1. “World TB day and TB in Mongolia”
O.Batbayar MD,MPH (University of London)
National Tuberculosis Program

2. World TB day-Stop TB in my Life Time

3. 2012 оны Сүрьеэтэй Тэмцэх Өдөр

7. TB in Mongolia
Mongolia is one of the 7th high burden TB country in West Pacific region of WHO.
3985 cases last year per 2.7 population ( cases per 270 mln USA population)
185 MDR cases
Total 19 XDR cases
400 paediatric cases
TB incidence 219 per
TB prevalence 280 per
TB Mortality 21 per
2011 statistics is promising

8. Last ten years incidence, treatment success and mortality

9. Last ten years incidence and treatment success

10. Timeline 1968: The TB laboratory was established
1992: The TB laboratory network was developed
1994: NTP was established and DOTS launched
1994: Organization of the National Reference Laboratory
1997: Quality assurance system was introduced, Supranational Reference Laboratory (SRL) Japan
1997: First Drug Resistance Survey (DRS) conducted
1999: 100% DOTS coverage
2001:Reogranization of the TB Department under the National Center for Communicable Disease (NCCD)
2001: GFATM Round1 launched, later on RCC1
2002: National Programme of Communicable Diseases (NPCD) approved, TB program is a sub-programme of the NPCD
2005: GFATM Round 4 launched, Later on RCC 4
2006: launching of GLC approved project for management of 375 patients with drug-resistant TB (DR-TB)
2007: Second DRS conducted
2008: The review of the NTP
2009: Testing of drug resistance to second-line anti-TB drugs (SLD) started
2010: second National Programme of Communicable Diseases (NPCD) approved for the years , TB program is a sub-programme of the NPCD
2010: National strategic plan to stop TB in Mongolia, (Objective 3-expand programmatic management of MDR-TB)
2010: Updated the guidelines on tuberculosis care and service (appendix 3- guidelines on drug resistant TB services and care) approved by MOH, 2010
2010: National TB Infection control (IC) guidelines developed and approved
2010: GLC approved second cohort for 790 patients
2011: GFATM Round 10 approved and the consolidated grant will be launched in July 2011
2012 ; ACSM strategy is in development process

11. Current TB situation Political and financial commitment
National strategic plan to stop TB in Mongolia (Objective 3-expand programmatic management of MDR-TB), MoH, 2009
National guidelines on tuberculosis care and service updated and approved by MoH, 2009 (appendix 3- guidelines on drug resistant TB services and care)
Successful resource mobilization from the GFATM (since 2006 –present, single stream funding)

12. MDR-TB patients enrolled (2003- 2011)
MDR-TB estimates burden by WHO: 106 new MDR-TB cases every year
BUT BY END OF 2011 – WE DIAGNOSED 180
First three month of 2012 – 22 new cases
DRS survey 2007:
among new cases: 1.4%
Among retreatment cases 27.5%
893 MDR-TB cases were diagnosed, out of them:
58.1% (519) have been enrolled to treatment, 26.5% (237) died, and 1.3% (12) refused treatment, 1.1% (10) were treated abroad or private hospital, 0.8% (7) were not able to be enrolled in treatment due co-morbidities, 12.1% (108) were on the waiting list.

13. National TB reference laboratory with 37 branches and sputum transportaion scheme

14. Current MDR-TB situation
Available infrastructure:
NTRL (DST, culture, liquid culture, LPA on FLDs)
Treatment is available through GFATM support
Infection control:
Administrative measures
General infection control order, approved by MoH, 2010
TB infection control guidelines, 2010

15. Treatment success rate
Treatment outcomes
Final outcomes for 2008 cohort
Year
Total
Cured
Treatment completed
Failed
Defaulted
Died
Cure rate
Treatment success rate
2006 50
21(42.0)
11(22.0)
8 (16.0)
2(4.0)
8(16.0)
42.0
64.0%
2007 64
40(62.5)
9(14.1)
4(6.3)
6(9.4)
5(7.8)
62.5
76.6%
2008 65
48(73.8)
2(3.1)
3(4.6)
6(9.2)
73.8
76.9%
179
109(60.9)
22(12.3)
15(8.4)
14(7.8)
19(10.6)
60.9
73.6%

16. Partners
World Vision International Mongolia (WVIM) started the implementation of the GF TB grants since It has been collaborating with the “Enerel” charity and Prison Hospital on provision of TB care services for vulnerable population as homeless and prisoners, conducting active case finding and ACSM activities
Mongolian Anti-Tuberculosis Association (MATA) worked as sub-recipient (SR) for GF supported project since 2003 on the implementation of home-based and lunch-DOT for TB patients through trained health volunteers nationwide. Also they led ACSM activities for general population as well as for patients and their family to reduce stigma and discrimination against TB.
Mongolian Association of Family Clinics (MAFC) implemented the PPMD since April 2009 within the Round 1 RCC. The MAFC has been carrying out the following interventions: training TOT among family physicians on early detection and treatment, referral of TB suspects to a secondary and tertiary level of TB services, transportation of sputum samples from primary health care services to TB dispensaries, and developing clinical guidelines for family doctors

17. Partners Mongolian Antituberculosis Union newly formed in 2011
Health Science University of Mongolia (HSUM) collaborates closely with the NTP on the revision of the curriculum of relevant health sciences courses including medical course, nursing and pharmacy. The HSUM is instrumental in on formalizing of policy documents in collaboration with the Ministry of Education.
The GFATM provides financial support
World Health Organization (WHO) provides technical assistance through its Country and Regional Offices.

18. Strength and Weakness Strengths of T B Control Program
Good and detailed National Strategic Plan to Stop TB in Mongolia ( )
KAP survey for health providers completed and published
KAP survey with general population in final stages
Partnerships in place and community mobilization
Commitment of staff and available technical support
Challenges in TB Control Program
Human resources (all)
Limited knowledge of TB (all)
Stigma and discrimination (all)
Coordination
Significant amount of data but not used appropriately, TB prevalence survey not contacted
Engaging all providers/community groups
Political commitment

19. Challenges and some factors
Various vulnerable groups (homeless, alcoholics, poor) difficult to reach
Seeking diagnosis late
Treatment default
Infection Control practices/guidelines not implemented
No diversified funding for TB control activities
Limited knowledge on TB (all) and availability of services among population
Limited knowledge on Interpersonal Communication and Counseling skills (providers)
Lack of target specific messaging on TB
No coordination or/and consistency of TB messages among partners
Coordination, planning, partnerships, networks
No standardized training curriculum and tools for providers and community volunteers
Health providers have no interest to work in TB sector
Currently limited efforts to gain political support for TB

20. Best TB Dispensary

21. TB HR seminar and Paediatric department

22. TB day HRD strategy ACSM strategy TB patient social care and isolation
KAP survey
TB incidence among HCW
MoU with high burden districts
TB registration web
Media and web
Activity among TB patients
AXA among school children
Debjee- amongTB Voluntary Workers
TV education program

23. Thank you