TB and Bangladesh - Threats and Way Forward. Describes the overall TB situation in Bangladesh in 2023 based on evidence. It also describes the challenges, diagnostic options, and also way forwards in the management of TB in Bangladesh.

1. TUBERCULOSIS:
Bangladesh Perspective 2023
Threats and Way Forward
Md. Nadim Reza
TB PPM Expert, Bangladesh
PhD Researcher, Mahidol University, Thailand
Email: nadim.rez@student.mahidol.edu
TB Education Series

2. When Breath
Becomes Air
(Fills up with AFB)

3. TB Situation in 2021: Bangladesh

4. How TB Affects Bangladesh
Source: WHO Global Tuberculosis Report 2022

5. Major Achievements of NTP
Source: WHO Global Tuberculosis Report 2020
• Shorter regimen scaled up since 2019 & SOTR since 2021
• NTP achieved a very high TB treatment success rates for TB (~94.4%) and
~73% for DR TB cases
• Rapid expansion of GeneXpert - >450 sites
• 109 digital X-ray machines rolled out in 2021
• Revised and updated TB National Strategic plan 2021-2025
• Countrywide sensitization and orientation on TB

6. Percentage of notified TB cases
(New & Relapse) in 2022
56%
19%
25%
Pulmonary Bac. Confirmed
Pulmonary Clinically Diagnosed
Extra-Pulmonary

7. 9
5
9
5
9
6
9
7
9
7
94
8
9
8
5
9
1
.
5
9
2
9
2
9
1
.
6
9
2
9
2
9
2
9
3
9
4
9
4
9
5
50
55
60
65
70
75
80
85
90
95
100
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
percentage
Treatment Success Rate, New Bacteriologically
Confirmed TB, 2003-2020 cohort
7

8. Treatment Success Rate-MDR TB (%):
2010-2020 cohort
70 70
73 73
70
77 76 74
70
66
82
74 72
80
86 84
87
72
75 76 75
0
10
20
30
40
50
60
70
80
90
100
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Longer Regimen
Shorter Regimen

9. 9
24 27 25
260 260 260
226 225 225 225 225 225 225 224 225 221 221 218 221
29
36
40
45
51
52
54 53 51
80 78 74
63
260
382
504
495
482 446
413 409
405 402 404
260 260
221
227 221
0
100
200
300
400
500
600
1990 '95 2000 '05 '10 '11 '12 '13 '14 '15 '16 '17 '18 '19 '20 21
Rate/100k
pop
Mortality Prev all forms Incidence all cases
Achievements in terms of Impact

10. TB Management in Bangladesh:
Laboratory Network
RTRL(5),
CDC/District Level
laboratories, Mircoscopy
EQA Centers (44)
UHC/GeneXpert Sites/Microscopy Centers
(1170) Peripheral Laboratory
NTRL(1)
National Tuberculosis Reference
Laboratory(NIDCH)
Regional Tuberculosis Reference
Laboratory
(Shaymoli, Sylhet, Chittagong, Khulna,
Rajshahi)

11. Incidence
 Annual incidence stagnated since 1990
 Overall 36% TB cases missed in 2020
 66% child TB missed
 ~ 66% DR-TB cases missed in 2020
 ~ 48%* symptomatic patients seek care late
 Access to rapid diagnostic tools
 Access to bacteriological EPTB diagnostics
 No high level political body to support
 Funding gap
Source: Global tuberculosis report 2021, WHO
* National TB Prevalence Survey, Bangladesh 2015-16 Report
New and relapse TB cases notified
HIV-positive TB incidence
Challenges

12. Is TB a Notifiable
Disease or Not?

13. So what About our
country?

14. TB Management in Bangladesh
There are total 56 Chest Disease
Hospital in Bangladesh and
Respiratory Medicine Dept. in 14
Govt. Medical College

15. TB Management in Bangladesh
National Tuberculosis Control
Programme (NTP) started its
programme in 1965 and expanded
its activity nationwide

16. List of PMDT sites treating MDR TB patients in Bangladesh
TB Management in Bangladesh

17. National Institute of Diseases
of the Chest and
Hospital(NIDCH) started
functioning as 200 bedded TB
hospital in 1955
TB Management in Bangladesh

18. NIDCH has special architectural
pattern for cross ventilation to limit
the transmission of Tuberculosis
which is similar to Herring Bone
Pattern
TB Management in Bangladesh

19. TB Hospital later renamed as NIDCH
in 2003 with increment of number
of bed to 600. National Asthma
Centre was established in 2004 on
the premise of NIDCH with
additional 70 bed.
Extension of existing facilities has
already taken place and 200
additional bed will be functional
very soon.
TB Management in Bangladesh

20. What if the Suspected PTB
patient has Pauci Sputum
Or
Sputum Smear/Xpert
Negative
Or
Conventional Pleural Biopsy
of suspected TB-PE Came out
to be Inconclusive

21. 0
50
100
150
200
250
1990 2015 2020 2025 2030 2035
Incidence will decline &
Bangladesh will achieve its target in line
with End TB
Incidence
Management
of LTBI ( post
exposure Rx)
Test all
presumptive TB
by X-pert,
universal access
to TB care &
services
10% reduction per year

22. Implementation of
Effective Diagnostic Tool

23. Proper Notification &
Registration

24. Effective Treatment and
Follow-up

25. Identification
of
DR TB

26. Identification and
Treatment of LTBI

27. Vaccination: Prophylactic
and Therapeutic

28. Political Commitment
“I firmly believe that tuberculosis is preventable
and treatable.
It needs commitment, determination and
solidarity... let's make a pledge to work
together towards that end”

29. Thank You
The Sun Smiles Under The Cloud