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TB16: DOTS Plus in Arkhangelsk 2002-2004

Project title TB16: DOTS Plus in Arkhangelsk 2002-2004
Database CBSS Task Force on Communicable Disease Control in the Baltic Sea Region
ID in the source database
Thematic area
  • Prison Health
  • Tuberculosis
Topic Barents Region
Project geographical area Russia
Substate level / administrative units /regions Arkhangelsk Oblast
Lead partner (organisation) Arkhangelsk Region Administration
Lead partner (owner or/and project manager) no data
Partner organisations no data
Start date 2002-06-01
End date 2004-12-31
Duration (months) 31
Target audience National, local and international authorities for prevention and control of TB National, local authorities in charge of curative and mycobacteriology services National and local health and TB authorities; personnel responsible for procurement, storage, distribution and use of medical supplies National and local health and TB authorities; personnel responsible for registry, laboratory and curative services for TB patients National and local health and TB authorities; personnel responsible for quality assurance of diagnosis and treatment of TB; N/R reference laboratories; personnel responsible for registry, laboratory and curative services National and local authorities for Justice, Interior, Health and TB. Prison and hospital administrations. Healthcare workers, patients with symptoms of TB, TB patients Decision makers, medical professionals, other health personnel and the population (i.e., politicians, mass media, health workers, men and women with TB, groups at risk of TB infection and disease, the community at large)
Summary - Monitor and evaluate outcome of treatment - Train personnel involved in the care of TB patients - Establish centralised drug procurement - Monitoring of the TB control activities for DOTS and DOTS-Plus in the oblast - Evaluation of the DOTS-Plus project at the end - Obtain equipment (3M respirators) for infection control in institutions
Background no data
Objectives NOTE FROM TF-ITA on May 12, 2003: This proposal was approved in Krakow on May 5 2003 on the condition that it is granted a Green Light by WHO-GLC and with the following comments: In future be brief and to the point! Shorten the proposal! (Summary maximum 200 words). Only include in this proposal activities for "DOTS-plus", clarify the training plan (do not mix training for "DOTS" and "DOTS-plus"), explain the proposed treatment strategy, drugs and drug prices. Improve the logframe (e.g., indicators for monitoring). Arkhangelsk TB programme started to implement the IUATLD/WHO recommended strategy for TB control in 1998 assisted by LHL The Norwegian Heart and Lung Association. The DOTS strategy is in place covering both civilian and prison populations from 2000 and the whole oblast from 2001. According to the NTP data there has been a slight reduction of new TB cases in the prison system and a stabilization of incidence in the civilian sector during last years. Cohort analysis on patients registered in 2000 shows a success rate in Sm+/Cu+ and Sm-/Cu+ pulmonary cases at 68.2% (67.7% in 1999), default rate was 9,4%, failure rate was 13,6% (including 3% MDR-TB). A survey of anti-TB drug resistance has been carried out to estimate the burden of MDR-TB in the oblast. The Tuberculosis Laboratory of Arkhangelsk Regional Tuberculosis Dispensary (ARTD) has performed this. 202 never previously treated cases were tested and 16,8% out of tested were found to be multidrug resistant in 2001. An analysis performed by NIPH in 1998-1999 of the resistance patterns among 89 new cases from Arkhangelsk oblast shows 13,5% MDR-TB. A level of any resistance among retreatment cases was 55.4% in 2001, and 60% in 1998-1999. The prevalence of MDR-TB was in 1999 160 MDR-patients, in 2000 the prevalence was 176 MDR-patients; in 2001 the prevalence was 229 MDR-patients (all figures excluding the prison population). There is no accurate data on the prevalence of MDR-TB in the prison system. However the rough estimated prevalence in the prison system is about 185 MDR-TB patients and incidence of new cases of MDR-TB is estimated to 65, in total 250 to be offered treatment. The total estimated prevalence of MDR-TB in both prison and civilian sector by the end of the year 2002 is 523. Realising the existing problem of MDR-TB the NTP applied to the Green Light Committee (GLC) for DOTS-Plus project to address the issue of multidrug resistant tuberculosis (MDR-TB). The representatives of GLC conducted a mission to the oblast in September 2002. The main aim of the mission was to assess the current status of DOTS strategy and to assess the current needs for implementing the DOTS-Plus project. During the mission several recommendations were made to strengthen the DOTS implementation and to address the issue of MDR-TB in the oblast. The oblast and local authorities, the NTP and the LHL have undertaken several actions to implement the recommendation agreed upon during the GLC mission. Arkhangelsk oblast authorities has expressed its readiness to finance the DOTS plus pilot project with 3,5 million rubbles for improved bacteriological diagnostics (Bactec machine and/or reagents for drug susceptibility testing) and 3,5 million rubbles for 2nd line drugs annually. Federal health authorities has been applied to cover 2nd line drugs for 20 patients. In addition the NTP has applied to the TF to start the project addressing the problem of defaulter rate in the oblast. There are some more projects ready to be registered to the TF database like the project to strengthen laboratory service in the prison system, the project for improving infection control measures in the hospitals. Still some external support is needed to implement the DOTS-Plus pilot project in Arkhangelsk oblast. There is not enough funding for second line drug supplies, supervision and training. Therefore the NTP is kindly asking to support theses activities through the TF. The project will be implemented by the Arkhangelsk TB programme with cooperation from LHL and NIPH, Norway and WHO/GLC. The timeframe of the Arkhangelsk-LHL cooperation is four years until 31st December 2004. The DOTS-Plus pilot project proposal to the WHO/GLC will be approved after the implementation of the recommendations and provide access to the consencually prised drugs for the approved cohort of MDR-TB patients. The cooperation will be realised through provision of technical, administrative and financial support. The planned size of the MDR-TB cohort for this project is 800 patients, being enrolled during 2 years. 500 MDR-TB patients will be enrolled during the first year and 300 during the second year. The project will be implemented in civil society as well in the Penitentiary System. The inclusion/exclusion criteria, criteria for diagnoses, treatment regimens, treatment follow-up, reporting/recording, protocol for managing the side effects are described in the application to the WHO/GLC. The plan is to have sustainable, evidence based strategy for a successful management of MDR-TB by the end of this project.
Specific objectives/indicators no data
Results no data
Total foreseen budget EUR 596,803
Total implementation costs
(for completed projects, if available)
no data
Conversion to € was done on
(according to the relevant
exchange rate at
Infoeuro Monthly Files)
no data
Financing agencies / organisations no data
Project's URL / project's website no data
Papers associated with this project no data
Further information Preliminary Budget: 4 843 202€Financed by the local authorities 125 101 €The training activities covered by the regional budget:• Local training courses for laboratory doctors and assistants from civilian and prison systems 10 persons per year -1000 €• Courses of improvement of qualification for doctors - phthisiatricians (16 persons annually)-8900 € annually• Courses of improvement of qualification for medical sisters of TB services (40 persons annually) 3050 €• Training of PHC medical personnel: lectures and telemedicine conferences (1000 persons annually)3351 $Requested from the TF Total 4.718.101 €Budget summary:Training: 186.869 € (69.000 € 2003) Supervision/Monitoring: 41 032 € ( 24 300 € for 2003)Equipment for training: 700 € (2003) 3M respirators 99.000 € (49.666 € 2003)ESTIMATE Drugs 2nd line: 4,5 million €ACTIVITIES Train personnel involved in the care of TB patients TOTAL: 147 110 Euro-Train staff responsible for diagnosis and treatment of TBFinance: Total financial needs for training: 34 637 Euro International training courses for doctors Tartu for 3 persons a 2.300 euro = 6.900 euro 2003: 6.900 euro 2004: 6.900 euro total: 13.800 euro KNCV/WHO training course for National Tb programme managers in Warsaw 1 person x 2 years 2003: 2500 Euro 2004: 2500 euro Total: 5000 Euro -Training of medical personnel locally at the premises of the Dispensary in cooperation with the Northern Medical State University: Training courses for all TB coordinators in civilian and prison TB services twice annually for 24 TB coordinators from raions, Prison system: 6 coordinators from Regional Prison Hospital, 2 doctors from Colony 8, 6 doctors from Puksa Hospital Travel costs and per diem 2000 rubles x 38 participants = 76.000 rub x 2 times per year = 152.000 rub x 2 years = 304 000 rub= 9.440 Euro Educational material, guidelines, methodological recommendations, manuals, reporting forms, posters, leaflets 35 000 rub x 2 years = 70 000 rub =2.175 EUro Copies , paper and printing ink 8000 rub x 2 years = 16 000 rub = 500 Euro Telemedicine conferences- training courses and consultations for doctors, medical nurses and feldchers in the Primary Health Care Network 300 persons per year (Ustjansky, Njandomsky, Leshukonsky, Mezen, Velsky, Onezsky, Vinogradovsky, Kholmogorsky, Kotlasky raions) 300 rubles per hour x 9 raions x 3 years = 257 Euro Internettservices (23 hours totally per month for 9 raions and the Dispensary; exchange of information (reporting, questions, follow-up) Dispensary: 500 rubles per month x 2 years = 12.000 rub = 373 Euro and Regional Prison Hospital: 150 rubles x 12 months x 2 years = 3600 rub = 112 Euro, Totally: 485 Euro Exchange of information, reporting in the prison system colony 8 and Puksa hospital where MDR-TB patients will be treated during the continuation phase. Expenditure for faxservices 2000 rub x 12 months x 2 prison units ( Puksa/Colony 8) x 2 years = 96 000 rub = 2980 Euro - Train eligible personnel Finance: Extensive training of medical personnel is needed for implementing the DOTS plus pilot project. This includes training both locally and abroad. Infection control measures (CDC course in Tchuvashia, 8 persons 1 week) Travel costs: flight tickets (5000 rub) and train (1500 rub) = 6500 rub x 8 = 52 000 rub = 1650 euroand per diem 800 rub per day x 8 persons x 7 = 44 800 rub = 1422 euro -Train personnel involved in the care of TB patientsFinance: Total: 30.070 Euro Seminars for feldchers in PHC in each reporting districts ( 24 units) for approx. 20 personnel in each district. 2003: 3.230 Euro 2004: 3.230 Euro Total: 6.460 Euro TB course for nurses in Tartu . Course fee: 1500 Euro x 5 nurses= 7500 Euro Travel costs. 215 Euro x 5= 1075 Euro 2003: 8.575 Euro 2004: 8.575 Euro Subtotal: 17.010 Euro Total: 23.610 Euro- Train personnel in clinical services Finance: Total: 56.608 Euro Course in Clinical themes MDR-TB 3 weeks course in Latvia (6 persons : 3 from prison and 3 from civilian TB services each year) Course fee for group 3896 Euro Course fee for each attendant 415 Euro x 6 persons= 2490 Euro Per diem 153 Euro x 21 days = 3213 Euro x 6 persons= 19278 Euro Travel costs: 215 Euro x 6 persons = 1290 Total 2003: 26.954 Euro Total 2004: 26.954 Euro Total 2 year: 53.908 Euro Course in Adverse Drug Reactions to 2nd line drugs Estonia 2003 for 2 personnel: Cost for travel and per diem: 2.700 Euro -Train staff responsible for registration/surveillanceFinance: Course on registration and reporting/recording system of MDR-TB in Estonia. 3 persons for one week Travel cost: 215 Euro x 3= 645 Euro Per Diem : 153 Euro x 7 days= 1071 x 3 perons= 3213 Euro Total: 3858 Euro -Train laboratory personnelFinance: Total 25 092 Euro Train two Head doctors of laboratories ( ARTD and Prison) at Warsaw course for NTP Head of Laboratories travel/per diem/ cost for course – 5.225 Euro ( 2003) 5.225 Euro ( 2004) in total 10.450 Euro Local training courses for laboratory doctors and assistants from civilian and prison systems 10 persons per year - 646 Euro ( 2003) and 646 Euro ( 2004) in total 1292 Euro 10% of strains analysed for susceptibility to NIPH: reagents 35 Euro x 70= 2450 Euro per year: 7350 Euro Transport of strains, 5 x 100 Euro= 500 per year: 1500 Euro Consultations: 2000 Euro per year: 6000 Euro 2. Monitor and evaluate outcome of treatment - 3062 euro3. Establish centralised drug procurement 4.5 million euro5. Investigate situation regarding TB inf control - 37.970 euro6. Obtain equipment for infection control in institutions (3M respirators)- 99.000 Euro
Last posted: on 2007-11-30 at 14:56:11

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