South Africa is classified by the World Health Organization as a high burden TB, HIV and multi-drug resistant tuberculosis (MDR-TB) country. In 2014, the country had the third highest estimated TB incidence rate in the world – 860 per 100,000 population, following Swaziland and Lesotho, with nearly half a million new TB cases. About 26,000 of the 330,000 reported cases of TB had MDR-TB, which is more difficult to diagnose, treat, and cure. One of the main factors behind the high rates of TB in South Africa is the HIV epidemic. TB is easily spread among people whose immune systems are suppressed by the AIDS virus, and it is the leading cause of death among people living with HIV/AIDS (PLHIV). In 2014, almost two-thirds of TB patients (62%) were co-infected with HIV.
Communities and civil society organizations play a key role in accelerating progress toward ending TB and on countries’ Journey to Self-Reliance. Community-based TB activities can support TB prevention, extend the availability of TB treatment and treatment support, and influence the quality of care. In 2019, countries who utilized community health workers (CHWs) and volunteers as part of their TB programs reported that on average, community referrals contributed 27% of TB case notifications, and that 87% of TB patients receiving community treatment support were treated successfully.1 Community-based organizations (CBO) and non-governmental organizations (NGO) can mobilize communities, reach vulnerable groups, provide services, and conduct monitoring and advocacy.
The COVID-19 pandemic highlighted how the strength of a health system can impact the magnitude of an infectious disease outbreak. An adequately resourced and adaptable health system can effectively respond to rapidly shifting and unpredictable diseases, whether localized or global. Strengthening health systems is at the core of USAID’s mission. USAID’s Vision for Health Systems Strengthening 2015-2019 identified four critical HSS outcomes:
Reducing out-of-pocket expenditures that prevent people from using necessary health services or impoverish them;
Advancing the availability and use of essential health services;
Ensuring equity in access for poor, underserved, marginalized, and vulnerable people; and
Assuring the dignity, confidentiality, autonomy, quality, and timeliness of services.
One of the most serious threats to global tuberculosis (TB) control efforts is drug-resistant TB (DR-TB). It includes multi-drug resistant TB (MDR-TB), resistant to two of the most powerful TB drugs, isoniazid and rifampicin, and the even more severe extensively drug-resistant TB (XDR-TB). DR-TB develops when TB drugs are used inappropriately or incorrectly, if ineffective formulations are used, or if the treatment isn’t completed. It can also be spread through person-to-person transmission.
Poor infection prevention and control (IPC) practices impact patient safety and the quality of care as well as the health of everyone providing care, undermining the use of health care services. Yet according to the World Health Organization (WHO), 10% of patients get an infection while receiving care. As an airborne disease, preventing tuberculosis (TB) is particularly challenging: in 2017, the notification rate for health care associated transmission of TB was twice as high among health care workers as the rate for the general adult population.
The rapid expansion of digital technology has created new opportunities for improving health and wellbeing. Tools such as smartphones, digital cameras, drones, and geolocation tools, as well as the use of machine learning and artificial intelligence, have transformed the flow of information within health systems. This potential has been recognized by USAID in the Digital Strategy 2020-2024, which highlights the importance of open, inclusive, and secure digital ecosystems for communities to achieve self-reliance in the digital age.
In the 1980s, Malawi’s strong tuberculosis (TB) control program was devastated by the emerging HIV epidemic. People living with HIV (PLHIV) are 15-22 times more likely to develop TB than persons without and TB is the major cause of HIV-related deaths. TB case notifications spiraled out of control, slowed only by the advent of antiretroviral therapy (ART) in 2004, which reduces the chances of developing active TB. By 2010, the incidence rate for TB had declined to 310 per 100,000 population. However, less than half of the estimated 45,000 cases of TB cases were being detected.
In 2010, and still today, tuberculosis (TB) was a significant health problem in Bangladesh, with an estimated 326,000 new TB cases. However, only 47% of cases were being detected; those with undiagnosed TB continued to spread TB. Approximately 4,000 of TB cases had multi-drug resistant TB (MDR-TB), which is more difficult to diagnose, treat, and cure.
TB CARE II (2011-2015) provided focused technical assistance to support the National TB Control Programme (NTP) address the burgeoning burden of TB. Working at the national level and in 39 districts, the project piloted and scaled-up innovative models for community-level TB service delivery; engaged non-governmental organizations (NGO) and the private sector to accelerate TB case-finding; supported the integration of TB services with diabetes, HIV, and maternal and child health (MCH); and strengthened the overall health system for aid TB service delivery.
Objective: This tracking tool is intended to ensure appropriate microbiologic screening for all potential suspects who meet local criteria for evaluation of MDR-TB. This tool will assist in identifying potential local challenges or bottlenecks, which prevent diagnosing and/or result in long delays between diagnosis and treatment initiation.
Who should use this Tool? This tracking tool should be completed by the healthcare worker (HCW), often times a program supervisor or coordinator, who is responsible for ensuring screening and initiation of treatment for MDR-TB; this may be within a single center, in a network or zone, or in a district. However, one individual (one HCW) should be responsible for filling out all components of this tool. This tool can be adapted as needed.
CONTEXT: IPT IN SWAZILAND Isoniazid preventive therapy (IPT) stands as an effective TB prevention method among people living with HIV (PLHIV). As detailed in the Cochrane Review from 2010, a 33% to 64% reduction in incident TB was observed among PLHIV who successfully completed IPT. This benefit is enhanced to 80% to 95% if IPT is combined with effective ART. Despite this clear benefit, uptake of IPT has been low. Based on a systematic review of IPT, only 10% of eligible patients are initiated on IPT, and among those, 32% had documented completion of IPT.
The Swaziland Ministry of Health (MOH) has endorsed a 6-month course of IPT as of 2011 to prevent the progression to active TB infection among PLHIV. Despite this endorsement, the midterm target of providing IPT to 50% of PLHIV has not been achieved as of the end of 2015.
The TB infection control strategy known by the acronym, F-A-S-T, describes a core set of interventions designed to “Find cases Actively, Separate safely, and Treat effectively.” The FAST strategy is built around the notion that prompt diagnosis and effective treatment are by far the most important components for preventing the spread of TB, without which all other traditional approaches would be ineffective.
The FAST strategy was developed in 2011 and included a general protocol and core package of materials, describing steps to be taken to introduce FAST in both in-patient settings (specifically targeting the identification of unsuspected MDR TB among TB and chest disease clients in hospitals) and out-patient settings (targeting detection of unsuspected TB). Since 2011, the FAST strategy has been implemented in a variety of countries encompassing a range of programmatic settings, including high burden MDR TB and high HIV prevalence countries, in general hospitals and TB hospitals, in high volume chest disease clinics and other service sites.
What is FAST? F-A-S-T is a TB infection control strategy which describes a core set of interventions designed to “Find cases Actively, Separate safely, and Treat effectively.” The FAST strategy is built around the notion that prompt diagnosis and effective treatment is by far the most important activity for preventing the spread of TB, without which all other traditional activities are secondary.
What is TB Infection Control (IC)? TB IC is a combination of measures aimed at minimizing the risk of TB transmission within populations. The foundation of infection control is early and rapid diagnosis, and proper management of TB patients.
The current diagnostic process for TB or drug resistant TB (MDR-TB) is an important bottleneck that impedes access to treatment in most high burden countries. Laboratory facilities are fewer in number and more centralized than the facilities where patients may be screened for TB and can obtain treatment. Although progress has been made to change this system, the improvements are not being made fast enough to increase detection and halt transmission. Early diagnosis of TB and MDR-TB is central to the TB control strategy, and simple, sensitive and specific diagnostic approaches are desperately needed. The importance of efficient use of GeneXpert MTB/RIF and other available diagnostics can hardly be overemphasized in the effort to meet the programmatic demands of nations burdened with TB.
Course Description This course has been designed to take three days. It is composed of lectures, in-class readings, exercises, case discussions and quizzes, the sum of which are intended to provide a diverse and compelling learning experience for participants. Each session generally includes a lecture, followed by various group activities, and finally a short quiz.
There is a long history of the relationship between lung health and mining industry which was documented centuries ago. Occupational lung diseases depend on the commodities mined, airborne hazard exposure level, and duration of exposure. It is very important for the healthcare providers in the mining sector know the significance of problem, the key symptoms, identify and manage the patients properly. It is critical to understand importance of preventing these diseases, since most of them have no cure, and increase the risk of Tuberculosis (TB) and lung cancer.
Introducing FAST in Vietnam and Objectives In order to improve early detection and diagnosis, and treatment initiation of TB and MDR-TB cases, the USAID TB CARE II Project, working with the National TB Program (NTP), initiated the FAST strategy in two Provincial Hospital of TB and Lung Diseases – Nam Dinh and Quang Nam in Viet Nam early 2014. FAST stands for Finding presumptive TB and MDR-TB cases Actively, Separating them safely, and initiating effective Therapy early. The core package was developed in June 2011, during a meeting of global stakeholders with expertise in TB and infection control. The FAST strategy is an infection control strategy aimed at increasing early detection and diagnosis of TB and MDR-TB cases, allowing for early and effective treatment initiation and thereby reducing TB transmission among both health care workers and patients at the two hospitals.
Prevention, care, treatment and control of tuberculosis (TB) pose strategic, technical and operational challenges, including important ethical issues that must be addressed. For instance, TB particularly affects the poor and vulnerable individuals of the populations, and therefore components of social justice and equity must be included in the response. TB is a lethal infectious disease, and care of patients and control of the disease raise questions of how to ensure the balance between individual rights and liberties and protecting the rights of patients and those who are at risk of infection. Success in pursuing the Stop TB Strategy requires the application of ethical principles.
The Southern Africa is rich in mineral and has a fast growing mining industry. An amply body of evidence suggests that mine workers are at increased risk of developing TB infection. They are exposed to a multitude of factors that compound their risk of TB infection. These risk factors include their working conditions (prolonged exposure to silica dust, poor ventilation, exposure to occupational injuries); socio-economic factors (migrant status, cramped and unsanitary living conditions, lack of knowledge of the health system or their rights regarding access to care); and their disease burden (co-exposure to HIV, silicosis, or both). Early detection and adequate management of TB among miners has tremendous importance in terms of reducing diseases burden in both mining and public sectors.
Quality of care is critical to ensure patients routinely seek out, adhere to, and complete tuberculosis (TB) treatment. “Quality” in relation to TB services can comprise many aspects of care, and although it can be defined in many ways, it is inextricably linked to the process of delivering appropriate, patient-centered care, according to standards, for each client every time they interact with the health system. In the new post-2015 End TB strategy recently endorsed by the World Health Organization (WHO), strengthening the quality of TB services is identified as a critical need to provide effective, patient-centered care.
The USAID TB CARE II project seeks to develop a Framework for Early Initiation of antiretroviral therapy (ART) for TB Patients in TB/HIV integrated programs. The goal of this Framework is to be flexible and adaptable to countries who wish to use it in their efforts to stem the mortality and morbidity of the dual epidemic. One of the main objectives of the framework is a comprehensive description of models of best field practices for TB/HIV integration and early initiation of ART. In order to develop the framework, a multi-country assessment has been undertaken to identify and describe current successes in increasing early ART initiation for TB/HIV patients.
In 2012, the USAID-funded TB CARE II project, implemented by University Research Co., LLC (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 antiretroviral therapy (ART) in a timely manner. The assessments focused at the service delivery level in sites with evident success in order to elucidate models of best field practices in TB/HIV integration and early initiation of ART. The lessons and practices described in each country assessment will be combined to develop a practical framework to support the implementation of service delivery interventions geared at increasing early initiation of ART for TB patients. The goal of this framework is to be flexible and adaptable to countries who wish to use it in their efforts to stem the mortality and morbidity of the dual epidemic.
TB (Tuberculosis) caused 9.6 million people to fall ill in 2014, and killed 1.5 million people1. One of the most serious threats to TB control efforts is multi-drug resistant TB (MDR-TB). Drug resistant TB can develop if there is a lack of adherence to treatment that is often caused by poor compliance, or an interrupted drug supply system. MDR-TB occurs when a patient is resistant to the two most potent TB drugs. Approximately 9% of these cases result in extensively drug resistant TB (XDR-RB), where patients are also unresponsive to an additional two classes of drugs.
TB (Tuberculosis) caused 10.4 million people to fall ill in 2015, and killed 1.4 million people.1 One of the most serious threats to TB control efforts is multi-drug resistant TB (MDR-TB). Drug resistant TB can develop if there is a lack of adherence to treatment that is often caused by poor compliance, or an interrupted drug supply system. MDR-TB occurs when a patient is resistant to the two most potent TB drugs. Approximately 9% of these cases result in extensively drug resistant TB (XDR-RB), where patients are also unresponsive to an additional two classes of drugs.
TB (Tuberculosis) caused 9.6 million people to fall ill in 2014, and killed 1.5 million people1. Infection control of TB, particularly among vulnerable populations, remains a public health challenge. Mine workers are exposed to a multitude of factors that compound their risk of TB infection. These risk factors include working conditions (prolonged exposure to silica dust, poor ventilation), exposure to occupational hazards, socio-economic factors (cramped and unsanitary living conditions, limited access to health services), and their disease burden (co-exposure to HIV, silicosis, or both).
TB and silicosis have long been recognized as occupational diseases. The risk of a person with silicosis developing TB is 2.8 to 3.9 times higher compared to healthy control groups. Early TB detection, timely enrollment in treatment, prompt diagnosis, and treatment and care of HIV/TB co-infection remains a challenge.
TB (Tuberculosis) caused 10.4 million people to fall ill in 2015, and killed 1.4 million worldwide.1 Diagnosis is key to the reduction and control of TB. Early diagnosis and prompt treatment are pivotal parts of the ‘End TB’ global strategy. However, the current capacity to diagnose TB in rural and low income areas of the world are lacking. In 2015, 95% of TB attributable deaths were in low and middle income countries.
Tuberculosis is one of the world’s deadliest public health threats, but successful management of TB in high-burden countries is too often impeded by a lack of effective tools to rapidly and accurately diagnose TB infections. Multi-drug resistant TB (MDR-TB) develops when TB germs become resistant to the two most-effective anti-TB medicines that are normally used to treat TB. Low detection contributes to the challenge of TB control, as untreated TB and MDR-TB patients remain a source of infection for others. Untreated TB also results in considerable morbidity and mortality, especially in HIV-infected individuals.
In 2009, Malawi’s national TB case detection rate was only 49%. DOTS registration remained highly centralized, meaning that patients, even those found to be sputum smear-positive at peripheral microscopy sites, often needed to travel to the district hospital for registration and hospitalization. In 2010, there were only 59 TB registration sites in the country. However, Malawi has made tremendous progress in decentralizing ART sites. In 2010, there were 417 ART sites in Malawi. The USAID TB CARE II Project in Malawi (2010-2015) worked with the National TB Programme (NTP) at the national level to strengthen the laboratory network, strengthen the NTP centrally, and pilot novel diagnostics. At the district level, the project implemented a comprehensive set of interventions, including integration of antiretroviral therapy (ART) into the TB program, training community health workers in TB/HIV intervention, expanding the smear microscopy network, and upgrading infrastructure in selected facilities to accommodate increased HIV testing and counseling and ART for TB patients.