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FAST National Guidelines - Vietnam

The FAST strategy is mainly implemented at specialized and general hospitals with TB units. With support from the USAID TB CARE II Project, the Vietnam NTP developed the “Guideline for FAST strategy implementation”. According to the Guideline, implementing facilities should immediately order GeneXpert MTB/RIF tests for eligible patients including: Pulmonary TB patients AFB(+), presumptive drug-resistant TB patients, presumptive TB among HIV positive people, children with presumptive TB or TB meningitis.

Advanced TB Diagnostics Research Education

A new technology entitled GeneXpert was deemed a ‘game-changer’ in the world of TB diagnostics.  To reduce the burden and mortality of TB, it is imperative to not only have advanced technologies to detect TB bacteria, but to also have experts that know how to use the new technology.  In 2016, USAID TB CARE II funded the attendance of 11 people from select low or middle‐income countries to attend the McGill Summer Institute in Infectious Diseases and Global Health to take courses on Advanced TB Diagnostic Research.

Multi-Drug Resistant TB

In 2014, approximately 480,000 people developed MDR-TB.  3.3% of new cases and 20% of previously treated patients develop MDR-TB.  It was estimated that only 41% of cases were notified that they had MDR-TB in 2014.  In low and middle income countries, access to quality TB services is often limited.  Since the beginning of TB CARE II in 2010, TB CARE II has worked to decrease MDR-TB.

Community Programmatic Management of Drug Resistant Tuberculosis Planning Tool

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The community MDR TB planning tool focuses on operationalizing implementation of MDR TB community level interventions, drawing on information gained from the experience of several countries implementing a community model to deliver MDR TB services to patients.

The tool provides a situation analysis table to facilitate understanding of the health system context and model to provide MDR TB services in country, and considers TB and MDR TB country/district burden and the resources available in order to identify gaps in provision of MDR TB services.

Cover page of the Community Programmatic Management of Drug Resistant Tuberculosis Planning Toolkit

TB CARE II - Quality Improvement Handbook for TB and MDR-TB Programs

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In recent years, national health programs have expanded their focus to include not only improving access to care, but also improving the quality of care received by patients and communities. As part of quality assurance for many clinical diseases, including tuberculosis (TB),
international and national evidence-based standards and guidelines have been developed. Having explicit standards and guidelines helps ensure high-quality care, better health outcomes, and cost effective treatments. In addition, they provide a reference point for assessing provider or system performance and quality of care. It is important to note, however, that adherence to these guidelines is not just a result of the development and dissemination of them, but of integrating the guidelines as part of a quality management program.
 
The USAID funded TB CARE II project recently conducted assessments in Bangladesh, Zambia, and Kenya to investigate factors influencing provider compliance to evidence-based TB guidelines and standards highlighted numerous factors that affected compliance. Overall, it is clear from the findings that a number of challenges continue to affect the ability of health providers to adhere to clinical and programmatic guidelines to maintain a consistent quality of TB services.  These challenges are related to provider skills and knowledge gaps, a lack of monitoring and supervision, and regular reviews of performance data. The Quality Improvement Handbook provides key principles and operational steps that will assist in improving the quality of TB and MDR-TB services in resource-constrained settings.
 
This manual is intended for health personnel working in health facilities that diagnose and treat TB patients as well as for administrative staff working in the management of health services at the health facility, sub district, or district levels. The purpose of this manual is to explain how to apply quality QA improvement strategies to help decrease the gap between TB quality of care standards and actual performance. Specifically, it provides guidance to Quality Improvement Coordinators to: 1) Identify and prioritize problems based on data and 2) develop and monitor action plans to solve problems.
Handbook cover page