Challenge TB Countries
Details of Challenge TB plans country by country
Details of Challenge TB plans country by country
Challenge TB Botswana focuses mainly on the provision of technical support from both in-country and periodic international expert technical advisors in various technical areas of TB and TB/HIV control. Through Challenge TB, one senior technical advisor is full-time seconded to the Botswana National Tuberculosis Control Program (BNTP) and one senior laboratory advisor is full-time based at National TB Reference Laboratory (NTRL).
KNCV Tuberculosis foundation, through USAID funding, has been working closely with the Botswana Ministry of Health since 2006. KNCV has been actively supporting capacity building at both the National TB program and the National TB reference laboratory. Our strong partnership with Ministry of Health enabled some key achievements:
The Challenge TB project focuses on addressing these key areas through strengthening the NTP in analysis and strategic planning for novel intervention strategies. The current work plan is for 16 months, outlined over a five quarter system starting with quarter four of year one and continuing through year two.
Challenge TB will also continue to collaborate with other PEPFAR partners in the country in the various technical areas of TB and TB/HIV control.
In 2013, the TB incidence notified in the Democratic Republic of the Congo (DRC) was 94/100,000 inhabitants for new case and 149/100,000 for all TB forms The case detection rate estimated by WHO for TB all forms was 51% (47-56) for 2013 in the 23 Coordinating Facilities Against Tuberculosis (CPLT). The epidemic of HIV infection is generalized with a prevalence of 1.2 percent in the general population. The highest rates are in Maniema (4%), and the lowest are in Bas Congo (0.2%), the percentage of HIV among TB patients notified in 2013 was 14%. The total number of pulmonary tuberculosis (PTB) cases notified in 2013 was 113,603. Among them 71,526 were new cases smear positive (SM+), 3,981 were relapses and 1,164 were other cases previously treated. The proportion of MDR-TB among TB patients was estimated at 2.6% (0.01-5.5) among new SM+ PTB are MDR-TB and 13% (0.2-28) among retreatment cases (WHO 2014).
Challenge TB is a five year USAID funded project supporting the National TB Program (NTP) with implementation of the national strategic plan for TB. The project leader is The Union, which coordinates the project and provides the National Program Against Leprosy and Tuberculosis (NPLT) with the necessary support in implementing priority activities not covered by Global Fund and other donors at national and CPLT levels. The Union works with MSH, which will support the NPTL for implementing a minimum TB/HIV intervention package in the 54 health zones of the three provinces where PEPFAR projects are already under implementation.
The major challenges identified are the following and will be covered by Challenge TB:
Challenge TB provides Technical Assistance (TA) and logistic at central and provincial level, additional recipients of TA include community organizations and other local partners such as CAD, LNAC, Ambassadors, Femmes plus and Initiative Inc.
Under the USAID funded Challenge TB five year Project the East Africa Regional program is a nine month program funded by the USAID East Africa. The program focuses its activities in six priority countries in the region namely Ethiopia, Kenya, Rwanda, Somalia, Tanzania and Uganda. The project is designed to cover activities that are beyond individual countries and to develop demonstration/learning sites through which best practices can be generated and shared for adoption and implementation.
The priority technical focus areas for the Challenge TB Regional project are:
This project will work closely with the East Central and Southern Health Community (ECSA-HC), the Rwanda Center of Excellence (CoE) for programmatic management of drug resistant TB (PMDT), and the Supranational TB reference laboratory (SNRL) in Uganda and will focus on regional cross-cutting issues namely:
USAID support in Ethiopia started in 2008 with TB CAP after which support under TB CARE I followed (2010-2014) and subsequently Challenge TB (2015-2019).The Challenge TB project has been designed in alignment with the Ethiopia TB NSP (2013/14-2020) and the post 2015 global end TB strategy with a focus on three major areas of support:
In its first year implementation strategy, Challenge TB Ethiopia will focus on Improving quality of TB services ( both in terms of access and service utilization as well as patient centered care), increasing case finding (both in terms of targeted active case finding (ACF) and diagnostic capacity) and enhanced sustainability and strengthening health systems at all levels.
Challenge TB Ethiopia will work in two rural agrarian regions (SNNPR and Tigray) and three urban districts (Addis Ababa, Dire Dawa, Harari). Strengthening community TB care service (Challenge TBC) in Ethiopia’s decentralized health system using new and innovative strategies will be key. There will be a focus on Ethiopia’s three key populations (rural, pastoralist and urban) working towards improving service utilization in terms strengthening referral linkages at all levels, ensuring available technologies like GeneXpert are optimally used at all levels with special attention to ensure MDR-TB cases benefit optimally both in terms of case finding as well as linkage of services optimizing patient centered care.
In addition, the project will work to address challenges to ensure quality diagnostic capacity, TB/HIV collaborative activities, Pediatric TB, TB in prisons, TB-IC, Contact investigations and active case finding. It will also strengthen the health systems at all levels by building strong technical programmatic capacity for TB control both nationally as well as in the two focus regions and in urban setting. An overarching theme will be data quality and operations research support to enhance TB control.
Malawi continues to be severely burdened by the TB-HIV epidemic. Provisional results of the nationwide prevalence survey in October 2014 indicate a TB prevalence of 286/100,000 for bacteriologically confirmed PTB which is almost 2 times higher than previously estimated by WHO; with a 1.4 higher prevalence in men than women, and a 2.7 higher prevalence in urban as compared to rural areas (although not statistically significant), and higher TB prevalence in persons aged 35-45, 55-64, and 65+. With an HIV prevalence in the general population of 10.8% and among TB patients of 56%, HIV remains the most important risk factor for developing active TB disease. The geographic distributions of TB is similar to the distribution of HIV in Malawi and routine service data indicate that the high TB and HIV burden tend to overlap in urban centers and the southern part of the country.
Alignment with NTP Strategic Plan and Global Fund Concept Note, and close coordination with NTP and other relevant TB and HIV technical partners; Increasing case detection in each of the geographic focus areas. This will be achieved by targeted implementation of intensified case-finding in all health facilities, targeted active case-finding (e.g. mobile teams and digital chest X-ray screening), contact investigation, as well as other interventions (community sputum-collection centers, community mobilization) which have been well evaluated for their costs and effectiveness; Strengthening NTP leadership at central level, zonal level and a number of selected districts; The project will collaborate closely with PEPFAR supported partners, both at national and district level, to maximize synergy in project operations on improving TB prevention and care for PLHIV. This includes: capacity building on 3I's, specimen sample transportation, M&E, laboratory strengthening, etc; The project will strengthen the leadership of NTP in coordination and planning of operations research, sharing of research results and reaching consensus on policy implications for NTP.
Challenge TB Activities will focus on:
Alignment with NTP Strategic Plan and Global Fund Concept Note, and close coordination with NTP and other relevant TB and HIV technical partners;
Increasing case detection in each of the geographic focus areas. This will be achieved by targeted implementation of intensified case-finding in all health facilities, targeted active case-finding (e.g. mobile teams and digital chest X-ray screening), contact investigation, as well as other interventions (community sputum-collection centers, community mobilization) which have been well evaluated for their costs and effectiveness;
Strengthening NTP leadership at central level, zonal level and a number of selected districts;
The project will collaborate closely with PEPFAR supported partners, both at national and district level, to maximize synergy in project operations on improving TB prevention and care for PLHIV. This includes: capacity building on 3I's, specimen sample transportation, M&E, laboratory strengthening, etc;
The project will strengthen the leadership of NTP in coordination and planning of operations research, sharing of research results and reaching consensus on policy implications for NTP.
Challenge TB implementation in Mozambique is led by FHI 360 with KNCV as partner.
The project is implemented in four high TB burden provinces of Zambézia, Nampula, Sofala and Tete, covering 64 districts, more than 50% of the total country population. The provinces were identified by the Mozambique National TB Program (NTP) and the implementation strategy will be tailored to respond to province/district specific challenges, though Community Based DOTS Strategy (CB-DOTS) will be the core activity in each province. The project target population/key groups include People Living with HIV (PLHIV) un-enrolled, enrolled in pre-ART and/or not receiving IPT/ART, prisoners, children under five years, mining communities, Health Care Workers and the general population especially rural communities where CB-DOTS will be implemented.
The project will increase demand for TB services by implementing various activities at community level (CB-DOTS, monthly cough days etc.) and health facility enhanced active case finding strategies (FAST and clinical screening trainings) and the response to the increase in demand will be the strengthening TB prevention, diagnosis and treatment services at all levels (peripheral, district, provincial and central).
Challenge TB in Namibia will commence on 1st July 2015, immediately after the close-out of TB CARE I. The work-plan development process has already begun with consultations with the USAID local mission, the Ministry of Health and Social Services and other key stakeholders and will be concluded in mid-July 2015. The key interventions will be implemented in 7 priority regions and will have a TB/HIV bias as opposed to its predecessor which was broad-based and mainly focused on national level technical assistance. The seven priority regions of Namibia include; Oshana, Ohangwena, Omusati, Oshikoto, Kavango, Windhoek and Zambezi. These were selected on the basis of having a huge HIV and TB/HIV burden.
Challenge TB will work to expand TB/HIV diagnostic and treatment services across the seven regions, building on lessons learnt through the 3I’s OGAC initiative which has been implemented in four regions (which are also part of the priority seven). To this end, it is envisaged that Challenge TB will support increased usage of GeneXpert in the country, improved IPT coverage, improved infection control(IC) practices and intensified TB case finding in communities. The long-term plan is to replicate these efforts to the rest of the country.
In addition to a huge focus on TB/HIV related activities, Challenge TB will attempt to maintain and sustain the gains realised over the past decade in the country through an effort to continue, though to a limited extend, with technical areas that KNCV has been supporting through TB CARE I and TB CAP including but not limited to: Universal and early access, TB-IC, programmatic management of drug resistant TB (PMDT), Health Systems Strengthening (HSS), M&E and Operations research. Capacity building of local staff is one sure way of fostering sustainability in any programs; Challenge TB plans to influence the in-service as well as pre-service training of health care workers through partnerships with training institutions. Encouraging evidence based decision making through operations research is one area where TB CARE I had made significant impact; Challenge TB aims to take operations research to another level (more research and publishing work already done including the second anti-TB drug resistance survey). As the country prepares to conduct the first ever TB disease prevalence survey, Challenge TB will be involved in the whole process from planning through field work and report writing.
A new focus and on pediatric TB and on TB in congregate settings is being considered under Challenge TB. This follows a successful campaign during the 2014 World TB commemorations, where screening for TB among inmates and prison wardens was conducted in correctional facilities across the country.
Challenge TB in Nigeria is 16 month USAID funded program with the focus to concentrate activities in 12 priority states with focused support to strengthen national-level systems. The project is designed in alignment with the National TB Strategic Plan for 2014-2020 to ensure state-specific interventions with the aim of providing universal access to TB diagnosis and treatment through strategic expansion of services. Challenge TB will focus on quality, evidence-based planning in collaboration with state teams with an emphasis on actions that produce the desired results (case notification and treatment success). Challenge TB will co locate with Global Fund (GF) to work in 6 priority states with the highest burden of TB: Akwa Ibom, Bauchi, Kano, Katsina, Lagos and Rivers and in 6 other states: Benue, Cross River, Enugu, Niger, Ondo and Osun.
The five priority issues for Challenge TB prevention and care in Nigeria include the following:
Through guided evidence, Challenge TB will work to expand diagnostic and treatment services across the 12 states. The project will expand diagnostic and treatment sites strategically to increase coverage in high-volume or underserved areas, again based on mapping of existing sites versus population to determine optimal placement. Given the low level of awareness about TB and TB services, Challenge TB will develop targeted awareness-raising and outreach for the community and expand community-friendly services. In addition, the project will work to Increase capacity of providers to identify persons with presumed TB and refer for diagnosis. Working with the pediatric association, the project will support roll-out of the national pediatric guidelines and mentoring in up to five high-volume pediatric centers in states with a low proportion of diagnosed childhood TB cases.
South Sudan has limited access to TB services (diagnostic, treatment and preventive) to the general population including other populations like, people living in the Internally Displaced Persons (IDPs) camps. TB services are not integrated into the general health services with only 8% of functional health facilities providing TB services. Although there are multiple non-governmental organizations NGOs and faith based organization FBOs supporting health services in the different counties including the IDP camps, there is no clear guidance on how to roll out TB control by the different providers including in the IDP settings. In addition, the laboratory system is still weak with EQA spread in only 22 of the health facilities. The TB/HIV collaboration is still suboptimal with HIV testing and anti-retroviral treatment (ART) indicators still low. The diagnosis of Programmatic Management of Drug resistant TB (PMDT) is just beginning with two GeneXpert machines located in the Central Reference Laboratory and to date no culture and Drug Susceptible Test (DST) in the country.
Suboptimal performance in TB control cut across South Sudan. To be able to make impact, Challenge TB will implement high impact interventions in specific geographical locations. The Challenge TB project selected populations in the three states of Central Equatoria, Eastern Equatoria and Western Equatoria. These states have a mix of the following parameters: high population, high TB and HIV burden and are mostly accessible. The focus will be on: integrating TB care (including HIV care) in the general health care services, implementing community based care through CBOs using the existing structures, supporting the expansion of the quality diagnosis, and support capacity building of the National Tuberculosis Program NTP at the central and state levels. The overall Challenge TB strategy will be aligned to USAID Operational Framework once it has been defined. In the first year, the Challenge TB project will leverage its resources to impact TB control under the following four sub objectives of the Global Challenge TB project: Enabling environment; Comprehensive, high quality diagnostic network; Patient-centered care and treatment; and Political commitment and leadership.
The Challenge TB project in Tanzania builds on the foundations laid by the previous project (Task Order TB2015 implemented by PATH) and the USAID/Tanzania Country Development Cooperation Strategy (October 3, 2014 – October 3, 2019): Empowering Women and Youth, Tanzania’s Socio-Economic Transformation toward Middle Income Status by 2025 Advanced.
The Challenge TB project will be implemented in 6 regions which are Dar es Salaam, Zanzibar, Pwani, Kilimanjaro, Arusha and Mwanza. Also the project will support laboratory activities at the Central Reference Laboratory (CTRL) aiming at strengthening the capacity of the laboratory network in the country.
Zimbabwe is one of the 22 high-burden countries for TB, with a disproportionate burden of TB/HIV co-infection as high as 69% in 2013. Through this grant, Zimbabwe seeks to consolidate the gains made over the past decade while addressing strategic gaps and priorities for TB control through the following:
The Union is the lead partner in Zimbabwe that will continually provide technical, managerial and financial support to the National Tuberculosis Programme throughout Challenge TB. It is working with World Health Organization (WHO), Interactive Research & Development (IRD) and KNCV as collaborating partners.Read the latest Zimbabwe newsletter from November 2016.
Bangladesh (160 million population) is both a high TB and a high MDR-TB burden country in the South East Asian region. The epidemic of TB in Bangladesh is generalized: prevalence is estimated at (402/100,000 population). Case finding is low, with only 190,000 cases notified each year, just over half of the estimated incidence. 1.4% of all new TB cases and 29% among retreatment cases are estimated to be drug resistant. Each year around 70,000 people die of TB. A prevalence survey is currently underway, with results expected in 2016. HIV prevalence is low in Bangladesh (less than 0.1%).
Challenge TB in Bangladesh is a 5 year USAID funded project supporting the National TB Program (NTP) with implementation of the national strategic plan for TB through ensuring technical leadership. The project helps the NTP in making strategic choices for a sustainable difference, ensuring the highest impact with limited resources.
Challenge TB Bangladesh is implemented by Management Sciences for Health (MSH) with the technical support from Interactive Research and Development (IRD). The overall aim of the project is to implement a broad range of sustainable interventions.
The Challenge TB framework is in line with the National Strategic Plan for TB control. The objectives of the project include:
Challenge TB works throughout Bangladesh. The package includes all relevant components of TB control including laboratory network strengthening, PPM, PMDT, and surveillance. In addition to the nation-wide support, Challenge TB Bangladesh provides grants to local NGOs to increase case finding among key populations in specific areas and sectors, including urban slums, garment workers, tea gardens, and areas with high levels of returning migrant workers as well as high risk populations such as diabetic patients and children. Special attention is being given to children with TB, diabetics and workers in the readymade garment industries.A special feature of the project is the installation of a container based laboratory for increased access to diagnostic MDR-TB services in the Sylhet division.
Cambodia is one of the 22 countries in the world with a high burden of TB. The prevalence, incidence and mortality rates of TB in 2012 were 764, 411, and 63 per 100,000 population respectively. Cambodia’s mortality rate for TB is the highest among these 22 countries, while the prevalence rate is the second-highest. There have been two national TB prevalence surveys conducted in Cambodia, in 2002 and 2011. These surveys showed a decline of 38% among smear positive prevalence rate (4.2% annual reduction) between 2002 and 2011. The surveys also showed a decline of 45% among bacteriologically positive prevalence rate or 5% annual reduction. The MDR-TB rate rose from ~10.5% in 2006 to ~15% in 2013 among retreatment cases. The MDR-TB rate among new cases was 1.4%, as last measured in the Drug Resistance Surveillance in 2006-2007.
Approximately 80% of the population in Cambodia is registered as rural, and both TB prevalence surveys found geographic variations between urban and rural clusters. Elderly people had smear-positive TB prevalence rate of ~1,000 cases per 100,000 population and bacteriologically-positive TB prevalence rate of ~3,000 cases per 100,000 population. These are about four times that of the general population. The proportion of smear-positive TB among bacteriologically positive TB was higher in rural areas than in urban areas (35% vs 23%).
Challenge TB Cambodia is led by FHI 360, collaborating with two in-country coalition partners (MSH and WHO). The project is assisted through short-term technical assistance from three collaborating partners. It is a 5 year USAID funded project supporting the National TB Program (NTP) with implementation of the national strategic plan for TB 2014 - 2020. The project will help the NTP make strategic and informed choices based on proven best practice for a sustainable difference, ensuring the highest impact with limited resources.
The Challenge TB five year framework is in line with the National Strategic Plan for TB control and country programmatic and geographic gap. The core priority components of the National TB Program presenting in three main pillars of intervention as below:
Challenge TB provides technical assistance to all levels of the health care system, to improve clinical diagnosis and treatment and implementation of new intervention approaches to find the missing TB cases. At central level, Challenge TB will provide technical assistance to ensure quality of diagnostic tools and guideline development and standardization of interventions across all partners.
Challenge TB Cambodia will also provide support to the Country Coordinating Committee and also a board members of National Center for Tuberculosis and Leprosy Control (CENAT), a Principal Recipients (PR) of Global Fund Against AIDS, TB and Malaria. Challenge TB will assist the PR’s to monitoring the progress of the program, address specific technical and managerial issues, and support in planning and implementation. USAID/ Challenge TB Support is complementary to Global Fund assistance.
The Revised National TB Control Program (RNTCP) has made significant achievements since its inception including attainment of the TB-related targets of the Millennium Development Goal well ahead of time. However, challenges remain – India continues to carry the highest TB burden in the world, around one million cases are both missed and not notified to national programme, mortality continues to remain high and the emerging challenge of drug resistance TB threatens to undo the gains made so far. To address these, the RNTCP, with support from its technical partners, prepared an ambitious “fast track plan” to accelerate activities aimed at achieving demonstrable progress toward the Country’s vision of “TB Free India”. Understandably, addressing a public health issue of this magnitude requires intensified and collaborative efforts from all stakeholders in the country and beyond.
Challenge TB India is a two-year USAID funded project primarily designed to implement a Call to Action for TB Free India. The project is led by The International Union Against Tuberculosis and Lung Disease (The Union) and assisted through short-term technical assistance from KNCV. It is implemented under the stewardship of the Ministry of Health and Family Welfare in India.
The goal of Challenge TB India is to create and sustain high-level domestic commitment through mobilization of a wide range of stakeholders to provide a momentum capable of demanding and sustaining high-level domestic commitment to end TB in India. Challenge TB will tap the energy and influence of key stakeholders to drive engagement of the private sector, civil society, media, and public representatives to bring them on a common platform for a call to action to end TB.
The 'Call to Action' has kick started and catalysed the Government of India's efforts to accelerate TB prevention and care in partnership with all stakeholders. The Call to Action aims to unite existing and new stakeholders in the fight against TB and bring together knowledge, resources and capacity. A key part of the campaign will be to create new partnerships, perhaps sometimes where they are unexpected.
Indonesia (Population: 250 million) is both a high TB and a high HIV burden country with the fastest growing (mainly concentrated) HIV epidemic in the region. The epidemic of TB in Indonesia is generalized: the latest TB prevalence survey (2014) revealed the prevalence 2.5 times higher than previously estimated (average 660/100.000 population). The estimated incidence is more than 1 million new cases / year, however only 327,103 TB cases were notified in 2013. 2% of all new TB cases and 12% among retreatment cases are estimated to be drug resistant. Each year around 100,000 people die of TB.Challenge TB in Indonesia is a 5 year USAID funded project supporting the National TB Program with implementation of the national strategic plan for TB through ensuring technical leadership. The project helps the NTP in making strategic choices for a sustainable difference, ensuring the highest impact with limited resources. Challenge TB Indonesia is led by KNCV, collaborating with two in-country coalition partners FHI 360 and WHO. KNCV is assisted through short-term technical assistance from three external coalition partners; American Thoracic Society (ATS), Management Sciences for Health (MSH) and Interactive Research and Development (IRD). The overall aim of the project is to implement a broad range of (distinct financial and technical) sustainable interventions.
The Challenge TB 5 year framework is in line with the National Strategic Plan for TB control. The plan addresses the major gaps of the National TB Program, prioritizing five technical intervention areas:
At national level Challenge TB provides Technical Assistance (TA) to the Directorate of CDC within the Ministry of Health as the main beneficiary / partner. Additional recipients of TA include other Government Institutes (such as Medical Services, Laboratory and Pharmaceutical Services), provincial and district health offices, professional societies, community organizations and other local partners in all supported provinces.
Challenge TB works in nine provinces: Five of these provinces (Jakarta, West Java, Central Java, East Java, and North Sumatra) are prioritized and receive intensified assistance in 10 priority districts, supporting down to selected (sub) district level. The aim is to design "best models", testing these through small-scale implementation at district level, with a view to scaling up these best models both within these provinces and more broadly. The intensified package includes all components of TB control including laboratory network strengthening, PPM, PMDT, TB/HIV and surveillance.
Additionally Challenge TB provides technical support to 4 other provinces (Papua, West Papua, West Sumatra and South Sulawesi). The focus in these provinces are on expansion and quality assurance of essential components of TB control including laboratory, TB/HIV, PMDT expansion and intensified TB case finding. Local health services and partners in these provinces will receive a more ‘’specified package’’ of technical assistance based on their needs.
Challenge TB Indonesia will also provide support to the principal recipients of Global Fund TB. As a Sub Recipient, KNCV will assist the recipients to address specific technical and managerial issues, and support in planning, implementation and troubleshooting. USAID/Challenge TB Support is complementary to Global Fund assistance.
Burma is one of the 41 high TB/HIV burden countries, with one of the most severe HIV/AIDS epidemics in Asia. The HIV prevalence in the general adult population has declined over the past five years from 0.6% in 2010 to 0.5% in 2013. However, according to HIV Sentinel Surveillance data collected in 2013, there was a concentrated HIV epidemic among key affected populations including people who inject drugs (18.7%), men who have sex with men (10.4%), new TB patients (9.2%) and sex workers (8.1%). The number of new infections among adults over 15 years in 2013 was 7,097.
Challenge TB in Burma is a 5 year project designed to address low case detection, limited access to quality assured laboratory diagnostic services, and low MDR-TB treatment capacity.
The Challenge TB framework is in line with the National Strategic Plan for TB control. The objectives of the project include:
Viet Nam ranks 12th among the top 22 countries with the highest TB burden in the world and 14th among the 27 countries with the highest TB multi drug resistance burden worldwide (WHO report 2014). WHO estimated the annual reduction of TB prevalence and incidence in Viet Nam for 1990-2010 as 4.6% and 2.6% respectively. WHO estimated that the TB-related mortality dropped from 1990 to 2010 by about 4.4% per year. Compared to 1990, the TB prevalence and mortality in Viet Nam have dropped by about 62% and 60% respectively.
The overall strategy of Challenge TB in Viet Nam is to develop, pilot and evaluate TB care and prevention innovations that are planned under the National Strategic Plan 2015-2020, in close collaboration with the NTP, VAAC, the USAID Mission and partners. After evaluation and ensuring adjustments, the innovations will be mainstreamed by the NTP with domestic and other donor (mainly GF) resources. This approach was shown to be effective during TB CAP and TB CARE I implementation. In this way Challenge TB investments will leverage other resources, while spearheading program innovation. Challenge TB will also ensure effective use of Global Fund investments, by providing technical assistance to the rollout of the innovations. Evidence will be collected to document the operational processes and their impact.The nine technical areas that will be covered by Challenge TB in Viet Nam are:
Several activities of Challenge TB have benefited all 63 provinces across the nation; however, the key focus of the project in the first year was primarily on 15 Provinces; 4 high TB/HIV prevalence provinces, 9 MDR-TB treatment centers, and two PMDT satellite provinces. With this coverage, Challenge TB has supported 38.6 million people in 3,232 communes of 193 districts, an equivalent of 39% Viet Nam’s total population (2013). Additionally, Challenge TB continued its support for access to the WHO-approved rapid diagnostic platforms (GeneXpert) in all 45 provinces within the framework of the PMDT of National Tuberculosis Control Program.
Afghanistan ranks as one of 22 high TB burden countries. The estimated incidence of TB all forms is 189 per 100,000 population per year, and the prevalence of all forms of TB was estimated at 340 per 100,000 population. Annually, there are approximately 58,000 new TB cases in the country, the existing numbers of cases are estimated to be 100,000, and an estimated 13,000 Afghans die of TB every year.
In 2014, the National Tuberculosis Control Program (NTP) was able to notify 31,746 new TB cases (all forms) which is only 55% of all estimated TB cases in that year. The treatment success rate for all TB cases was 88% and for new bacteriologically confirmed TB cases it was 90%.
The Challenge TB project in Afghanistan is led by MSH and KNCV is the coalition partner will have local partnership with BPHS NGOs for its implementation. Challenge TB will focus on helping the NTP maximize its outcomes through these technical areas; Strengthening leadership and management for TB control focus on provincial level, Increasing TB case notification and improving quality of care strengthening M&E, surveillance and operations researches, expansion of urban DOTS and community based DOTS, implementing TB infection control and strengthening health systems.
The main aim of the Challenge TB Afghanistan project is to assist the NTP to reach its strategic objective of increasing TB case notifications by at least 6% annually through provision of quality TB services to the needy communities countrywide.
To enhance the leadership and stewardship role of the NTP team and NGOs, Challenge TB will improve the governance and coordination of TB service delivery at provincial and local levels. As a result the NTP will be able to develop and apply tools and approaches that will improve its leadership and management capacity. Ultimately, decentralization and multi-sectorial partnership at provincial level must address NTP’s strategic programmatic gap of low TB case notification and maintain the treatment success rate.
To further strengthen the CB-DOTS approach implementation in country, Challenge TB will implement this approach in 13 provinces: Baghlan, Badakhshan, Herat, Takhar, Jowzjan, Faryab, Kabul, Bamyan, Khost, Paktya, Kandahar, Nangarhar Balkh and in selected districts in Ghazni and Paktika provinces. Also, the Challenge TB will develop the contingency plan for all those provinces with insecurity.
Health systems strengthening is an essential area that will allow the NTP to reach its strategic objectives. Challenge TB will assist the NTP with having the most up-to-date and practical policy guidelines to address the TB challenges.
Challenge TB will sustain the progress made in TB-IC and expand implementation to selected heath care settings in CB-DOTS provinces and Urban DOTS cities. Challenge TB will implement the following illustrative key interventions:
The Challenge TB project will also improve upon the gains made during previous USAID TB projects on strengthening monitoring & evaluation and operations research.
Kyrgyzstan is among the 27 countries in the world with a high burden of MDR-TB and 18 high-priority countries for TB in the WHO European Region.
The overall goal of the Challenge TB project in Kyrgyzstan is to reduce the TB burden in Kyrgyzstan by improved management of pre- XDR, XDR-TB and other complicated forms of MDR-TB.
Based on the National Strategic Plan and taking into consideration the partners’ activities in the country, Challenge TB will provide technical assistance to the national TB program in the preparation and implementation of new drugs and treatment regimens in the context of the national situation. KNCV will help the country to set up the essential treatment and management conditions for the use of new drugs and treatments, while at the same time developing measures to care for and to prevent community transmission from patients for whom no effective treatment is yet available.
TB re-emerged as an important public health threat after the breakdown of the Soviet Union, and its burden remains high in Tajikistan. According to the World Health Organization, the estimated TB incidence was 100 per 100,000 populations in 2013, which is the fifth highest level of TB burden among 53 countries of the WHO European Region. The estimated TB mortality rate (excluding TB/HIV cases) in 2013 was 6.9 per 100,000 population. According to the national TB program notifications data, a total of 6,495 TB cases (79.2 per 100,000 population) all forms, were registered in the country in 2013 (including penitentiary sector); and out of these, 5,306 were new cases (70.0 per 100,000). The high burden of anti-TB drug resistance is one of the key challenges in Tajikistan.
According to the NSP, over next six years, about 42,870 all forms TB cases, will need anti-TB treatment in Tajikistan. Out of these, over 5,840 cases are expected to have advanced drug resistance (M/XDR-TB) and thus will require second-line and third-line TB drugs. The national strategic plan aims to reach universal treatment coverage for MDR-TB (including XDR-TB) by the year 2020 (i.e. coverage of at least 90-95% of the estimated total need).
The Challenge TB project has identified as the main priority the introduction of shortened regimens and regimens containing new drugs (including adequate PV). The vast majority of MDR-TB patients (approximately 85%) without additional resistance to key SLDs would be eligible for shortened treatment regimen. For the remaining cases with wider resistance (pre-XDR, XDR-TB) regimens containing group 5 (including new TB drugs such as bedaquiline and delamanid) should be urgently introduced to improve treatment success rates among this group and to stop XDR-TB transmission. Within the project, special emphasis will be paid to improvement of the pharmacovigilance system for anti-TB drugs, as part of the overall pharmacovigilance system in the country. For introduction of new drugs and regimens, WHO requires active pharmacovigilance. Therefore, in addition to reinforcing spontaneous reporting by health care institutions and providers involved in the management of TB cases, KNCV will incorporate active pharmacovigilance into the MDR-TB treatment program. This will allow not only for effective post-marketing surveillance of the medicines, but it will also strengthen the NTP’s capacity to improve the management of adverse drug reactions, thus reducing the risks of treatment interruption and failure because of these reactions.
In this regard, the overall strategy of the Challenge TB project in Tajikistan is to improve quality of care for patients with MDR-TB through building the NTP’s capacity for management and implementation of shorter treatment regimens and new TB drugs.
In order to carry out this strategy, KNCV, through the Challenge TB project, will focus on following activities:
The goal of the first year Challenge TB Project in Ukraine is to improve MDR-TB services and outcomes for MDR-TB patients in partner Mykolaivska and Poltavska oblasts through the integration of a patient-centered approach based on the ambulatory health care system into oblasts’ routine MDR-TB case management system, resulted in reducing mortality, lowering default rates, improving MDR-TB case detection and diagnosis, and enhancing treatment success. The lead partner of Challenge TB in Ukraine is PATH in partnership with KNCV.
Improve enabling environment through developing and piloting a model of ambulatory care for MDR-TB patients based on a patient-centered approach considering different local conditions (rural vs. urban, special populations, etc.) and different patient's preferences to maximize the benefits to the MDR-TB patient and minimize the costs to both the patient and the health care system. During Year 1, Operations research on the cost of MDR-TB treatment based on different models will be conducted.
Ensure patient-centered care and treatment through advocating to Health Care authorities in project sites for expanding TB services to ambulatory primary health care, emphasizing the advantages of ambulatory care which include a decrease in the costs related to hospitalization, reduction in the risk of ongoing TB transmission to other patients and healthcare staff within facilities, and an increase in patient autonomy and satisfaction that will lead to greater completion of treatment and decreases in loss to follow up.
During Year 1, the Project will:
Strengthening infection control to ensure compliance with proper infection control (IC) measures in all health care settings and community, providing assistance in project oblasts in development of the oblast IC plans, and revising the oblast TB hospitals’ IC plans.
Enhancing political commitment and leadership to ensure sustainability of effective TB-related interventions at the national and oblast levels, the project seeks to enable the government of Ukraine to make critical, technically sound policy and program decisions to improve MDR-TB control in accordance with international best practices, providing technical assistance to the WHO national TB program review and development of the next national TB strategic plan (Program) for 2017 – 2021. The Project will assist with the development of the national MDR/XDR-TB Scale-Up Plan and national guidelines on side-effects management.
Addressing human resource development and strengthening the capacity of providers at the oblast level in MDR-TB case management, including in people with HIV comorbidity, through a number of trainings and a study tour to the WHO MDR-TB Collaborative Center in Riga (Latvia).