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Zero TB Karachi: Targeting Multiple Diseases from a Single Disease Platform

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Zero TB Karachi: Targeting Multiple Diseases from a Single Disease Platform Zero TB Karachi: Targeting Multiple Diseases from a Single Disease Platform Aamir Khan MD, PhD Executive Director IRD, Singapore Outbreak Response: community-based TB/HIV screening Zero TB Working with Provincial HIV program • HIV outbreak response - collaboration across public and private sector • Concurrent TB & HIV screening camp • 1000 HIV positive individuals found • >800 were children • 3 MTB positive individuals identified • Continued active screening for TB/HIV Zero TB CITIES is a global initiative targeted at creating “islands of elimination” with strong local ownership in high burden settings Zero TB implements evidence-based Search, Treat & Prevent approaches from around the world shown to be successful in controlling TB Zero TB Cities and districts – current, new and potential Almaty, Kazakhstan** Manila, Philippines** Balti, Moldova Melbourne, Australia** Bangkok, Thailand** Mexicali, Mexico Chennai, India Mtata, South Africa** Dhaka, Bangladesh* Mumbai, India** Geissen, Germany Muscat, Oman** Hai Phong, Vietnam Odessa, Ukraine Hanoi, Vietnam Pattaya, Thailand** Ho Chi Mihn City, Vietnam Peshawar, Pakistan Indore, India** Quetta, Pakistan** Karachi, Pakistan Shenzhen, China* Kathmandu, Nepal** Sofia, Bulgaria** Kano, Nigeria** Tbilisi, Georgia** Kisumu, Kenya Ulaanbaatar, Mongolia Lagos, Nigeria ** Vladimir, Moscow Lima (Carabayllo), Peru * First of multiple cities planned ** Discussions of alignment underway Pakistan’s Zero TB Initiative Global Fund Support 2016-2017 USD 40m – Zero TB Karachi +32 districts 2018-2020 USD 40m – Zero TB Karachi, Peshawar, Quetta + 32 districts 3 Zero TB > 3 55 >1.5 >61,000 Cities / ~1200 million mobile million TB 32 staff symptom X-ray Screened patients districts screened vans by CXR notified Karachi: All Forms TB Notifications 2008 – 2018 30000 25,064 25,339 25000 20,560 19,336 20000 18,693 18,270 17,545 18,115 16,104 15,993 15000 14,470 Notifications 10000 5000 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 TB-HCV Integrated Screening and Treatment HCV Testing and Treatment Cascade Jan to July 2019 25000 20371 20000 15000 10078 9598 (49%) (95%) 10000 Number of Individuals of Number 5000 806 745 475 324 245 (8%) (92%) (64%) (68%) (76%) 0 Eligible for Verbal RDT screening Anti HCV +ve PCR testing PCR positive Baseline Treatment screening screening evaluation initiation No. of people screened* Karachi HCV Micro-Elimination Plan: 203,593 Korangi, Landhi, Ibrahim Hyderi 7% prevalence Anti HCV +ve 14,252 (7%) 10% drop out rate Baseline PCR testing 12,826 (90%) 50% active viremia Diagnosed 6413 (50%) Started on Treatment 5772 (90%) Treatment complete 5599 (97%) Integrated HCV-TB Diagnostic Services Expansion of HCV services via integration with GeneXpert testing facilities throughout the private and public sector Number of GeneXpert machines 157 Integrated Practice Units (IPU) Supported by the Harvard Medical School-Center for Global Health Delivery-Dubai Integration of mental health and diabetes services with 6 existing TB facilities to improve adherence, treatment outcomes and provide holistic care Mass screening for TB Adherence & Mental Psychologist-Severe Diabetes Screening Diabetes Medication and Depression & Anxiety Health Counseling Case Consultation and Consultation Counseling Integrated Practice Units (IPU) Psycho-Social Support Interventions (PSSI) 6 10 3,500 1,012 3,441 IPUs developed Counselors trained Screened for Enrolled and given Screened for across public and and deployed Depression and baseline adherence Diabetes. 21% private hospital Anxiety. 30% counselling. 562 Symptomatic settings Symptomatic completed MH intervention Key Finding from Integrated Practice Unit (IPU) for Mental Health and TB 92% of patients who completed the mental health intervention also completed TB treatment, compared to a 75% TB treatment completion rate in those who did not complete the mental health intervention (Unpublished data) Gavi Pilot - Integrating Immunization & Mobile Van TB Screening Services in Pakistan Sehatmand Zindagi Mobile Screening 64 Centres across Pakistan 55 Vans across Balochistan Pakistan Karachi Gavi supported immunization services being integrated in to private sector TB diagnostic centres supported by Global Fund + Pooling resources with TB vans instead of buying new immunization only vans + Conclusions Targeting Multiple Diseases from a Single Disease Platform • Demonstrated feasibility in Zero TB Karachi context – TB, HIV, mental health, routine immunization, diabetes • Responsive to needs of patients and communities – Improved community engagement and treatment outcomes • Synergizes investments from multiple sources – cost savings, more efficient use of testing platforms, pooled procurement • More focus required from donors and governments for multi-disease platforms (i.e. health systems strengthening).
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