DOTS Expansion: Monitoring Drugs Leopold Blanc TBS, Stop TB WHO, Communicable Diseases

  Global monitoring examples   Monitoring drugs

Indicators for Tuberculosis Impact: change in epidemiological profile (special studies)   Number of smear-positive cases per 100,000 population (prevalence/incidence)   Number of deaths from TB (all forms) per 100,000 population annually (mortality)

Estimated Global Incidence 2000 The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2001

DOTS results in TB incidence decline. The Case of Peru TB cases/100,000 DOTS 1990 PTB falling at 6% per year case finding

% Case Fatality (–Program) Case Fatality (+Program) Deaths Averted Deaths averted 59, % 30, % 26, % TB Deaths Prevented in China World Health Organization

Indicators for Tuberculosis Coverage/Outcomes (routinely collected) At national/intermediate/district level   Proportion of all treatment units implementing DOTS (DOTS coverage: 100%)   Proportion of smear-positive TB cases registered under DOTS successfully treated (treatment success rate: 85%)   Proportion of all estimated new smear-positive TB cases detected under DOTS (ratio of detection: 70%)

Projected Case Detection Under DOTS Without accelerated expansion, World Health Assembly targets will be reached in Cases notified under DOTS (%) Average rate of progress: target 2013 Accelerated progress: target 2005 WHO target 70% DOTS begins 1991

DOTS Progress in 22 High-burden Countries, 1999–2000 Source: Global Tuberculosis Control. WHO Report WHO/CDS/TB/

Indicators for Tuberculosis Process/outputs (examples)   Financial - Proportion of total financial requirements for DOTS implementation/expansion available; proportion from government - Proportion of implementation units with adequate budget for DOTS components   Diagnosis - Proportion of respiratory symptomatics examined by smear examination - Proportion of units with adequate cross-check results in QA system   Treatment - Regimens: proportion of patients receiving standard regimens - Case management: proportion of all cases receiving adequate supervision in intensive phase   Drugs: Workshop discussion   Monitoring - Proportion of units with adequate supervision and monitoring - Proportion of units submitting accurate, complete, and timely reports

Indicators for Tuberculosis Management of drugs (examples)   Drug policy/registration   Procurement   Distribution   Use of drugs   Quality control

Drug Policy/Registration   Percentage of TB drugs that are registered in the country   Average number of days to register or re-register TB drugs after they arrive in country   Percentage of TB treatment facilities that have the national guidelines for treatment of TB

Procurement   Average lead time to receive approvals for an order of TB drugs   Average lead time for suppliers to fulfill contracts   Average time required to clear shipments of TB drugs from the port of entry for the last three procurements   Costs of TB drugs as percentage of costs of GDF

Distribution   Average percentage of time out-of-stock for a set of TB drugs at central level and at treatment facility   Average percentage of a set of unexpired TB drugs available in MOH storage and treatment facilities   Average percentage of stock records that correspond with physical counts for a set of TB drugs at central level and in treatment facilities

Drug Use   Percentage of new smear-positive patients with pulmonary TB who were prescribed drugs and dosage according to national guidelines   Percentage of TB patients who could describe how the prescribed medication should be used   Percentage of prescribed TB drugs actually dispensed   Percentage of drug retail outlets where rifampicin and streptomycin were available without prescription

Quality Control   Percentage of TB drug samples that failed quality- control testing out of the total number of TB drug samples tested   Total number of quality problems reported during the year by storerooms, prescribers, dispensing personnel, and patients