TB CARE Annual Work Plan and Budget

The activity aims to improve tuberculosis (TB) diagnosis and treatment in Botswana, with a focus on high-quality diagnostics and comprehensive TB/HIV case management. During the second quarter of 2016, significant progress was made in the implementation of the activity's objectives. The national rollout of GxAlert, a digital platform for TB diagnosis, gained momentum, with 17 participants from the MOH, National Tuberculosis Program (NTP), National Tuberculosis Reference Laboratory (NTRL), and other departments attending a one-day national level training. Following the training, the local team completed the installations of GxAlert at 29 GeneXpert sites, with the systems administrators able to effectively log onto and navigate the basics of the site. The integration of national TB and HIV surveys in Botswana was also explored during this quarter. A one-day round table meeting was held to discuss the proposed integration of the national TB prevalence survey with the Botswana AIDS Impact survey (BAIS). Key stakeholders, including the NACA, Statistics Botswana, NTP, USAID, CDC, WHO, Global Fund, BUP, and KNCV, participated in the meeting and agreed to combine the two surveys. Training of health care workers on TB/HIV case management and the updated GeneXpert algorithm was also conducted during this quarter. A 5-day training was held in Letlhakane, Botswana, with 25 health care workers trained on TB/HIV case management and the updated GeneXpert algorithm. The revised algorithm has been incorporated into the standard MOH's TB/HIV case management training course. The NTRL renovation project, which aims to improve the provision of culture and drug susceptibility testing (c/DST) services, is progressing well. The MoH has contracted the services of Air Filter Maintenance Services (AFMS) to install a new ventilation system, and CTB has made a financial contribution to the refurbishment of the NTRL containment facility. The work is expected to be finalized by the end of July 2016. The NTRL containment facility has not been functional for almost two years, causing problems in the provision of c/DST services. This has compromised the quality of patient care in the country, as clinicians have been forced to make decisions without DST testing. A key challenge in the GxAlert roll-out process was the MoH's mandate to use the Government Data Network (GDN) instead of secure routers, which required switching the routers with wi-fi hubs and other equipment structures. The activity's progress in comprehensive, high-quality diagnostics is also being monitored. The planned key activities for the current year include performing an internal audit of the current c/DST and M/DST with recommendations for improvements to provide quality and efficiency in testing. However, the audit results are not yet available, as the NTRL is not functional yet. The NTRL has currently limited slots in the CDC Research Laboratory (Gaborone) to carry out some urgent routine work and proficiency test of samples panels. The 2nd-line validation process is already completed, with reported results showing 100% concordance for first-line phenotypic testing, second-line phenotypic testing, and MDR TB plus LPA testing. The activity is also working to link the lab with the WHO SRL network for international proficiency testing.