June 2012

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Updated
Basic page PMDT

Programmatic Management of Drug-resistant TB (PMDT): While the causes of multi-drug resistant TB are similar in all high burden countries (low adherence, weak DOTS, poor treatment compliance, inadequate drug supplies, direct transmission, etc.).

23 Apr 2013 11:40
Basic page TB DOTS

The following documents provide information and materials related to implementing TB control strategies:


The Global Plan to Stop TB 2011–2015: Transforming the Fight—Towards Elimination of Tuberculosis, released by the STOP TB Partnership in Oct 2010, updates the Global Plan to Stop TB 2006-2015 and sets new and more ambitious targets. The new plan identifies all the research gaps that need to be filled to bring rapid TB tests, faster treatment regimens and a fully effective vaccine to market. It also shows public health programmes how to drive universal access to TB care, including how to modernize diagnostic laboratories and adopt revolutionary TB tests that have recently become available.


Global TB Control Report 2011

This is the sixteenth global report on tuberculosis (TB) published by WHO in a series that started in 1997. It provides a comprehensive and up-to-date assessment of the TB epidemic and progress in implementing and financing TB prevention, care and control at global, regional and country levels using data reported by 198 countries that account for over 99% of the world’s TB cases.


The effectiveness of TB DOTS supporters in South Africa

This report presents reflections on South African supporters of DOTS, the internationally recommended strategy for tuberculosis (TB) control. The DOTS strategy has been implemented on a national level in South Africa's fight against TB, and DOTS supporters are lay health workers who provide some of the services called for by the strategy. The report draws on qualitative data from the Western Cape metropolitan area and the Nyandeni district of the Eastern Cape. While the DOTS strategy has been widely implemented, still little understood are factors such as: the extent to which TB patients value it, the experiences of supporters in providing support, the necessary conditions for ensuring a successful support program, and the likelihood of successful integration of an HIV/AIDS program into a successful TB DOTS program. The research discussed in this report focused on exploring, from the providers' and consumers' perspectives, a range of organizational factors that are perceived to be necessary to facilitate the function of the DOTS supporters. The report concludes with recommendations to health providers and policy makers to improve the delivery of care to patients with TB. It asserts that before DOTS supporter programs are implemented in a community, the formal health facilities in the area need to be fully functional. It also concludes that for DOTS supporters to be effective, some sustainable form of incentives needs to be provided.


Improving Tuberculosis Control in Rural Bolivia

In 2006, USAID/Bolivia asked the Quality Assurance Project (QAP) to work with its bilateral health project, Gestión y Calidad en Salud (GCS) and the National TB Control Program (NTP) of the Ministry of Health (MOH) to implement an improvement collaborative aimed at strengthening the TB program’s performance. A rapid assessment conducted by GCS and QAP in 38 public health facilities in Los Yungas in January 2007 found divergent cure rates (as low as 47%), abandonment rates of 21%, and no directly observed treatment. Other problems found were limited patient adherence support, weak drug logistics, lack of clinical training of personnel, poor lab quality control, and lack of surveillance of multi-drug-resistant TB.


Reducing treatment default among tuberculosis patients in the Philippines

The reduction of the default rate among patients with tuberculosis (TB) in Metro Manila is presented. An intervention study was performed among 239 patients with TB, aged 12-84 years. All TB service providers were given instructions and practice in the use of flip chart and the patient and health care system contract. Consequently, the patients with systematic pattern of drug collection for at least 10 weeks were counted as compliers. Anyone who began the treatment but did not continue for at least 10 weeks was counted as default of treatment. Results showed that only 220 remained, 144 were male and 76 were female. The difference of the compliance rate between males (78.5%) and females (73.7%) was not significant. The rates of default were ranged from 10% to 31.2%. Thus, this research was conducted to match the two tools designed to improve the compliance rate of TB patients, and a distinct difference emerged. Moreover, the compliance rate in the mid-80s is still acceptable from an epidemiological point of view. The actual copies of Tuberculosis Counseling Cards were also included.


Bangladesh: NGO and public sector tuberculosis service delivery -- rapid assessment results

The Quality Assurance Project commissioned a rapid assessment of the Bangladesh service delivery system for TB-DOTS, the internationally recommended strategy for tuberculosis control. The assessment was designed to inform the development of a context-specific strategy to ensure the delivery of high-quality TB-DOTS care to achieve sustained detection of 70% of new smear-positive patients and an 85% cure rate. Examining the various aspects of both the Government- and NGO-managed systems, the assessment measured the following elements of the Bangladesh National Tuberculosis Program, of which the USAID-funded NGO Service Delivery Program is also a part: awareness-raising efforts, identification of suspects, case detection, mode of DOTS, cure rate, physical facilities, technical capacity, record keeping, referrals, and facility-to-facility referrals. After a presentation of findings, the report makes recommendations to achieve the targeted case detection and cure rates.


Treating tuberculosis in the private sector: Cambodia

While AIDS has taken the lead in terms of disease threat to humankind, tuberculosis (TB) remains a serious threat, especially where it attacks people with HIV/AIDS. This report presents 2003–2004 survey data of private sector TB practices in Cambodia so that decision-makers can move forward in ensuring proper case management of TB and stemming its spread while using precious resources effectively. This report provides a solid foundation both for improving the use and delivery of TB services in Cambodia and for measuring progress over time.


Computer-based Training for TB Education in Indonesia

To support the National Tuberculosis Program (NTP) of Indonesia in its efforts to train private health care practitioners in tuberculosis (TB) directly observed treatment, the USAID Health Care Improvement Project was asked by USAID to update and adapt for Indonesia a computer-based training product that had previously been developed for Bolivia by the USAID-funded Quality Assurance Project.

In collaboration with the NTP, the Indonesian Medical Association (Ikatan Dokter Indonesia, or IDI), the Indonesian Midwife Association (IBI), and the Indonesian National Nurses Association (PPNI), HCI and its local partner One Comm developed a computer-based training package in Bahasa Indonesia for medical and other health practitioners. Launched in July 2011, the training program has nine modules that are based on the International Standards for Tuberculosis Care

  1. Introduction, history, and epidemiology of TB
  2. Pathogenesis of TB infection and tuberculosis disease
  3. Diagnosis of TB infection and TB disease
  4. Treatment of TB infection and TB disease
  5. Treatment of TB in children
  6. Adherence to TB treatment
  7. TB and HIV infection
  8. Multi-drug resistant TB diagnosis and management 
  9. TB infection prevention and control 

Data Collection Tools to evaluate the cause and frequency of delays in TB diagnosis

In 2011-2012, TB CARE II undertook a study to understand TB patients’ delays and inform the development of an integrated set of recommendations for TB program managers and service providers regarding the appropriateness of different strategies for reducing patient factor delays in accessing TB diagnostic and treatment services. Led by URC with support from New Jersey Medical School Global TB Institute, the project developed a series of questionnaires which were field tested and applied to conduct field studies in two high burden TB countries (Bangladesh and Swaziland) as part of a qualitative assessment to address specific factors causing TB patient delays.  Results and recommendations from the studies will be presented in the forthcoming report “Reducing Delays in TB Diagnosis: Methods to evaluate the frequency and causes of delays.


Sentinel Project - Stories of Children with drug-resistant TB

The Sentinel Project on Pediatric Drug-Resistant Tuberculosis is a global partnership of researchers, caregivers, and advocates who have come together to end the neglect of this vulnerable population of children. The project team collaborates to develop and deploy evidence-based strategies to prevent the death of children from this treatable disease; it is a learning network committed to generating and disseminating knowledge and data for immediate action.

In October 2011, the Department of Global Health and Social Medicine at Harvard Medical School (Boston, MA, USA; http://ghsm.hms.harvard.edu) joined forces with the National Institute for Research in Tuberculosis (Chennai, India; www.trc-chennai.org) to convene and host this partnership. Already, more than 140 individuals from more than 30 countries have come together to collaborate on joint projects.

Network members have divided into task forces currently working on projects including: developing practical field tools to guide treatment; developing consensus research definitions; designing multi-site research studies; and effecting targeted advocacy ventures, such as collecting this first set of stories.


Community-based Targeted Case Finding for Tuberculosis and HIV in Household Contacts of Patients with Tuberculosis in South Africa

The article discusses improved methodological approach to case-detection for TB to reducing mortality and preventing transmission in areas with high TB and HIV prevalence. South Africa has a high-prevalence of TB/HIV-coinfected adults in whom TB is often diagnosed late in the course of disease. The article proposes an alternative to the WHO's global TB control policy's DOTS strategy which relies on passive case detection in symptomatic individuals presenting to health services. Suggesting that passive case finding is insufficient in detecting TB and HIV early enough to prevent substantial transmission, morbidity, and mortality, the authors argue that targeting households is more efficient than unselected community-based screening.

Using the South African example, the article demonstrates that screening household contacts of patients with TB in high-TB-prevalence areas detects TB and HIV in a high proportion of contacts, and when TB culture is used TB is detected before it is symptomatic. The authors conclude that active case finding in TB contact households should be considered to improve TB and HIV case detection in high-prevalence settings, but sensitive diagnostic tools are necessary.

The work discussed in the article was made possible through the USAID Technical Assistance and Support Contract (TASC) 2 TB Project in South Africa, administered by URC.


National Guidelines for the Management of Tuberculosis in Children

 

The Bangladesh National Tuberculosis Control Program (NTP), in partnership with USAID through the TB CARE II project, recently published a set of guidelines meant to assist in the diagnosis and management of TB in children. The guidelines come in response to the World Health Organization (WHO)’s Stop Tuberculosis (TB) Strategy.  The Strategy, which ultimately seeks to create a TB-Free world, promotes equal access to care for all people in an effort to reduce the human suffering and socioeconomic burden associated with TB. This document is meant to work in conjunction with existing WHO guidelines to assist in filling a significant gap in knowledge relating to the diagnosis and management of pediatric TB. 

While the diagnosis of adults with TB is a rather straightforward process in which clinicians examine sputum samples for acid-fast bacilli, pediatric cases are much more difficult. Children often do not present TB symptoms in the same way that adults do.  Furthermore, the disease is paucibacillary (meaning there is not a lot of bacteria in the mucus) which makes it more difficult to diagnose microbiologically. Test results can also be skewed depending on whether the child is extremely malnourished or HIV positive. As a result, diagnosis relies heavily on clinical examinations and historical investigations. 

Additionally, there seems to be a gap in the number of pediatric TB cases that are reported each year by NTP with that of the actual disease burden of the community. Without improving the detection and diagnoses process of TB in children, it will be impossible to properly manage the disease.

The guidelines address key risk factors, standard case definitions, diagnosis, treatment, and prevention for pediatric TB in an effort to better educate health care managers and providers involved in every level of pediatric TB care in Bangladesh – both within NTP itself, as well as in the public and private sector.


 Management of Multidrug-Resistant Tuberculosis in Children: A Field Guide

TB CARE II recently introduced a new field guide on the management of pediatric Multidrug-Resistant Tuberculosis (MDR-TB) at the Union World Conference. This guide is the first of its kind to address the neglected issue of drug resistant TB among children, and was developed in coordination with the Sentinel Project on Pediatric Drug-Resistant Tuberculosis at Harvard University.

Compiled by a group of experts with years of experience in treating children with MDR-TB all over the world, the guide was created with the hope that it will be used as a tool to increase the quantity and quality of care for children afflicted with this disease.

16 Jan 2013 21:14
Basic page Infection Control

The list below provides information, tools and materials related to strengthening infection prevention and control. 


 

Design database for health facility improvements

16 Jan 2013 21:18
Basic page TB/HIV

The resource below provide information on strategies to increase use of integrated TB/HIV services.


Tools to integrate TB and maternal and child health services 

In 2011, TB CARE II developed and disseminated two tools that address TB case finding and comprehensive HIV care within the antenatal care setting. The Focused Antenatal Care + Tool (FANC+ Tool) and fundal height Tape Measure were both launched at the International Confederation of Midwives quadrennial congress.   Both tools focus on challenges of integration of TB/HIV in countries with high burdens of both diseases and are designed to assist countries with high burdens of TB and HIV in particular to ensure new diagnostic tools & pathways are incorporated. TB CARE II is distributing these tools in countries that express interest in their adaptation for future use by midwives and other MNCH professionals.


Report: Expanding TB and TB/HIV Integrated Services in Thai Binh Province, Vietnam

This report provides an evaluation of an 18-month quality improvement intervention supported by the USAID-funded Quality Assurance Project (QAP) and its successor, the Health Care Improvement (HCI) Project, in Thai Binh Province of Vietnam. The province, located in the Red River’s Delta in northern Vietnam, has 1.8 million population, an annual TB case load of 1600–1800 cases, and an cumulative number of 2188 HIV-infected cases. In April 2007, QAP, in collaboration with NTP and Thai Binh Department of Health, initiated an 18-month work plan to pilot-test a model for TB/HIV integration activities at the provincial level and in all the eight districts in the province. Assistance to the intervention transitioned from QAP to HCI in 2008. The project also promoted partnerships between the TB program and other public and private health providers in order to maximize coverage of the DOTS program. A number of activities to expand TB/HIV integration were carried out, including policy development; capacity building; maintaining the continuum of care; quality assurance of services; support for public and private partnerships; strengthening the monitoring and evaluation system; and conducting information, education, and communication activities.
 

 
The Quality Assurance Project (QAP) began to work with federal and regional health authorities in the Russian Federation to apply the improvement collaborative approach to design a model system on HIV/AIDS treatment, care and support in pilot sites in four cities: St. Petersburg (one of 18 districts), Orenburg, Engels, and Togliatti. The aim of the demonstration collaborative was to develop a municipal model for delivery of integrated treatment, care and support services, including tuberculosis (TB) testing and treatment, to persons living with HIV/AIDS (PLWHA). QAP worked with selected organizations in the four regions to develop a system for all HIV-positive patients to be tested for TB, receive Isoniazid preventive therapy (IPT) and, if necessary, be treated for TB. Key partners included local health authorities, infectious disease specialists from AIDS Centers and polyclinics, TB specialists, substance abuse specialists, social service providers, NGOs, and PLWHA.

 


16 Jan 2013 21:16
Story
Updated
Story Transforming the Fight against Tuberculosis in Swaziland

The Kingdom of Swaziland has long described itself as a nation at war with HIV, acknowledging the tremendous fight required to combat a national prevalence rate of 26%.  Now this small, landlocked country in Southern Africa also has the highest per capita TB burden in the world. Eighty percent of these TB patients are also co-infected with HIV according to the National Tuberculosis Control Programme.  On World TB Day 2011, the Prime Minister Dr Barnabas Sibusiso Dlamini  declared a national state of emergency against the epidemic of tuberculosis at an event in Swaziland’s commercial capital of Manzini. To the convened attendants, including the Minister of Health, the Minister of Justice and Constitutional Affairs, US Embassy Representative, WHO Representative, development partners, health managers from each region, health care workers, and TB/HIV patients in attendance, the Prime Minister pointed out that an emergency declaration implies an urgent response to a new or impending disaster; in many ways, this declaration is a recognition of the reality faced by every person who has suffered from TB, along with their families and communities. TB has always been a personal emergency, an individual disaster which has been visited on far too many Swazis, as well as many thousands more throughout Southern Africa. With this declaration, individuals, families and communities are joining with the nurses and doctors who fight TB daily and also their leaders, planners and decision makers in the regions and nationwide to attempt to transform the fight against TB, to see what can be achieved when a nation works together to eliminate a disease. They are joined in this by their partners in other high burden countries, neighbors in Southern Africa who are fighting their own TB and HIV epidemics, TB advocates around the world, and international agencies and organizations dedicated to eliminating a curable disease.

16 Jan 2013 19:47
Story TB CARE II supports the strengthening of Technical Assistance Centers for Drug-Resistant TB

Fighting drug resistant TB requires expertise and innovation. TB CARE II is tackling this need by working with TB policy makers and implementers to develop a network of experts and resources to strengthen national and regional drug resistant TB programs. 

Building from the expertise available through Partners In Health Technical Assistance Centers (TAC) in LesothoRussia and Peru (through PIH sister organization Socios En Salud), TB CARE II is working to support the development of TACs so we can share experiences to build effective PMDT worldwide.  To read more about the TACs, please click here.

09 Jan 2013 11:47
Story Lessons Learned from Community-Based MDR-TB Treatment Programs: Workshop overview
In October 2011 during the 42nd Union World Conference on Lung Health in Lille, France, URC and Partners In Health presented a workshop geared at providing concrete lessons from existing community based MDR TB programs. Community-based treatment for MDR TB has gained increased recognition as the most effective, efficient and ethical means of delivering care to patients with MDR TB. As the model has been implemented in a growing number of countries, it has shown to be practical and feasible even in resource limited settings.
 Union Conference Lille 2011
 

09 Jan 2013 11:05
Story Position Vacancies - TB CARE II Bangladesh

URC, through the TB CARE II Bangladesh Project, invites applications for the below vacant positions in Bangladesh.  Funded by USAID, TB CARE II Bangladesh is a 5-year technical assistance project that assists National Tuberculosis Control Programme (NTP), implementing partner NGOs, and other stakeholders to strengthen TB control and prevention activities in Bangladesh.

Please click the attachment to view detailed job descriptions for all positions.  Interested candidates who fulfil the requirements are requested to submit their resume along with a cover letter by 16 April, 2012 (by 12:00 AM Bangladesh time) to TBCARE@urc-chs.com. Only short listed candidates will be contacted for interviews.

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27 Dec 2012 15:33
Story TB CARE II supports the Bangladesh National Tuberculosis Program in developing the first guidelines for tuberculosis infection control

Guidelilnes cover imageThe USAID TB CARE II project and the Bangladesh National Tuberculosis Program (NTP) have published the first ever Guidelines for Tuberculosis Infection Control in Bangladesh in September.  TB infection control is growing in importance because of the association of TB with HIV and the emergence of multi drug resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) in Bangladesh.

Shortly after the project started in April 2011, TB CARE II Bangladesh brought together representatives from the National TB Program (NTP), World Health Organization, and partner organizations such as the Damien Foundation and BRAC, to review and finalize draft guidelines that built on work done by the previous TB CAP project.  Components of the guidelines include:

  • The rationale for TB infection control and the pathogenesis and transmission of TB.
  • A detailed description of Bangladeshi specific recommended practices for managerial, administrative, environmental and personal protective measures.
  • Infection control measures for special settings such as public spaces and households.
  • Photographs taken from the country’s TB facilities, demonstrating correct infection control practices.
  • Tools and methods for conducting facility assessments, screening health care providers for TB, calculating air flow and exchange of air, etc.

09 Jan 2013 15:09
Story Response to Questions: TB CARE II Bangladesh Request for Concept paper

Please click the attachment to view the responses to questions for the TB CARE II Bangladesh Request for Concept Paper.

09 Jan 2013 13:57
Story TB CARE II strengthens Bangladeshi laboratories for diagnosing TB

October 2011

In September, USAID’s TB CARE II project in Bangladesh completed training in AFB microscopy for all 103 lab technicians in six targeted districts.  

Bangladesh has 1,050 microscopy centers located all over the country, which provides good coverage for microscopy services for tuberculosis smear examinations. However, ensuring a consistently high quality of smear microscopy has presented a challenge; particularly for smear examinations conducted at the end of the intensive phase of the treatment.

Lab Technician TrainingTo prepare for the training, TB CARE II worked with the National Tuberculosis Program (NTP) to develop a standardized curriculum and training materials on AFB microscopy that will be used nationwide.  Draft materials were reviewed at a workshop in August 2011 led by NTP with the participation of the World Health Organization and other partners working in TB control.  

The TB CARE II training updated lab technician skills in sample collection, smearing and staining, microscopic examination, smear evaluation, recording and reporting, supply management, quality assurance, reagents preparation, and troubleshooting.  The participants spent the majority of their training time in front of microscopes, practicing the theoretical lessons they had learned.  Also, the course coordinator reviewed the performance of the trainees at the end of each training session and awarded the best performer.  This encouraged the trainees to strive for perfection.

09 Jan 2013 14:55