Final Report: TB CARE Annual Work Plan and Width

The TB CARE II Bangladesh project, initiated in mid-2011, supports a range of interventions to enhance national capacity for increasing detection and management of TB and MDR-TB. The project works with the National TB Control Program (NTP) and local non-governmental organization (NGO) partners to implement its objectives. The project's implementation approach focuses on expanding and strengthening universal and early access to TB services, strengthening diagnosis and management of DR-TB, enhancing capacity and quality of lab services, and strengthening health systems. Technical assistance is provided to the NTP to support these efforts. The grants program, supported by the project through local NGOs, aims to streamline effective community-based approaches for increasing detection and management of TB. National case notification data for 2014 shows a slight increase in total notification of all forms of TB, from 184,506 in 2013 to 186,926 (provisional data). The proportion of notified cases of all forms has increased from 45% in 2011 to approximately 53% in 2014. The detection of child TB remains a challenge, with a slight increase in absolute numbers in 2014. The project has been supporting 14 local NGO sub-grantees to strengthen TB control activities, particularly in underperforming districts and targeted to vulnerable populations. The project's sub-grant programs have contributed to the detection and treatment of TB cases, with the DAB project detecting and treating 411 TB cases among diabetic patients. The sub-grant with BRAC implemented in 10 districts has significantly increased case detection, especially for smear-negative and extra-pulmonary TB cases. The public-private initiative supported through NGOs has contributed to the identification of 5,812 presumptive TB cases during the current quarter. The project provides direct technical assistance to implement the FAST approach, designed to promote active screening of presumptive TB cases, especially at large hospitals. The FAST approach is currently implemented at NIDCH, BIRDEM, and CDH Chittagong, and has identified and tested 562 TB and other lung disease patients, detecting 60 TB cases, including 4 rifampicin-resistant cases. The Xpert MTB/RIF test has become the primary diagnostic tool for Bangladesh in the detection of MTB rifampicin-resistant cases. The expansion of national capacity for facility-based and community-based treatment of MDR-TB patients has progressed as per the work plan. During this quarter, a total of 226 patients were initiated to MDR-TB treatment through NTP and Damien facilities, and 185 patients have been transferred to the community for continuation phase treatment. Counseling is taking place on a routine basis to provide psychological and emotional support to MDR-TB patients, with pre-admission and in-treatment counseling provided at NIDCH and similar counseling done by DOT providers for patients receiving treatment at the community level.