1. Tuberculosis:
Philippine Experience
Jennifer Ann Mendoza-Wi, MD, FPCP, FPCCP, FCCP
Past Chairperson
Philippine Coalition Against TB (PhilCAT)
RESPINA 2011

2. Outline
 To present updates on the current
state of TB control in the Philippines*
 To present achievements and
challenges in TB control in the country
 To present what professionals and
professional societies can do
(PhilCAT)
*as presented in August 2011 during the Annual PhilCAT Convention

3. Where is the Philippines now?
 Impact:
Prevalence: 799/100,000 to
<400/100,000
Mortality: 87/100,000 to <44/100,000
 Outcome: 85% Case Detection (NS+s)
90% Treatment Success
15,000 MDR-TB cases
15,000 TB-HIV cases (PICT)
Presented by: *Rosalind G. Vianzon, MD, MPH
National TB Program (NTP) manager
NCDPC, Department of Health
Republic of the Philippines

4. Prevalence and Mortality Rates from Tuberculosis,
Philippines, 1990 - 2015 (per 100,000 population)
(SOURCE: WHO Global Tuberculosis Control. 2000-2009)
1,100
Prev, All forms Mortality, All forms
1,000
900
800
700
600
500
400
300
200
100
0
1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

5. Tr ends of CDR (New Sm+ , All Forms) ,
100
Cur e and Treat m ent Success , 2000 - 2015
90
80
5
o 89 0
70
t
70 to
60 85
50
40
CDR,New Sm+
30 CDR, All forms
Cure
20
Success
10
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

7. Strategy 1. Localize implementation
of
TB control
 DOTS Compliance Assessment
Tool
- for province and highly urbanized city
 8 system standards for DOTS Compliance
 Pilot-tested in the BIG 3 regions

8. Classif icat ion schem e: St age of Com pliance
8 Self-Assessment
DOTS Points
(DCAT)
Sustaining:  Multiyear TB plan
3 consecutive years and
with initiatives on MDR-
TB and  Governance structure – “PP”
vulnerable populations
 Network of quality-assured labs
DOTS Performing:
DOTS compliant and
achieves the casefinding  Efficient TB drug mgm’t system
and caseholding targets
and EQA standards  DOTS service network
DOTS Compliant:  Activities to increase demand
achieves the 8 standards
 Regular monitoring/analyses

9. Strategy 2. Monitor health system
performance
200,000 200,000
160,000 160,000
120,000 120,000
80,000 80,000
40,000 40,000
0 0
4A NCR 3 Luz Viz Min 4A NCR 3 Luz Viz Min
TB Sxs TB Sxs TB cases

10. TB Cases and TB Sxs, 2010
10% 9%
24%
29% 14%
16%
8%
9%
21%
20% 20%
20%
4A NCR 3 Luz Viz Min 4A NCR 3 Luz Viz Min

11. Strategy 2. Monitor health system
performance
 Ongoing surveys:
2nd Drug Resistance Survey (DRS)
Data Quality Audit (DQA)
Client Satisfaction Survey (CSS)
1st Mortality Survey
 Systems performance:
Scorecards (LGU, CHD, Central units)

12. Strategy 3. Engage All Health
Care providers
200,000 Public
3200
Private Public
Private
160,000
2400
120,000
1600
80,000
800
40,000
0 0
Relapse EP
New Sm+ New Sm- Total

13. Strategy 3. Engage All Health
Care providers
Initiatives Sites Partners Nos.
CATCH-TB selected Public hospitals
within Metro Manila WHO-CIDA 14
SECURE- Private hospitals in PTSI-
TB various regions TBLINC- 41
USAID
Hospital Remaining DOH-owned
expansion hospitals in Metro Mla GFATM 9

14. Strategy 4. Promote and strengthen
positive behaviour of communities
 Proportion of symptomatics who are self-medicating
and not consulting HCP reduced by 30% (4thNPS 2014)
 Default rate with > 7% reduced by 40%
8
7
6
5
4
3
2
1
0
1 2 CARAGA6 7 8 3 4B 5 9 10 11 CARARMM 4A 12 NCR PHL

15. Strategy 5. Address MDRTB, TB-HIV
and needs of vulnerable population
T B
Clinical Risk Groups Populations at Risk
MDR-TB TCs, TSats,
Culture, DST
R Inmates
Jail, Prison
7 penal farms, NBP
CIW,City/Prov Jails
TB-HIV Nationwide NCR
I Elderly
Inst’tn
Veterans MC,
Golden Acres
TB-DM For research
(PGH,Other hosps) S Indigenous
Groups
(Rural poor)
Mansaka,Mandaya,
Subanen, Manobo
TB-
Parago-
nimiasis
Endemic sites
K Urban Poor R.U.P.approach,
Payatas, SM

16. Strategy 6. Regulate and make available
quality TB diagnostic tests and drugs
Types of drugs provided by NTP:
 TB Kit 1 - Category 1, 3 treatment for adult
 TB Kit 2 - Category 2 treatment for adult
 Pediatric Kit - treatment of disease for children
 INH syrup (IPT) - preventive therapy for children
Types of laboratories with QA diagnostics:
Microscopy Center - DSSM
Culture Center - conventional LJ, LPA
DST Site - precipitate method ; all public
NTR

17. Points of Care for PMDT
(Diagnostic and Treatment Facilities)
Tx
Gene Cent ers
Xpert
Tx
Microscopy Sat ellit es
Tx
Microscopy Sit es

18. Strategy 6. Regulate and make
available quality TB diagnsotic tests and
drugs

19. Strategy 7. Certify and accredit
TB care providers
DOTS
Service Providing
Facility
S e l lff
Se
Asses
Asses
s m e n tt
smen Technical
T o o l ls
Too s Assistance
Provider
DOTS Certifiers
1,166 DOTS certified CHD NTPs
as of June 2011

20. Strategy 8. Secure adequate funding, improve
allocation & efficiency of utilization
 COSFIT – TB costing and financing tool
 TB-DOTS OPD Package – case payment of
PhilHealth for TB

21. CHALLENGES
 Finding more and finding fast the TB cases
 Addressing “difficult” and “costly” groups of
cases
 Introducing, adopting and sustaining the new
tools for diagnosis
 Addressing limited human resources, particularly
at implementing levels
 Balancing partner’s support with their
contribution to the Program

22.  PHILCAT What Professionals and
 PHIL.TIPS


DOH
PHILHEALTH Professional Societies
Can Do for TB- PhilCAT
 PAFP
 PCP
 PCCP
 PCOM
 PPS
 PSMID
 To describe non-clinical but nevertheless important activities and programs
shown to improve TB control efforts in the community and country
 To show how these activities enhance TB control by assuring sustainability
and accessibility of TB services

23. Barriers to accessing TB care
in poor communities:
 Economic barriers- poverty
 Geographical barriers- distance from services
providing TB diagnosis and treatment
 Socio-cultural barriers- STIGMA and lack of
knowledge of TB and available TB services
 Health systems barriers- poor health seeking
behavior of patients; lack of health system
responsiveness

24. COUGH… and TB

25. Interventions to Involve
Private Practitioners

26. PhilCAT Activities

27. Installing PPMD Units Nationwide: A Project Under the GFATM

28. Local
Guidelines
International
Guidelines
Medical Curricula
Education and Training

29. Annual PhilCAT Convention DOTS Referring COURSE
Educational and Collaborative Meetings
Advocacy Symposium for BHWs
Ang Katotohanan Tungkol sa TB (Tuberculosis)
10 Roles of a TB- D.O.T.S. Advocate

30. NCC Meeting
1994
PhilCAT
Involvement in program
planning
ADVOCACY
International Collaboration

31. PPMD…an ADVOCACY, not just a Strategy
VVMF PPMD
PMDT- ITRMC…another challenge!

32. Recognition/Awards

33. Fighting TB Through Unified Action
MABUHAY AT MARAMING SALAMAT PO ! ! !