen, despite the availability of 98% curative drug regimens. Developing countries carry the major burden of disease. To aid these countries, National TB Programs (NTP) were designed. Sputum smear positive cases, the most infectious, are diagnosed by microscopy and treated with short course chemotherapy (SCC); outcome is measured as cure, fail, transfer, abscond, or die. Ten such programs treating over 100,000 cases per year, report 75% cure. In industrialized countries, after 30 years of declining rates, the recent rise has been linked to declining infrastructure and in some areas HIV infection. There is an assumption
77
is: NATIONAL, spreading all over the country, divided into 9 operational zones, composed in turn of 38 districts altogether. SEMI-VERTICAL, from the Programme Manager (Ministry of Health's Central Unit) down to the Zonal Supervisor (a Medical Officer, ZTLS) and the District Supervisor (generally a Medical Assistant, DTLS): INTEGRATED, at grassroots level, into the ordinary health delivery system (horizontal component), to jointly fight against'the two diseases. Main sponsoring agencies: the German Leprosy Relief Association and the Italian Co-operation. TB diagnosis is based on direct microscopy by Z-N method. Patients' detection is generally made by passive case-finding; correct case-holding's implementation is a current priority. Treatment regimens are: 2STH/10TH for sputum -ve, both pulmonary and extra-pulmonary TB (standard course); 2SRHZ/6TH (or 6EH in case of HIV +ve patients) for sputum +ve pulmonary TB and severely ill patients (short course); re-treatment: 2S3RHZE/5TH (or 5RHE in case of H resistance) three times a week.
diabetes mellitus, 7 were alcohol abusers, 1 was HIV+ and 1 had steroid-dependent asthma. All cases were diagnosed at our specialized health facility; 20 received treatment there and 80 of them were sent to their community health center. 98 patients received short-term regimen with 2HRZ/4HR, one patient with 1S2HRZ/4HR, and another one 2ER/2HRZ/4HR. 57 patients were considered cured, 29 were defaults, 3 failures, 5 died and 6 were transferred. Treatment was directly observed in just 37 patients (35 cured, 1 transfered, 1 died). We conclude that more emphasis should be given to resolve the shortcomings of the TB control program in our country through more extensive directly observed treatment, along with better patient education.
In 1994 a total number of 24,657 new cases were registered with the following breakdown: new AFB+: 12,958 (52.5%, M = 59.1% and F = 40.9%); relapses AFB+ 4.5%; new A F B - 21%; relapses A F B - 2%; clinical diagnosis 11%; extra-pulmon. TB 9%. Case-finding indicators are as follows: case detection rate all forms = 137/100,000; case detection rate AFB+ = 72/100,000 (37.5% of expected incidence with the M.o.H. currently estimated A.R.I. of 3.5%). Treatment outcome indicators (52.6% reports submitted):
This pilot district to implement TB SCC in Kenya has a population of about 400,000 people living in an area of 2,800 sq kin. The population density is 132/sq kin. and TB CDR is 89:100,000 pop. The 8 month regimen - 2SRHZ/6TH (6EH) was introduced in the district in April 1993. The first two months are supervised usually under admission while the continuation phase was self administered from the nearest health centres or dispensaries. Evaluation of the first cohort of 69 smear sputum positive patients reveals:- SCCT coverage of 82.1%, sputum negative rate at 2 m of 85.2%, 5 m of 80%, 8 m of 80%. Mortality 10% and out of control rate of 2.9%. No failure cases were recorded from this cohort. The mortality rate was highest within the 1st two weeks of treatment. This programme based evaluation shows that the implementation of shortcourse chemotherapy in Embu District has been successful and compares to the WHO/ IUATLD standards.
%
Sh. C.
St. C.
Re-treat.
Cure rate Treat. Compl. rate Overall Death rate Failure rate Defaulting rate
31.3 28.2 59.5 9.9 0.2 13.2
22.7 31.8 54.5 12.0 0.9 23.9
37.6 20.5 58.1 7.4 2.4 22.0
In some sample serosurveys, 60% of the newly diagnosed patients are HIV +ve. A multicentric epidemiological study is now in progress to assess the overall HIV positivity rate in TB patients countrywide.
213-PCll A cohort evaluation of tuberculosis treatment results in Mexico Garcia-Cruz, A., Olvera Castillo, R., Espinosa, C. Instituto Nacional de Enfermedades Respiratorias, Mexico DF, Mexico
As a part of an international multicentric study aimed at evaluating the practicability of the standard definitions of the IUATLD and the WHO in the assessment of treatment results of infectious TB cases, we selected a randomised cohort of 100 newly diagnosed, smear positive cases, identified from January 1 to December 31, 1992. 62 patients were male. Age ranged from 16 to 79 years old with an average of 43 + 16.15 years. Coexisting illnesses were found in 29 patients of which 21 had
225-PCll Shortcourse chemotherapy implementation in Embu District Kangangi, J., Kibuga, D. National Leprosy~Tuberculosis Programme, Kenya
2 3 6 - P C l l Outcome of tuberculosis treatment: a comparison of Alberta, Canada and Nicaragua Kassam, N., Cruz, R., Fanning, A. University of Alberta, Edmonton, Canada
Worldwide, tuberculosis is the commonest cause of mortality from a single pathogen, despite the availability of 98% curative drug regimens. Developing countries carry the major burden of disease. To aid these countries, National TB Programs (NTP) were designed. Sputum smear positive cases, the most infectious, are diagnosed by microscopy and treated with short course chemotherapy (SCC); outcome is measured as cure, fail, transfer, abscond, or die. Ten such programs treating over 100,000 cases per year, report 75% cure. In industrialized countries, after 30 years of declining rates, the recent rise has been linked to declining infrastructure and in some areas HIV infection. There is an assumption