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||National Tuberculosis program-Yemen
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||Manager assistant and head of surveillance department
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|1- Tuberculosis Prevention Care and Control in Yemen
2- I am NTP Manager In Yemen So I am interested and should i be interested
3- NTP has strategic plan 2016-2020 and the management unit will do the best to adopt and implement all activities of TB prevention, care and control even in the critical situation which Yemen passing and this will be a big challenges on NTP in Yemen in addition NTP in Yemen needs the cooperation of all stop TB partners.
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Specializations / Areas of Work
Civil Society and Community Engagement
Delivery of health services and care
Engaging political leaders and ensuring inclusive leadership
Funding, including innovative and optimized approach to funding TB Care
Provision of drugs, diagnostics and commodities
Research and Development
Working on Community, Rights and Gender (CRG)
Working on Key Populations related to TB
Other Organization Information
|Total number of staff in your organization:
|Number of full-time staff who are directly involved with TB:
|Number of part-time staff who are directly involved with TB:
6 - 10
|Number of volunteers who are directly involved with TB:
26 - 50
|How did you hear about the Stop TB Partnership:
Involvement in TB control provision
|If you were informed or referred by another partner of the Stop TB Partnership please tell us who:
|Why do you wish join the Stop TB Partnership:
Involvement in Stop TB Working Groups
|Are you a member of a Stop TB national partnership:
|Are you in contact with your national TB programme:
|Please tell us how your organization is contributing to your country's national TB control plan:
|NTP has strategic plan 2016-2020 and the management unit will do the best to adopt and implement all activities of TB prevention, care and control even in the critical situation which Yemen passing and this will be a big challenges on NTP in Yemen in addition NTP in Yemen needs the cooperation of all stop TB partners.
|Which country is your headquarters located in:
|Which countries do you do operate in:
(This includes countries you are conducting activities in)
|Please tell us how your organization will contribute to the Global Plan to Stop TB by briefly describing its involvement in any of the areas of work listed below:|
TB Care Delivery:
Approximately 10,000 new TB cases are notified every year through the NTP network. According to WHO, 77% of new TB cases, that appear in Yemeni population, were identified, registered and treated in 2014. The NTP has managed to ensure TB diagnosis and treatment services free of charge for all people who are living across the national territory. The treatment success rate of TB patients reached 90% in the last cohort analysis (2013).
The NTP of Yemen is not for the time being confronted to a major burden of MDR-TB; this suggests that anti-TB drugs, especially rifampicin and isoniazid, has been, to date, in general appropriately used across the country. Given that 77% of incident TB cases are identified and 90% of them are successfully treated, this suggests that 69% of patients who are newly affected with TB do not die from this disease. It is quite reasonable to think that the strategic interventions implemented through NTP network have probably an impact on mortality from TB in general population of Yemen
• To enroll on programmatic management of drug-resistant TB at least 45% of the estimated MDR-TB cases by 2017 and at least 70% of the estimated MDR-TB cases by 2020.
• The NTP has set grounds for the development of PMDT in Yemen. There is, within the Central Unit, a staff assigned to develop, implement and monitor PMDT activities. A TB drug resistant survey was carried out in 2010-2011 which showed that MDR-TB prevalence was 1.7% in new TB patients and 15% in retreatment TB cases. National guidelines on PMDT were prepared and produced. Culture and DST facilities have been developed in four TB centres (NTI, Aden, Al-Hodeida and Taiz) where the management of patients with drug-resistant TB have been initiated. In 2013, 27 patients with drug-resistant TB were identified and enrolled for treatment with second line anti-TB medicines as recommended by WHO. The second-line anti-TB dugs are procured through the Green Light Committee with a funding support from the Global Fund. However, the capacities of the NTP network are still insufficient to ensure appropriate PMDT services. There is no Xpert testing services in the country, only one physician was trained at international level on the management of MDR-TB patients, there is no DSTs for second-line anti-TB drugs and the 4 PMDT sites are not fully functioning.
• The number of MDR-TB cases is estimated at: i) 74 for the period July to December 2016, ii) 166 for 2017, iii) 178 for 2018, iv) 188 for 2019 and v) 191 for 2020. It is expected that 59 MDR-TB cases (40%) will be enrolled on second-line TB treatment between July and December 2016, 74(45%) in 2017, 98(55%) in 2018, 122(65%) in 2019 and 134(70%) in 2020.
• To this end, the following intervention will be developed and implemented:
• Twelve Xpert machines will be purchased and implemented in the TB laboratories of 12 Governorates; the cartridges needed and annual calibration of the machines will be ensured (see activities
• Consumables for culture and DSTs will be ensured for the NRL (NTI/Sana'a) and the laboratories of the governorates of Aden, Al-Hodeida and
• Equipment to perform LPAs will be purchased and implemented in the NRL (NTI/Sana'a) and the laboratories of the governorates of Aden, Al-Hodeida and Taiz; the consumables to carry out LPAs will be procured (see activities
• A study tour will be organized for the PMDT focal point in the NTP Central Unit in a neighboring country with a well-functioning PMDT program (example: Egypt); in this study tour, the focal point will observe how PMDT activities are undertaken, organized and managed from an NTP central unit.
• The rehabilitation of hospital wards to manage drug-resistant TB patients in the 4 PMDT sites (NTI, Aden, Al-Hodeida and Taiz) in line with the requirements for TB infection control will be undertaken by the NTP Central Unit in coordination with the relevant departments of the MOPHP.
• The training of 2 clinicians and 2 nurses from each of the 4 PMDT sites will be organized in one of the neighboring countries with appropriate PMDT services (example: Egypt); this training will be on clinical management of drug-resistant TB patients.
• The national guidelines on PMDT will be updated in line with the last WHO recommendations.
• The updated national guidelines on PMDT will be printed.
• SOPs on treatment administration and monitoring of drug-resistant TB patients and on infection control will be developed in line with the updated national guidelines on PMDT. These SOPs will be used by health staff of BMUs and PHC facilities and community health workers who will manage drug-resistant TB patients when they are on ambulatory treatment.
• SOPs on treatment administration and monitoring of drug-resistant TB patients and on infection control will be printed.
• The training on PMDT of the health staff of BMUs and PHC facilities will be carried out on case by case basis in the relevant PMDT sites.
• The community health workers will be trained, on case by case, by the staff of BMUs or by the health workers of PHC facilities. It is assumed that 25% of MDR-TB patients will need the involvement of community health workers in the treatment provision on ambulatory basis.
• The transport of specimens to the laboratories performing culture and DSTs will be ensured for each patient with drug-resistant TB
• TB cases with rifampicin resistance will be registered and enrolled for treatment with second-line anti-TB drugs which will be adjusted later according to the DST results, as necessary, in line with the updated national guidelines on PMDT.
• The patients diagnosed with MDR-TB will be enrolled and provided second line TB drugs in line with the updated national guidelines on PMDT (see below activity 2.17).
• All the patients who receive second-line anti-TB drugs will be prescribed ancillary medicines as necessary.
• As highlighted above, the procurement of the second-line TB drugs and the ancillary medicines to manage their adverse effects will be ensured for
o 30 MDR-TB patients during the period July to December 2016,
o 74 in 2017,
o 98 in 2018,
o 122 in 2019,
o 134 in 2020.
• The treatment will be monitored through regular smear examination, culture and other laboratory tests in line with the updated national drug-resistant TB guidelines. All patients will be linked to the nearest BMUs for weekly follow-up as well as to a PMDT site for an assessment that will take place every month for the first six months after hospital discharge and then every two months until the end of treatment. Specimens, as required, will be sent for culture to the laboratory which performs culture.
• In order to ensure treatment compliance and minimize the risk of treatment interruption and lost-to-follow-up, all patients will be provided social support (food basket) and travel incentives. Food support will not only help improve nutritional status of patients but also facilitate their adherence to treatment. The food basket will be provided to each drug-resistant TB patient.
• Transport refund and a daily subsistence allowance will be ensured to community health worker when she/he accompany the drug-resistant TB patient to the PMDT site for the visit planned every month or every two months.
• The clinicians and nurses who are managing drug-resistant TB patients at PMDT sites will be offered opportunities to share their experience in international meetings and workshops with other health staff from other countries.
• Health staff who are monitoring and following drug-resistant TB patients on ambulatory basis in BMUS and PHC facilities will receive continuous and refreshing training courses on ambulatory-based model of care, with a focus on the early identification and management of adverse reactions associated with TB medicines.
• The infection control measures at PMDT sites, PHC facilities and community will be sustained for personal as well as environment control; these measures will be undertaken in coordination with the actions that will be taken for infection control in health facilities with TB/HIV services
• The capacities in drug-resistant TB management will be strengthened in the governorates through: i) the supervision and monitoring of the identification process of drug-resistant TB patients in BMUs and PHC facilities, ii) the monitoring of the management of drug-resistant TB patients, iii) the management of second line TB dugs and iv) regular evaluation.
• A national survey on TB drug resistance will be undertaken in 2019. It is expected that the political situation will improve by then in the instable areas. If the situation does not improve or worsens then the drug resistance survey will be conducted in Sana’a Capital City; if this is the case, the drug prevalence that will be reported will probably overestimate the national prevalence.
• Functional coordination mechanisms will be established at national and governorate levels
• The existing coordination mechanism at national level through the NTF for Collaborative TB/HIV Activities will be strengthened and sustained.
• The NTP and the NAP will propose to the Director General of Public Health Care Sector and the Under-Secretary of Medical Services and Primary Health Care to revise the membership and define clearly the mission of the NTF for Collaborative TB/HIV Activities. The affected communities and all the relevant stakeholders dealing with HIV/AIDS issues will be invited to be represented.
• The NTF for Collaborative TB/HIV activities will meet every six months to discuss the TB/HIV strategic orientations adopted and/or needed to be adopted, progress made in the implementation of planned activities, resources’ mobilization and issues in the coordination of TB/HIV activities. This NTF will also meet on ad hoc basis according to the needs.
• Sub-national task forces for collaborative TB/HIV activities will be created in the Governorates of Aden, Al-Hodeida, Hajjah, Ibb, Sana'a and Taiz. The Central Units of the NTP and NAP will assist the Coordination Units of NTP and NAP of these six Governorates to: i) develop a protocol defining the constituencies and the missions of the sub-national task forces for collaboration TB/HIV activities at governorate level, ii) ensure the representation of affected communities as well as that of all the relevant stakeholders and iii) subsequently submit to Director of Health of their respective governorates for formal notification. The sub-national task forces for collaborative TB/HIV activities will meet every six months to discuss the progress made in the implementation of interventions, the financial and budget issues, the strategic orientations, the issues related to the coordination between NTP and NAP and the actions that need to be taken. The sub-national task forces will meet also on ad hoc basis whenever needed.
• In the district health facilities of the six Governorates and where both TB and HIV services are available, a coordination committee of the district health facility will be constituted to review the progress of collaborative TB/HIV activities and resolve routine matters through regular meetings. This coordination committee will develop and sustain linkages with the communities through NGOs operating in communities and community health workers.
• The national guidelines on collaborative TB/HIV activities will be thoroughly revised by the NTP and the NAP in coordination with the NTF for Collaborative TB/HIV Activities in Yemen; these guidelines will clearly specify the role of each stakeholder, especially that of the NTP and NAP.
• Training material on collaborative TB/HIV activities will be developed by the NTP and the NAP in collaboration with the relevant stakeholders; this training material will be used in the refreshing and initial training of the health staff.
• The intensified case finding of HIV in TB patients will be strengthened and expanded in the six main Governorates and initiated in the remaining governorates.
• Refreshing training will be undertaken for the health staff of the BMUs where HIV testing and counseling in TB patients were already initiated (Governorates of Aden, Al-Hodeida, Hajjah, Ibb, Sana'a and Taiz).
• Initial training will be undertaken for the health staff of all the BMUs of the Governorates of Aden, Al-Hodeida, Hajjah, Ibb, Sana’a and Hajjah. This initial training will focus on provider-initiated HIV testing and counseling in TB patients.
• Initial training will be undertaken for the health staff of at least one BMU of the remaining Governorates. This training will focus on provider-initiated HIV testing and counseling in TB patients
• Rapid tests for HIV screening and HIV infection confirmation, in line with
• the WHO and NAP guidelines, will be procured to meet the needs of the BMUs; this
• procurement will be made through the NAP.
• The procurement of the items needed to collect blood samples in TB patients will be ensured.
• The registration of HIV-co-infected TB patients identified will be ensured in the HIV/AIDS registration system; if this registration system is not available in the same health facility then the patients will be referred to the nearest health site which ensure NAP services.
• All the HIV-co-infected TB patients identified will receive ARV therapy and CPT through NAP services.
• Information feed-back on TB assessment results to the relevant HIV/AIDS health facility will be ensured by the BMUs’ staff. This assessment will be carried out for the PLHIV and the persons at high risk of HIV infection who are referred by HIV/AIDS facilities.
• Intensified case finding of TB will be reinforced in PLHIV and people at a high risk of HIV infection
• The capacity building of the staff of HIV/AIDS health facilities will be enhanced. This capacity building will focus on TB screening and TB issues’ management in PLHIV and people at high risk of HIV infection, and will be ensured through training, refreshing courses and supervision.
• Questionnaires for active and systematic TB screening of PLHIV attending health facilities with HIV services will be printed. The questionnaires will be used on individual basis and will, at each visit, screen for any fever, any cough, night sweat and recent weight loss.
• Xpert machines to improve the diagnosis of TB in symptomatic PLHIV will be procured (see above activities 188.8.131.52, 184.108.40.206 and 220.127.116.11).
• The containers to collect specimens for TB microscopy examinations and Xpert testing as well as the safety boxes needed to transport them to TB microscopy centres or health facilities with Xpert machines will be available in the HIV/AIDS facilities (see above activity 1.2.15).
• All PLHIV diagnosed with TB will be referred to BMUs for registration and appropriate TB treatment administration and monitoring.
• All PLHIV with rifampicin-resistant TB identified through Xpert testing will be referred to the closest BMUs; these BMUs will then refer the rifampicin-resistant TB/HIV co-infected patients to the relevant PMDT sites.
• All PLHIV in whom the active screening for TB did not identify any active TB will be treated with IPT.
• The sub-National Task Forces for Collaborative TB/HIV Activities of the 6 Governorates will establish in their respective governorates a mechanism to organize referral and linkages between HIV/AIDS facilities and BMUs through the development and production of reference directory. This directory will specify the locations of the appropriate health facilities, the identification of the relevant stakeholders at Governorate and district levels and the identification and contact details of the relevant focal persons
• Infection control procedures will be ensured in the district health centres which provide both TB and HIV/AIDS services.
• The national guidelines on TB infection control, that has been recently developed, will be translated into Arabic.
• The national guidelines’ document on TB infection control will be printed in sufficient copies.
• In collaboration with the NAP, an operational plan will be developed to implement infection control in the district health centres that will offer both TB and HIV services in line with the increase in the number of health facilities planned to be providing these services.
• The relevant staff of the district health centres providing both TB and HIV/AIDS services will be trained. This training will be in line with the national guidelines on TB infection control and carried out in close collaboration with the NAP. The training process will follow the established operational plan.
o Masks will be procured for the infectious TB patients who attend the district health centres which offer TB and HIV/AIDS services.
• The monitoring and evaluation of TB/HIV collaborative activities will be proceeded.
• The TB/HIV component will be updated and revised in the monitoring and evaluation system of the NTP in line with the last WHO recommendations and in coordination with the NAP.
• Training sessions will be organized for the staff of the NTP and NAP Coordination Units of the 6 Governorates. Each Coordination Unit will be represented in this training by the coordinator and the monitoring and evaluation officer at Governorate level.
• The revised TB/HIV component of the NTP information system will be field-used on routine basis.
• The data generated on TB/HIV collaborative activities will be collected, compiled and analyzed on quarterly and annual basis.
• Strengthening the existing TB diagnosis capacities and up-grade the TB laboratory network.
• Seven new TB microscopy laboratories will be implemented. Each laboratory will be established in each of the 7 districts with a population size over 100,000 inhabitants and with no TB microscopy laboratory; these 7 laboratories will be equipped with LED microscopes. Renovations will be undertaken to fulfill the requirements needed for functional TB microscopy laboratories.
• The existing optical microscopes will be replaced by LED microscopes in 180 TB laboratories (out of the existing 270 TB microscopy laboratories); this replacement will be undertaken from January 2017 onwards; the priority will be given to the laboratories with a high work load (with a focus on the urban areas of the governorates with the highest TB notification).
• Consumables will be procured to carry out TB microscopy activities based on the number of TB suspects and smears to be examined in 277 TB microscopy laboratories(270 + 7); among these, 187 laboratories will use LED microscopes; the number of smear expected to be examined is as follows: 82,921 from July to December 2016, 194,876 in 2017, 242,665 in 2018, 294,250 in 2019 and 310,139 in 2020.
• The required training will be ensured:
• The national TB microscopy guidelines will be revised and SOPs for TB microscopy developed in line the new WHO recommendations.
• The TB microscopy guidelines and SOPs will be printed in sufficient copies.
• The required training material for TB microscopy will be developed and printed.
• Initial training on TB microscopy will be ensured for 2 staff of each of the 7 new TB microscopy laboratories; this course will include a session on infection control in a TB laboratory.
• Refreshing training will be organized for the staff of the existing 270 TB microscopy laboratories according to the conclusion of the supervision visits and the results of the EQA; this refreshing training will include a session on infection control in a TB laboratory.
• SOPs to standardize and carry out EQA activities will be developed and printed.
• The EQA of microscopy activities carried out in the existing 270 TB microscopy laboratories will be maintained and strengthened and extended to the 7 new TB microscopy laboratories.
• Twenty five staff from the governorate TB coordination units will be trained to ensure the supervision of the activities carried in the TB laboratory network and 25 other staff will be trained as well to carry out the EQA-related activities.
• The supervision of TB microscopy laboratories’ activities will be ensured.
• Xpert testing will be expanded (to date, 4 Xpert machines have been implemented in Yemen):
• Twelve Xpert machines will be procured; the priority will be given to the governorates with a high TB notification.
• The cartridges needed will be procured according to the planned activities; the number of Xpert tests expected to be carried out is as follows: 2,323 between July and December 2016, 6,720 in 2017, 8,941 in 2018, 9,945 in 2019 and 11,270 in 2020.
• The annual calibration of the 16 Xpert machines (4+12) will be ensured.
• Consumables will be procured to carry out:
• Culture liquid and DSTs (including for the 2nd line anti-TB drugs) in the NRL and the laboratory of Aden.
• Culture and DST (1st and 2nd line TB drugs) on solid medium in the Governorate Laboratories of Aden, Al-Hodeida, Sana'a and Taiz.
• Training 4 laboratory staff on DST for 2nd line TB drugs in the Supra-National Reference Laboratory of Egypt
• Line probe assay (LPA) activities will be developed:
• The LPA equipment that needs to be implemented in the NRL and in the Governorates laboratories of Aden, Al-Hodeyda, and Taiz will be purchased.
• Guidelines to use and maintain LPA equipment will be developed and printed
• Training of 8 laboratory staff on LPA equipment use in the Supra-National Reference Laboratory of Egypt
• Rearrangement of the design of the 4 laboratories in order to carry out appropriate LPA activities
• The consumables needed to carry out LPA activities will be procured.
• Solar panels will be procured for TB laboratories with no or poor access to electricity power.
• UPS back-up and printers will be procured where needed.
• UPS back-up will be procured for the solar panels
• Printers will be procured for Xpert machines and LPA equipment
• Laboratories performing culture and DSTs will be equipped with extraction fans.
• A communication system and specimens’ transport will be established: i)between BMUs and TB laboratories performing Xpert tests, ii) among Xpert sites, the laboratories ensuring cultures and DSTs and PMDT sites and iii) between HIV/AIDS facilities and TB diagnosis sites (BMUs or Xpert sites).
• The laboratory request forms and the new registers for microscopy, Xpert testing, culture and DST newly recommended by WHO in 2013 will be adapted and implemented in the TB laboratory network.
• Quarterly assessment of TB microscopy activities at district and governorate levels will be undertaken.
• Quarterly and annual assessment of Xpert testing, culture and DST activities will be ensured.
• The maintenance of TB laboratory equipment will be ensured whenever and wherever needed. For this, contracts will be established with the equipment suppliers.
• National standards for TB laboratory equipment and reagents that need to be used in Yemen will be developed, printed and disseminated.
• The NRL will be linked to the Supra-National Reference Laboratory of Cairo to strengthen quality assurance, including transportation of specimens from Yemen to Egypt.
• TB laboratory activities and the management of TB laboratory network will be reviewed every 2 years by an international expert.
• The operational research will be in priority based on the findings of the analysis of the data generated through the information system of the NTP. The outcomes of the findings will help identify hypotheses to explore in operational research studies. The operational research will aim at improving TB prevention, care and control situation in Yemen and therefore will orient problem-solving actions to be undertaken by the NTP.
? A focal point for operational research will be designated within the NTP Central Unit team.
? A National Task Force for Operational Research (NTFOR) will be established. It will include representatives of the existing medical schools of Yemen, relevant nursing schools, academic institutions and partners.
? A national workshop on operational research in TB prevention, care and control will be organized in close collaboration with the NTFOR. The participants of this workshop will have to: i) identify the issues needed to be addressed in order to build capacities for operational research and ii) establish a national agenda for operational research in TB epidemiology, prevention, care and control in Yemen based on the results of the information system of the NTP.
? A report on the outcomes of the national workshop on operational research will be prepared by the NTP Central Unit.
? This report will be distributed to: i) the academic institutions of Yemen in order to be informed on the priority areas regarding TB issues in the country, ii) the international partners involved TB activities in Yemen and iii) funding agencies.
? Funding proposals will be developed and submitted to international partners or organizations which can potentially provide financial support to carry out operational research studies; these studies will be in line with the agenda established in the national workshop on operational research.
? Operational research studies will be undertaken in line with the NSP but depending on the resources mobilized from the government and partners.
? The reports on the findings of the operational research studies that have been undertaken will be prepared and distributed to those who need to be informed.
? Articles will be prepared based on these reports and submitted for publication.
? Actions will be defined and implemented on the basis of the studies’ findings and the effects of these actions will be assessed through the data generated through the information system of NTP.
|Declaration of interests:|
May 22, 2016 |
June 15, 2016 |