South Africa is classified by WHO as a high burden TB, HIV and multi-drug resistant TB (MDR-TB) country. The country has the world’s third highest TB burden, with nearly half a million incident cases each year (or approximately one out of every 100 South Africans). Two-thirds (65%) of tested TB patients are found to be HIV positive and South Africa has some of the highest incidence of MDR-TB and extremely-drug resistant TB (XDR-TB) in the world.
TB CARE II South Africa was launched in October 2014 to support the South Africa National Department of Health (NDOH) TB prevention and control efforts, working closely with national and provincial partners to close gaps in areas identified and to further develop sustainable systems which can carry forward long-term improvements in TB and drug-resistant (DR) TB diagnosis, care, and treatment services. The USAID TB CARE II project builds on the activities and approaches utilized by the USAID TB Program South Africa (http://tbsouthafrica.org/), which from 2009-2015 has supported the NDOH in improving early case detection, increasing access to diagnostics, ensuring treatment support for patients on TB treatment, and ensuring that there is provision of appropriate and timely HIV care for TB patients and ART treatment for all TB/HIV co-infected patients. The USAID TB Program has worked closely with the NTP to build national support by mobilizing resources and creating a conducive environment for expansion of TB services, as well as with provincial and district health departments to support the collaborative development of need-based strategies to combat TB, TB/HIV and DR TB, and with communities to create appropriate social mobilization and service delivery models for rapid expansion of directly observed treatment short-course (DOTS) in the country.
TB CARE II South Africa provides targeted support to high priority districts, defined as those with high TB burden and below average performance indicators to assist them to achieve the targets set out in the National TB and HIV Strategic Plan (2012 – 2016). TB CARE II South Africa works under the following program objectives:
Improved quality of TB services: TB CARE II South Africa works to improve TB case management including early case identification, proper diagnosis, prompt treatment, and appropriate care and follow up.
Increase availability of TB treatment: TB CARE II South Africa works to expand access to TB services and improve management of TB among children, those co-infected with HIV, those co-infected with diabetes, and those with MDR/XDR TB. TB CARE II also strengthens the role of the private sector engaging employers, private health practitioners, the mining sector, correctional services, and schools in TB and DR TB prevention and control efforts. The project supports palliative care strategies for TB and MDR/XDR TB patients who remain uncured at the end of their course of treatment.
Increase demand for TB treatment: TB CARE II South Africa supports advocacy, communication, and social mobilization (ACSM) activities to increase awareness of and demand for TB services.
Improve management of TB support systems: TB CARE II South Africa provides needs-based mentoring and intensified support to improve data collection, documentation, and dissemination of TB and DR TB information. The project provides training and support to provincial and district managers in using operational research tools to solve specific operational and programmatic challenges.
Support small grants: TB CARE II South Africa supports the development of local capacity through the provision of small grants for demand generation, active case finding and contact tracing, and TB and DR TB case management.
Scaling-Up Coordinated TB/HIV Treatment
In 2012, the TB CARE II project, including URC and its partners Jhpiego and the Global TB Institute (GTBI) undertook a multi-country assessment aimed at identifying some of the programmatic factors that have contributed to success in increasing the numbers of co-infected TB patients accessing ART in a timely manner. The countries selected—South Africa, Swaziland, and Zimbabwe—have developed different models for delivering TB and HIV treatment and provide important lessons to guide the further scale up coordinated TB and HIV treatment. The assessments focused at the service delivery level in sites with evident success in order to elucidate the service delivery models used and the best field practices developed around TB/HIV integration and early initiation of ART. The lessons and practices described in each country assessment have been combined to develop a practical framework to support the implementation of service delivery interventions geared at increasing early initiation of ART for TB patients.