1. Large Hospitals DEWG – Group Work Report

2. Participants Indonesia Philippines South Africa Viet Nam Korea China Partners: KNCV, WHO, Gates

3. Current Situation Cases are often undiagnosed and those that are often not reported to NTP Many large hospitals are not part of NTP nor laboratory network Poor internal linkages – coordination within hospital between wards and unit Poor external linkages – referral, reporting and treatment between hospitals and NTP/local facilities, Difficult for NTP to penetrate large hospitals as they are under different administrative supervision Many opportunities to screen high risk groups for TB since they can concentrate in large hospitals (diabetes, HIV, OB wards) Not following international standards for detection, treatment and may lack diagnostic capabilities

4. Scaling Up Some pilot projects starting to look at bringing large hospitals into the NTP reporting system and strengthening referral systems and even establishment of DOTS clinics –Philippines –Indonesia hospital-DOTS linkage program piloted being scaled up nationally –China passed reporting laws and implemented an internet-based system to improve reporting Using ISTC to promote best practices among diagnosing physicians

5. Action Steps to Achieve Early and Enhanced Case Detection Assessment tools to define the current situation and advocate hospital involvement (NTP and hospitals supported by partners) Higher level government mandate (MOH, other ministries) with to ensure collaboration between hospital and NTP (NTP initiate, but higher level MOH) Build partnerships with hospital and professional organizations (NTP, National STBP) Intensified TB case finding amongst high risk groups in hospitals (hospital and medical schools, accreditation bodies, research groups)

6. Action Steps to Achieve Early and Enhanced Case Detection Build internal linkage within hospitals, including reporting (including laboratories), referral, treatment (Hospitals) Build external linkage between hospitals and NTP, (NTP, hospitals, MOH) Designating focal person or group to support these internal and external linkages (Hospitals, NTP) Build capacity to increase adherence to international standards and build appropriate diagnostic capabilities, (NTP, professional societies, partners) Enforce timely TB case notification of all cases (eg. web based technologies) (MOH and implemented by hospital)