TB CARE Annual Work Plan and Budget

The project's implementation approach focuses on developing the capacity of the National TB Control Program (NTP) and non-governmental organizations (NGOs) in screening, diagnosis, and management of all forms of TB. This includes expanding access to diagnosis and management of multi-drug resistant (MDR) TB, strengthening health systems, particularly laboratory services and systems, improving knowledge and awareness about TB, and strengthening private sector participation in the TB control program. The project has made significant progress in case detection since 2011, with a 3.6% increase in total notification of new cases of all forms in the first quarter of 2014 compared to the same period in 2013. The increase is mostly in smear-negative and extrapulmonary TB (EPTB) cases. The project has also expanded the FAST approach, designed to promote active screening of presumptive TB cases, to all TB and non-TB wards of the National Institute of Diseases of the Chest and Hospital (NIDCH). Through this approach, the project has identified and tested 1,276 TB and other lung disease patients and detected 175 TB cases, including 10 rifampicin-resistant cases. The project has also provided technical and financial support to ten local NGO sub-grantees to strengthen TB control activities, particularly in underperforming districts and targeted to vulnerable populations. The DAB project, implemented in BIRDEM and other DAB-affiliated hospitals, contributed to the detection and treatment of 214 TB cases of all forms among diabetic patients in the last quarter. The project has also supported two separate sub-grants through BRAC in 22 districts, resulting in a significant increase in case detection, especially for smear-negative and EPTB cases. The project has also expanded the use of the Xpert MTB/RIF test, which has become the primary diagnostic tool for Bangladesh in detecting MTB rifampicin-resistant cases. The project has completed the installation of 8 additional Xpert machines and performed GeneXpert tests for 2,010 DR-TB presumptive cases, detecting 182 MTB rifampicin-resistant cases. Additionally, 1,137 MTB-positive cases, including 81 rifampicin-resistant cases, were detected out of 7,546 samples of presumptive smear-negative cases tested by GeneXpert. The project has also made progress in expanding national capacity for facility and community-based treatment of MDR-TB patients. The project support has enabled NTP to add 32 additional beds for inpatient treatment of MDR-TB patients through Sylhet CDH. The project has also trained 395 field-level health professionals of the outpatient DR-TB teams from six new districts to develop their capacity for managing patients. During this quarter, a total of 220 patients were initiated to MDR-TB treatment through NTP and Damien facilities, and 132 patients have been transferred to community for continuation phase treatment. The project has also expanded the sputum collection and transportation system to link peripheral labs with Xpert sites for increasing access to Xpert tests for DR-TB presumptive TB cases and smear-negative cases. A total of 194 GO and NGO staff have been trained on sputum collection and transportation, and the system is now operational in 15 cPMDT districts. Counseling of MDR-TB patients is taking place on a routine basis, with individual and group counseling organized for patients during the in-patient treatment period. Under the wave 4 grants program, the project has awarded 4 new grants to NGOs and 6 more are awaiting USAID approval. These grants have been selected to strengthen TB control activities in under-performing urban and rural areas to increase case detection and community knowledge and awareness about TB.