MDR/XDR-TB Assessment and Monitoring Tool

The tool aims to identify high-priority gaps in the DOTS program that must be corrected to prevent the development of MDR-TB and XDR-TB cases, and to determine high-priority areas that should be addressed to improve diagnosis and treatment of MDR-TB and XDR-TB. The tool collects key data that are immediate indicators of a country's risk for MDR-TB or XDR-TB, such as treatment outcomes for TB patients. Analysis of these key data elements can point to gaps in programming that should be explored further. The tool then uses the six elements of the Stop TB Strategy to collect data on potential contributing factors to these gaps, so that these factors can be identified, prioritized, and used to develop an action plan to improve performance. The tool consists of several sections, each corresponding to a component or sub-component of the Stop TB Strategy. Each section includes a set of questions with assigned scores, which are used to evaluate the national or sub-national performance in that area. The scores are meant to provide a relative, not absolute, evaluation of performance and to help prioritize areas for improvement. The tool is designed for use by national tuberculosis program (NTP) staff, consultants, donors, and others for several purposes, including preparing national or sub-national plans for MDR/XDR-TB prevention and control, providing baseline information and monitoring progress, and providing data and analysis to prepare for Green Light Committee (GLC) and Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) applications. The application of this tool in a country or region of a country should be undertaken with the full collaboration of the NTP and with clearance from the Ministry of Health (MOH) or other appropriate official bodies. The tool is designed for three to five days' fieldwork for a national-level assessment, assuming that some data are available through WHO publications, NTP annual reports, and other standard sources of information. Prior to the initiation of fieldwork, it is recommended to obtain as much data as possible from the most recent WHO Global Tuberculosis Control Report (Global TB report) and Anti-tuberculosis Drug Resistance in the World: Report No. 4. Consultants and NTP managers bring a wealth of experience to inform the use of this tool, and it is essential to verify and validate data collected with this tool, and wherever possible, consult more than one data source in order to note discrepancies for key data points. The tool is not intended to provide a full TB program evaluation, but to focus inquiry specifically on issues related to MDR-TB and XDR-TB. However, it can complement and also draw information from national TB program evaluations and other assessments. The tool is designed to provide a starting point for planning an international mission or in-country data collection effort, and the following questions are meant to provide a starting point for planning: - If applied sub-nationally, how many regions/districts will you include? What is your strategy or criteria for selecting regions/districts? How many people will you need to send to the field? Will you need to have a team leader or coordinator? What is the expected duration of the fieldwork? What are the expected outcomes of the fieldwork? What are the expected deliverables of the fieldwork? What are the expected timelines for the fieldwork? The tool is designed to be flexible and adaptable to the specific needs and circumstances of each country or region. Practical considerations such as the budget and availability of human resources will guide the use of this tool in a given setting.