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National TB Control Programme Managers and Partners
Since the number of cases being detected is rising, an uninterrupted
supply of second-line anti TB drugs is a prerequisite. However, global
shortage of some drugs and cost escalation (~$2,100) reduce the number of
patients that can be initiated on treatment. There is a need for extensive
training, supervision and monitoring at all levels nationwide. Finally, dramatic
demand on local programme staff for supervision, ensuring treatment
adherence and timely follow-up puts a strain on existing human resources.
Country perspective: Nepal
Key features of PMDT in Nepal include fully supervised ambulatory
treatment with a standardized treatment regimen. There is systematic
clinical monitoring, treatment and documentation of side effects (monthly
during intensive phase, bimonthly during continuation phase) and regular
sputum and culture monitoring (monthly during intensive phase, bimonthly
during continuation phase).
A national DR TB Technical Advisory Group has been constituted
consisting of the German Nepal TB Project, Senior Clinical, Laboratory and
Section Heads of the NTP, Ministry of Health (MOHP) Senior Chest
Physicians, South Asian Association for Regional Cooperation TB Centre
and WHO. The key role of this group is policy and planning, guidelines
development, clinical advice on individual cases, and advocacy and
resource mobilization.
By 2010, 910 MDR-TB cases had registered for treatment and there is
a nationwide programme expansion. The number of treatment centres has
more than doubled since the start of programme, from five to 12, while
subtreatment centres have increased from 11 to 52. There has been a
revision of the DR TB Manual in 2010, leading to a change of regimen
(from 24 to 20 months) and Ofloxacin being replaced with Levofloxacin.
Key challenges include concerns around programme sustainability. As
of now all drug requirements are funded through external sources. The
programme in its current form is too expensive. Funding through national
sources is not feasible in the foreseeable future. There are also challenges
around timely availability of second-line drugs, with a long lead time
associated with Global TB Drug Facility (GDF) and WHO procurement.
There is a global shortage/unavailability of some drugs. The country has also
faced a high default rate (14.5% cumulative for five years) among MDR-TB
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