Tuberculosis

Situation Update:

Tuberculosis (TB) continues to be a major public health challenge in Afghanistan. Medicines and diagnostics are made available free of charge in the country. 65,000 cases and 11,000 deaths were estimated to be caused by TB in Afghanistan in 2016. In 2017, 47,406 cases were detected and enrolled on treatment. Out of all health facilities (2,857), 71% are providing Directly Observed Treatment (DOTS) services. 

In 2017, a total of 392,272 presumptive cases were tested for TB. Among the new cases, 19,479 (41.1%) were bacteriologically confirmed, 13,029 (27.5%) clinically diagnosed, and 12,329 (26%) were extra pulmonary cases. 9,732 (20.5%) of TB cases were children. Of all TB cases, 56% were women. Of all TB-diagnosed patients, 70.6% were in the productive age group (15-64 years), and 52.3% of women were in the reproductive age group (15-44 years). Contact tracing was conducted for 84% of respiratory symptomatic cases, and among them 22,939 (93% of children in contacts) were put on isoniazid preventive therapy (IPT). A total of 22,591 (47.6%) TB cases were screened for HIV and 7 cases (0.05%) reported TB/HIV co-infection, and 201 multidrug-resistant TB (MDR-TB) cases were diagnosed and enrolled for management. The treatment success rate for all cases in 2016 was 89.2%.

Achievements:

§   Made available an uninterrupted supply of TB medicines and laboratory consumables worth of USD 3.6 million.

§   Provided ancillary drugs for management of adverse drug reactions.

§   Trained nearly 960 health staff on TB drug management and facilitated 196 mentoring visits by NTP staff during 2015-17.

§   Developed/revised technical guidelines and standard operating procedures.

§   Mobilized 2-year grant from the Global Drug Facility (GDF) to treat 9,861 cases using new TB pediatric formulations (2016-2017).

§   Mobilized USD 8.6 million from the Government of Japan/JICA to support 50% of FLDs and 60% of SLDs for the period 2018-2020.

§   Facilitated the mobilization of USD 10.6 million from the Global Fund for 2018-2020.

§   Renovated TB Central Drug Stores, Kabul and storage at NTP, Afghan-Japan Communicable Disease Hospital and provincial TB stores.

Programme Risks and Challenges:

§   Cultural barriers and stigma around TB.

§   Deteriorating security situation affecting access to services.

§   Inadequate human resources capacity at the health facility level and lack of quality assurance in laboratory services.

Way Forward:

§   Partnership development and resource mobilization.

§   Scale up of pharmacovigilance of anti-TB medicines.

§   Further innovations to improve case detection.

§   Strengthen the management of childhood TB and Programme Management of Drug Resistant TB (PMDT).

§   Build the capacity of NTP staff on conducting implementation science research.

§   Scale up management of multidrug resistant TB.

§   Strength TB/HIV collaborative activities.

  Related Links: 

Evaluation of Programme Management of Drug Resistance TB

Annex1: Sample Transportation Plan 

Annex 2: National Strategic Plan for Tuberculosis Control 2017-2021

Supply of Anti TB Medicines, Laboratory Consumables & Developing Drug Management System Final Technical Report