KNOW TB Figure 2.

TB Case Notification by Region, 2019 Q2

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Issue No. 3 (November 2019)
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CASE NOTIFICATION OF TUBERCULOSIS, !"#$%

QUARTER 2 (April-June 2019)

Notified Tuberculosis Cases, All Forms
The National Tuberculosis Control Program (NTP) aims to notify 437,291
tuberculosis (TB) cases in 2019. By the end of the second quarter, there were
77,988 TB cases notified — lower than the reported Quarter 1 (Q1) accom-
plishment of 87,925 TB cases (Figure 1). The following analysis includes new
and relapse drug-susceptible (DS) and drug-resistant (DR) TB cases, regardless
of bacteriological status and anatomical site. Quarterly targets were calculated
as 25% of regional annual targets to simplify performance tracking across the
year. TB cases from mandatory notification were not included in the analysis.

Figure 1. Notified TB Cases (All Forms), 2019 Q1 and Q2

Q1 and Q2 Comparison
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The National Capital Region (NCR), MIMAROPA, and Region VI achieved more -)))********************56'
than 95% of their Q2 targets (Figure 2). Fifteen regions need considerable
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improvement as Q2 performance declined relative to their Q1 case-finding
levels (1% to 23%). MIMAROPA had a 15% increase in performance compared ))************************.4'
to Q1. Cordillera Administrative Region (CAR) and Bangsamoro Autonomous ()))********************.$'
Region in Muslim Mindanao (BARMM) performance remain below 50%. The
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NCR, Region IV, and Region III accounted for 43% (33,251) of the notified cases
in Q2. The rest of the regions in Luzon contributed 18% (13,872), Visayas 20% )-***********************3&'
(15,7170), and Mindanao 19% (15,148). The uneven performance shows the "0#*******************6.'
need for a more focused approach to identify strategic activities for increased
case identification and notification. It will require location-specific operational 70#//***********4,'
strategies to implement actionable plans to address this challenge.
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1
 KNOW TB NEWSLETTER Issue No. 3 (November 2019)

In Q2, 65% of all reported TB cases were among males (50,898 [65.3%] of 77,934 total) (Figure 3). These data mirror In six regions, more than 45% of cases were BC, with Region VIII having the highest proportion of BC cases (49%)
the results from the 2016 National TB Prevalence Survey (NTPS) that reported a higher prevalence of TB among males (Figure 5). Meanwhile, Region IV had the highest percentage of CD cases (69%).
and the need to address gender-related health-seeking barriers. The high proportion of male cases reported was
similar across age brackets for adults: highest at 70% among those 45 to 54 years (8,922) and lowest at 55% for those Figure 5. Proportion of Notified Cases by Region and Bacteriological Status, 2019 Q2
less than 15 years (3,675).
100% Clinically-
It is imperative to improve TB detection and treatment for children less than 15 years of age to reach the Philippine diagnosed

Strategic TB Elimination Plan: Phase 1 (PhilSTEP1) target. Only 9% of the reported data is less than 15 years of age, yet
the PhilSTEP1 target is 15% of the total TB cases notified.
80%

Figure 3. Number of Notified TB Cases by Sex and Age Group (All Forms), 2019 Q2
10,000

60%

70%

68%
8,000
68% Bacteriologically-
66% 40% confirmed
63%
63%
Number of Notified TB Cases

6,000

20%

4,000 37% 37%

34% 30% 32%
32% 0%
55% National NCR CAR I II III IV
MIMAR
V VI VII VIII IX X XI XII XIII BARMM
OPA

45% CD CD 48,692
Total, 8,808 347 2,343 1,402 5,227 7,970 2,219 2,566 4,754 2,876 1,395 1,165 1,811 1,529 2,546 1,083 652
BC BC 29,261
Total, 4,191 323 1,142 704 3,441 3,589 1,060 1,766 3,119 2,239 1,327 1,066 1,262 1,300 1,287 913 532

2,000

Eighty-four percent (67,861) of the TB cases were reported as new TB cases. Relapse cases, which are cases that had
previously been treated for TB and are considered cured or completed the prescribed treatment regimen, account-
ed for 13% (10,127) of all notified cases in Q1. Three percent (2,384) were other retreatment TB cases due to
0
0-14 15-24 25-34 35-44 45-54 55-64 65 and above treatment failure, treatment after loss to follow-up, or unknown treatment outcome. In three regions, more than
Male
Male
Female
Female
3,675
3,000
7,281
4,209
7,599
3,995
7,986
3,784
8,922
3,915
8,417
3,994
7,018
4,139
90% of cases were new, with Region IX having the highest proportion of new cases (94%) (Figure 6). Region XII and
Region I had the highest percentage of relapse cases with 18% and 16%, respectively.
Clinically-diagnosed (CD) cases constituted 62% of the total TB cases notified (Figure 4). Bacteriologically-confirmed
(BC) cases, which are patients from whom a biological specimen is positive by smear microscopy, culture, or rapid Figure 6. Proportion of Notified TB Cases for All TB Cases by Registration Group, 2019 Q2
diagnostic test (RDT) for TB, accounted for 38% (29,261) of all notified cases in Q2 — an increase of 6% from the Q1
100%
performance. Other
retreatment

Figure 4. Number of Notified TB Cases by Bacteriological Status, 2019 Q1 and Q2 Relapse

80%
Bacteriologically-confirmed Clinically-diagnosed

Q2 38% 62% 60%

New

40%

20%

Q1 32% 68%
0%
MIMARO
National NCR CAR I II III IV V VI VII VIII IX X XI XII XIII BARMM
PA
Other re-
Prev Tx
treatment 2,384 650 15 57 35 339 485 66 111 199 80 98 25 39 36 88 31 30

2
Relapse
Relapse 10,127 2,105 26 228 139 1,293 1,561 530 509 1,475 532 304 213 292 214 376 222 108
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% New
New 67,861 10,904 644 3,257 1,967 7,376 10,012 2,749 3,823 6,404 4,584 2,418 2,017 2,783 2,615 3,457 1,775 1,076
 KNOW TB NEWSLETTER Issue No. 3 (November 2019)

Figure 7. DR-TB Case Notification by Region, 2019 Q2

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Drug-Resistant TB (DR-TB) Cases

The NTP targets to identify 20,674 DR-TB cases in 2019. As of Q2, a
total of 2,488 (12%) had been reported. In Q2, 1,523 DR-TB cases were
detected nationwide, contributing 2% from all TB cases notified. More
than a quarter of these DR-TB cases were in the NCR, followed by
Region IV and Region III at 17% each (Figure 7). All other regions
accounted for only 40% of newly detected DR-TB cases. NCR made the
most progress by achieving 63% of its Q2 target. The majority of the
regions had an increase in Q2 performance, Region III with the highest
increase by 25% while CAR having no percentage change in two
quarters. Low performance in DR-TB detection may be caused by
limited availability and uptake of RDTs for TB, such as Xpert MTB/RIF, at
Q1 and Q2 Comparison
the point of service. NTP regional coordinators should assess uptake of
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RDTs for TB (Xpert MTB/RIF) and ensure increased utilization of tests
following the criteria for testing. ') /*& ''' ($&
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 KNOW TB NEWSLETTER Issue No. 3 (November 2019)

In Q2, 68% of all reported DR-TB cases were males (1,062 of 1,568 total) (Figure 8). The number of cases was similar
across age brackets for adults, highest at 74% for those 45 to 54 years (254) and lowest at 38% for those less than 15
years (6). The age bracket of 35 to 54 years accounted for 44% of the total DR-TB cases reported.
Figure 8. Number of Notified DR-TB Cases by Sex and Age Group (All Forms), 2019 Q2
Forty-seven percent (710) of the DR-TB cases were relapse TB cases (Figure 9). Other retreatment TB cases due
to treatment failure, treatment after loss to follow-up, or unknown treatment outcome accounted for 37%
(560), higher than cases with no previous history of TB treatment which is only 17% (252) of all notified cases in
Q2. CAR had the highest proportion of new cases (43%), BARMM for relapse cases (67%), and Region X for other
retreatment cases (45%).

Figure 9. Proportion of Notified DR-TB Cases for All TB Cases by Registration Group, 2019 Q2
300

100% Other
retreatment

250
74%
Relapse

67%
80%

200
Number of Notified DR-TB cases

65% 71%

60%
150

64%
33%
100 40%
35%
26%
62%
29%
36%
50
38% 20% New

38%
63%
0
0-14 15-24 25-34 35-44 45-54 55-64 65 and above
Male
Male 6 122 186 228 254 186 80 0%
MIMARO
Female 10 69 100 114 87 76 50 National NCR CAR I II III IV V VI VII VIII IX X XI XII XIII BARMM
Female PA
Other re-
Prev Tx
treatment 560 168 1 13 4 96 113 13 29 27 19 13 8 19 11 20 5 1
Relapse
Relapse 710 168 3 33 9 122 111 29 41 57 27 23 11 17 18 18 17 6
New
New 252 63 3 19 8 39 30 11 11 20 11 6 7 6 3 7 6 2

Source: Department of Health – Integrated TB Information System (ITIS), accessed October 1, 2019

National Tuberculosis Control Program

Department of Health
Room 103, Building 12, San Lazaro Compound, Rizal Avenue,
Sta.Cruz, Manila, Philippines 1003
+63 (02)-310-5713 / 230-9626
www.ntp.doh.gov.ph

To access real-time patient-based information

from facilities within the NTP network, visit the
“TB Dashboard PH” web dashboard. You may
also download the “TB Dashboard PH” mobile
apps via App Store or Google Play Store.

Copyright © 2019 National Tuberculosis Control Program. Department of Health - Philippines. All rights reserved. 4