References in the content below refer to the PBMEF Guide.
Definitions
Number of people with rifampicin-resistant (RR) and multidrug-resistant (MDR) TB notified during the reporting period.
RR/MDR TB: RR-TB is TB caused by Mycobacterium Tuberculosis (M. tuberculosis) strains that are resistant to rifampicin; MDR-TB strains are resistant to at least both rifampicin and isoniazid.
Note: This indicator no longer includes pre-extensively drug-resistant tuberculosis (pre-XDR-TB) and extensively drug-resistant tuberculosis (XDR-TB); these data should be reported separately under the core plus indicator for XDR. Values for these indicators should not be added together. This indicator might include patients with polydrug resistant TB (PDR-TB), if they are part of the RR/MDR recording in the national database. However, if PDR-TB is reported separately, they should not be included in this analysis.
Numerator
Denominator
Ref # |
MDR_NOTIF
(Previously RN-1) |
Tier Level |
Core Indicator
|
Category |
Reach
|
Type |
Core Outcome
|
Unit of Measure |
Number of people
|
Data Type |
Integer
|
Disaggregations |
Age (<15, 15+)
Sex
|
Reporting Level |
All Core PBMEF indicators should be reported at the national level; data may also be collected subnationally for more granular monitoring.
|
Reporting Frequency |
This indicator should be reported on a semiannual basis at a minimum. More frequent monitoring on a quarterly or monthly basis is recommended. Performance plans and reports (PPRs) for this indicator are based on calendar year (CY) periodicity to reflect national level attainment and align with the USAID congressional reporting requirements.
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This indicator is reported from National TB Program (NTP) official records. Quarterly report on TB case registration in the basic management unit.
The WHO equivalency for this indicator is: conf_rr_nfqr (lab confirmed RR/MDR).
This DR-TB indicator has been modified to report pre-XDR and XDR-TB in a separate indicator. Pre-XDR/XDR notifications should not be added to RR/MDR notifications to avoid double counting of DR-TB notifications. People who are diagnosed with pre-XDR and XDR-TB will already have been identified and recorded as having RR/MDR-TB. The number of RR/MDR-TB notifications should therefore equal the total number of DR-TB notifications. Note that when assessing treatment success rate, all people on DR-TB treatment will be monitored together.
Ongoing analysis of RR/MDR-TB notification data is critical to understanding transmission dynamics and to ensure accurate planning for second-line TB drugs (SLDs) and the human resources needed to manage DR-TB. These people account for a much higher percent of overall TB deaths, and the number of people with DR-TB has been increasing over time. DR-TB notification measures a country’s ability to detect drug resistance among the TB-infected population and initiate people with TB on appropriate treatment. Data on DR-TB notification are also valuable for planning drug logistics and supervision.
The global number of people with MDR/RR-TB notified in 2021 was 142,131 of the estimated 450,000 incident MDR/RR-TB cases that year. Closing this large detection gap will require improvements in diagnostic capacity. Point-of-care (or near point-of-care) rapid diagnostic tools that detect TB and drug resistance are the new standard of care. Early detection of resistance to rifampicin and isoniazid ensures that an appropriate drug regimen can be prescribed from the outset to increase the likelihood of treatment success, and to reduce the chance of acquiring additional resistance.
Understanding DR-TB notification trends is important to gauge the overall performance of the NTP in preventing the emergence of DR cases, either due to issues with adherence to treatment regimens or due to direct transmission of DR-TB. Drug-resistant TB notification can be analyzed on its own as a trend over time to see the total number of people with notified DR-TB within a given country. It can also be compared to the estimated incidence of DR-TB to determine the magnitude of the gap between the estimated number of people with DR-TB and those that have been detected. These gaps should also be reviewed in the context of availability of diagnostic services for DR-TB. The number of diagnostic facilities per 100,000 population can also give some indication of how accessible these services are to the population. The geographical distribution of the diagnostic facilities can help to understand the level of accessibility in different regions. Regional comparisons of this indicator could be helpful.
DR-TB diagnosis and notification is an important step in the DR-TB treatment cascade. Data can also be collected at the subnational level and used to learn from the geographic distribution of cases and detect outbreaks. Data should be reported annually at a minimum but semiannual or quarterly reporting will improve the timeliness of data for decision making.