Annual Report: Challenge TB - Malawi Year 2

The project aims to support the National TB Control Programme (NTP) in reducing tuberculosis-related mortality and morbidity. CTB is working through national and zonal levels to support 15 out of 28 districts in the country. The project was granted US $6,010,360 to cover a one-year period from October 2015 to September 2016. The CTB activities are aligned with Malawi's revised National TB Strategic Plan (NSP 2015-2020) objectives, which include reducing TB-related mortality by 50% by the end of 2020, increasing the Case Notification Rate (CNR) from 121 per 100,000 (2013) to 252 per 100,000 in 2020, and increasing treatment success rate for new smear-positive TB cases from 84% in 2014 to 90% by the end of 2020. To achieve its objectives, CTB Malawi focused on several sub-objective areas, including Enabling Environment, Comprehensive High Quality Diagnostics, Targeted Screening for Active TB, Infection Control, Political Commitment and Leadership, Comprehensive Partnership and Informed Community Involvement, Drug and Commodity Management Systems, Quality Data, Surveillance and M&E, and Human Resource Development. The collaboration between CTB and NTP has improved at all levels, resulting in quality implementation of activities where partners support one another. For example, CTB participates in NTP regular technical meetings where the status of workplans for both CTB and NTP are reviewed, challenges in implementation discussed, and action plans developed. Baseline assessments were conducted during the year, including an assessment of the entire TB laboratory network, the GeneXpert network, and an assessment of all the CTB 15 priority districts and selected health facilities with regard to various aspects of TB control. The main findings and observations for the TB laboratory network assessment included strengths such as the availability of TB microscopy services in many health facilities, adequate personnel in most of the laboratories, uninterrupted TB microscopy services, and the existence of a proficiency testing program for Xpert laboratories. Challenges observed included inadequate coordinating role of the NTRL and the NTP in strengthening TB laboratory services, weak specimens referral systems causing underutilization of the existing laboratory capacity, long turnaround times, poor infrastructure, use of non-serviced biological safety cabinets, inadequate on-job training and retraining, interrupted Xpert services due to stock outs of cartridges, lack of maintenance contracts for major equipment, lack of regulatory documentation on the laboratories, inadequate routine quality control, and inconsistent external quality assurance. The project also focused on improving the quality of diagnostics, with a particular emphasis on the GeneXpert platform. The assessment of the GeneXpert network revealed that the distribution, utilization, and functionality of the diagnostic platforms were adequate, but there were challenges related to the maintenance of the equipment, the availability of cartridges, and the training of personnel. The project also supported the implementation of the Directly Observed Treatment Short Course (DOTS) strategy, which aims to improve the treatment outcomes for TB patients. The project also supported the implementation of the Enhanced Case Finding (ECF) strategy, which aims to improve the detection of TB cases in the community. The project also supported the implementation of the Infection Control (IC) strategy, which aims to reduce the transmission of TB in healthcare settings. The project also supported the implementation of the Information Education and Communication (IEC) strategy, which aims to improve the awareness of TB among the general public. The project also supported the implementation of the Drug and Commodity Management Systems (DCMS) strategy, which aims to improve the availability and quality of TB drugs and