TB CARE Annual Work Plan and Budget

The project focused on increasing access to diagnosis and treatment of childhood TB and MDR-TB services, strengthening laboratory services and systems, and increasing private sector participation in the TB control program. Developing national capacity for increased and early diagnosis and management of child TB was a major highlight of the activities performed during this quarter. In collaboration with the National TB Program (NTP) and the World Health Organization (WHO), the project developed 33 master trainers on the management of childhood TB. Additionally, 89 graduate doctors were oriented on the national guidelines for management of TB in children, and 455 health professionals were oriented on TB Infection Control. The project also made significant progress in enhancing the national capacity for increasing access to diagnosis and treatment of MDR-TB cases. Eleven Gene Xpert machines are now operational, with two machines installed this quarter at the Regional TB Reference Laboratory (RTRL), Rajshahi, and Chest Disease Clinic (CDC) Khulna. A total of 1,393 DR-TB suspects have been tested by the 11 operational Gene Xpert machines, and 729 MTB-positive cases, including 207 MTB/RIF-resistant cases, have been diagnosed. The scaling up of community-based Programmatic Management of Drug-Resistant TB (cPMDT) activities was a milestone for the project during this quarter. Formation and training of Outpatient DR-TB Teams on clinical and programmatic management of MDR-TB patients have been completed in the Dhaka city corporation, 5 districts, and 34 Upazilas. A total of 32 DR-TB patients have been enrolled in community-based treatment (cPMDT) during this quarter, and the project has set up a monitoring and supervision system to ensure that treatment adherence and patient management are not compromised. The project also made progress in laboratory capacity development, including the certification of Bio-safety cabinets and training of NTP staff on relevant areas. The project drew on the expertise of the Alliance Bioscience, which organized training on Bio-safety Cabinets and Laboratory Equipment Maintenance and Calibration for 3 microbiologists and 10 Medical Technologists-Lab from the reference laboratories. The Alliance Bioscience also carried out inspection, repair, and certification of seven Bio-safety cabinets. The analysis of NTP data shows a tangible increase in the national case notification numbers in 2012 compared to 2011. The overall case notification has increased from 99/100,000 population in 2011 to 106/100,000 population in 2012 due to enhanced case-finding efforts. Case notification rate for new smear-positive cases increased from 65/100,000 population to 69/100,000 population between the period of 2011 to 2012. The project is currently supporting three local NGOs to implement activities for increasing case detection and management of all forms of TB, improving knowledge and awareness about TB, and providing in-service training of intern medical doctors. The progress made in expanding the public-private mix with graduate and non-graduate private providers has been remarkable. BRAC organized networking meetings and oriented 1,066 graduate and 1,223 non-graduate private practitioners on suspect identification, case referral, and basic DOTs. A total of 12,976 TB suspects have been referred by these private practitioners. The project has also initiated m-Reporting system at 5 Chest Disease Clinics (CDC) and 2 Chest Disease Hospitals (CDH) for instant reporting of Gene Xpert test results. The project has scaled up the mHealth system for cPMDT in Gazipur, Narayangonj, and Chittagong districts. The system will eventually cover all districts where cPMDT intervention will be rolled out. The web-based mHealth system generates real-time data to monitor the DR-TB DOTS services, management of side effects, treatment adherence, and keeps a record of patient's treatment history that is readily accessible for patient management.