This March, TREAT TB concluded a comprehensive technical assistance (TA) program for the Philippines National TB Program (NTP). The fruitful two-and-a-half-year partnership with the Philippines NTP was instrumental for the country’s scale-up of the standard short treatment regimen (SSTR) for multidrug-resistant tuberculosis (MDR-TB), strengthening the NTP’s supervision, monitoring and evaluation (SME) system, and building local capacity to conduct operational research (OR).
In October 2016, when TREAT TB began its activities in the Philippines, patients with MDR-TB were treated with the standard 20-month regimen, and approximately 50% were successfully treated. After piloting a shorter treatment regimen for MDR-TB, the NTP implemented its plan to scale up the SSTR under programmatic conditions in January 2017. Through onsite technical assistance, TREAT TB worked with the NTP to identify tailored solutions to barriers and challenges with scale up of the SSTR. By the end of 2017, the SSTR was rolled out nationwide, and by the end of 2018, 80% of patients enrolled in treatment were treated with the SSTR.
Technical assistance
The TREAT TB team conducted five technical assistance visits in seven regions with staff from national, regional, and provincial/city NTP offices. They provided in-person, supportive supervision and mentorship on the clinical management of MDR-TB for approximately 125 healthcare workers at more than 25 health facilities. In addition, six workshops were conducted with key stakeholders from the national and subnational levels to identify tailored solutions for challenges associated with the scale-up of the SSTR.
Training
The TREAT TB team trained more than 300 nurses on the SSTR and management of common adverse drug reactions associated with MDR-TB treatment. As nurses are the frontline healthcare workers, strengthening their capacity to treat patients with MDR-TB will have a major impact on MDR-TB outcomes. As one nurse described, “[The training] really helped a lot because we were guided to do our part as nurses and how to respond and manage adverse events.”
Operational research
Operational research (OR) plays a key role in generating the evidence needed to guide policies and programs and is essential for national TB programs. The TREAT TB team focused on increasing capacity of researchers from the NTP, Lung Center of the Philippines, and National TB Reference Laboratory to independently conduct OR. A total of 20 participants were trained, and seven participants completed the full course. Participants presented four abstracts on the shorter regimen and use of bedaquiline for the treatment of MDR-TB at The Union Asia Pacific Regional Conference in Manila in April 2019, and four manuscripts are being finalized for publication.
SME system
A well-functioning supervision, monitoring and evaluation (SME) system can generate relevant information about program performance and has the potential to significantly improve outcomes for MDR-TB. TREAT TB conducted an assessment of the NTP’s SME system to identify strengths, gaps, and areas for improvement. A key finding from the assessment was a need to routinely assess quality of routinely collected program data to improve reliability of data-driven decision-making. With the support of key partners including the local WHO office, TREAT TB developed and piloted a routine data quality assessment (RDQA) tool in the National Capital Region, and Regions III and IV-A, which together, account for nearly 50% of the MDR-TB burden in the country. Results from the pilot were presented to the NTP and partners in March 2019. The tools developed by TREAT TB will be adapted and used by the NTP and partners going forward.
During the 2.5-year project, the NTP has effectively scaled up the shorter regimen and achieved significant progress to improve outcomes for patients with MDR-TB.
Dr. Chen-Yuan Chiang, consultant with The International Union Against Tuberculosis and Lung Disease and technical lead for the TREAT TB project