TB CARE I - Afghanistan Quarterly Report January – March 2014

The project's technical team worked closely with the National TB Program (NTP) to improve access to TB services in the 13 intervention provinces. In 2013, the cumulative number of presumptive TB cases identified and screened for TB in the provinces reached 108, and from January to March 2014, an additional 26,000 presumptive TB cases were identified. TB CARE I also assisted the NTP in conducting an epidemiological assessment of TB data from 2006 to 2013. The assessment revealed a higher proportion of TB cases among women than men, with a low TB case notification rate of 52 percent. The study team analyzed the distribution of TB cases by province, age, and gender, and presented the results to the NTP. This data will be used to develop a Global Fund concept note. The project supported the NTP in updating the National Strategic Plan (NSP) for 2014-2018. TB CARE I shared recommendations from the Italy workshop on NSP development with the Ministry of Public Health (MOPH) and suggested that the NTP update the NSP's situation analysis and country context to address critical issues such as multidrug-resistant TB, new technologies, gender issues, and human rights. In January 2014, Clydette Powell, USAID's Medical Officer, visited Afghanistan to assess the TB CARE I project and gather ideas for the design of an upcoming USAID TB project in Afghanistan. The TB CARE I team facilitated and coordinated her visits to various health facilities and stakeholders. Additionally, TB CARE I organized a workshop for NGO managers and leaders to promote increased stakeholder involvement in TB service delivery and DOTS. TB CARE I also supported the NTP in conducting four trainings on standard operating procedures (SOPs) for TB case detection and treatment in Kandahar province. The trainings were attended by 41 health care staff, and the SOPs are being implemented in 370 health facilities in TB CARE I intervention provinces. Furthermore, TB CARE I trained 36 laboratory technicians in Kabul on sputum smear microscopy and slide reading, resulting in the expansion of TB case detection and treatment at 45 health facilities. The project's technical team continues to support the NTP in conducting research, promote evidence-based decision-making, and disseminate research findings to a broad audience. This quarter, TB CARE I assisted the NTP in writing and submitting abstracts for the 45th Union World Conference on Lung Health. The abstracts will allow TB CARE I and the NTP to share TB experiences from Afghanistan with a wider audience and promote evidence-based decision-making. TB CARE I also assisted the NTP in conducting an operations research on the gender distribution of presumptive TB cases in six provinces of Afghanistan. The study found that among the 21,963 reviewed cases, 14,712 (67%) were from female patients and 7,251 (33%) were from male patients. The study concluded that the proportion of sputum smear positive (SS+) TB cases among presumptive TB cases was equally distributed among females and males. However, the project faced technical and administrative challenges, including implementation delays by one of the project-supported NGOs and the end of the BPHS contract in September 2013. Next quarter, TB CARE I will sign contracts with two new NGOs: Bakhtar Development Network (BDN) and Solidarity of Afghan Families (SAF). In terms of universal access, TB CARE I supported the NTP in measuring the quality of services at 1,197 facilities, with an expected target of 1,400 facilities. The project also supported the NTP in conducting TB case detection and treatment activities, with a target of 300 TB personnel trained on the Patients' Charter. Additionally, TB CARE I supported the NTP in collaborating with 91 private providers and diagnosing 1,861 TB cases.