TB CARE Annual Work Plan and Budget

The project focused on developing capacity of the National TB Program (NTP) and non-governmental organizations (NGOs) in screening, diagnosis, and management of all forms of TB. The total case notification of new and relapse cases at the national level increased significantly over the past two years, with a 12% increase in 2012 and a 13% increase in 2013. The increase in notification of smear-negative and extra-pulmonary TB contributed to this change. Detection of child TB remained a challenge, with no noticeable change in overall notification. The project provided technical and financial support to ten 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. The Diabetic Association of Bangladesh (DAB) project contributed to the detection and treatment initiation of 174 TB cases of all forms among diabetic patients. Case detection continued to increase through other sub-grantees supported by the project. HEED and six other sub-grantees detected an additional 1,395 TB cases among their target populations. Apart from behavior change communication and social mobilization activities, the networking developed with 2,897 private providers through NGO sub-grantees contributed to the identification of 13,955 presumptive TB cases during the current quarter. Detection and enrollment of DR TB patients have been increasing steadily since 2012, when the MDR TB intervention was started. In the current quarter, 172 patients were enrolled in treatment. The project's PMDT strategy has been remarkably successful in Chittagong district, with the detection of MDR TB increasing to 54% of the estimated yearly case load in less than two years. The project completed the calibration process of 12 Xpert machines by certified engineers during this period. The Xpert MTB/RIF test has become the primary diagnostic tool for Bangladesh in the detection of MTB Rif-resistant cases. The project plans to procure and install 35 GeneXpert machines to decentralize and increase detection of RIF-resistant and smear-negative pulmonary cases. Counseling of MDR TB patients is taking place on a routine basis. At NIDCH, the project staff provided pre-admission counseling to inform patients about treatment duration, intensive and continuation phase treatment, release from hospital, transfer to home for continuation phase, treatment services at home, and infection prevention practices. Individual and group counseling were also organized for patients during the in-patient treatment period. As part of health system strengthening, the project continued its effort to develop capacity of NTP and NGOs lab technicians in the operation and management of GeneXpert, LED microscopes, and culture and DST. The project supported the joint organization of the 2nd SEAR Conference on TB and Lung Health in Dhaka with The Union and NATAB. The implementation of the FAST approach for active screening of presumptive TB cases, especially at large hospitals, went as planned. The project expanded this approach to all TB and non-TB wards of NIDCH, contributing to the identification of 1,075 presumptive TB cases and the detection of 131 TB, including 7 RIF-resistant cases. The project also scaled up the FAST approach in BIRDEM.