TB CARE Annual Work Plan and Budget

The project's objectives for the first quarter of FY 2014 focused on developing capacity of the National Tuberculosis Control Program (NTP) and non-governmental organizations (NGOs) in screening, diagnosis, and management of all forms of tuberculosis (TB). The project also aimed to expand access to diagnosis and management of multi-drug resistant TB (MDR TB), strengthen health systems, particularly laboratory services, and improve knowledge and awareness about TB. The project provided technical and financial support to nine local NGOs sub-grantees for increasing detection of TB cases and improving knowledge and awareness about TB. The sub-grant programs were implemented in underperforming districts and targeted vulnerable populations in urban and rural areas. The Diabetic Association of Bangladesh (DAB) project contributed to the detection and treatment initiation of 119 TB cases among diabetic patients. Other sub-grantees supported by the project detected an additional 1,263 TB cases among their target populations. The project also developed a network with 3,325 private providers through NGO sub-grantees, which contributed to the identification of 12,792 presumptive TB cases during the current quarter. The case notification rate at the national level continued to increase for the last three consecutive quarters, with a total of 137,878 new TB cases notified during January to September 2013, compared to 122,301 cases in the preceding nine months. The Xpert MTB/RIF test became the primary diagnostic tool for Bangladesh in detecting MDR TB. GeneXpert testing services were provided through 25 national and regional reference labs, Chest Disease Clinics, and Chest Disease Hospitals at different districts. In this quarter, Xpert tests were performed for a total of 3,941 samples, including 1,425 DR TB presumptive cases, which helped detect 196 RIF-resistant cases among DR TB and smear-negative presumptive cases and HIV-positive patients. The project assisted NTP to expand hospital facilities for treatment initiation and community-based programmatic management of drug-resistant TB (cPMDT) for continuation phase treatment. The project started the process for renovation works needed for increasing bed capacity for MDR TB patients at four district chest disease hospitals. In FY14, the project planned to expand the cPMDT model to an additional 20 districts and consolidate the program in the existing districts for increasing access to MDR TB treatment. Implementation of the planned activities for cPMDT was slow during this quarter due to political problems, although training was conducted for the Outpatient DR TB teams on cPMDT from three new districts. During this quarter, 172 MDR TB patients were initiated on treatment, and 89 patients were enrolled in the cPMDT program. Counseling of MDR TB patients took place on a routine basis, with project staff providing pre-admission counseling and individual and group counseling during the in-patient treatment period. As part of health system strengthening, developing national capacity for culture and drug susceptibility testing (DST) services was a priority. The project completed renovation works at the Khulna Regional TB Reference Laboratory site to improve the facility condition. Equipment procured for the laboratory was transported to the site, and the lab was expected to start operations early next quarter. The project implemented the FAST approach for active screening of presumptive TB cases, especially at large hospitals, which went as planned. The project expanded this approach to TB and non-TB wards of the National Institute of Diseases of the Chest and Hospital (NIDCH), contributing to the identification of 554 presumptive TB cases this quarter and detection of 119 TB cases, including 24 RIF-resistant cases. The project planned to scale up this approach to some other large hospitals during the year. The ongoing political unrest in the country severely interrupted and delayed the implementation of a number of activities planned for this quarter. Some activities needed to be postponed and rescheduled due to unpredictable nationwide strikes that made it impossible for staff to participate or organize the planned events and conduct monitoring visits. The expansion of cPMDT activities, which required on-site training of upazila and district-level staff and public sector counterparts, was greatly hampered since field visits by project staff were not possible.