TB CARE I - Botswana Year 4 Quarterly Report October – December 2013

The program's primary objective is to improve TB control efforts in the country, with a focus on universal access, laboratory strengthening, and multidrug-resistant TB (MDR-TB) management. In Year 4, the program achieved several significant milestones. The in-country Senior Technical Advisor participated in a data collection exercise for the evaluation of community TB Care (CTBC) research project, which aims to assess the contribution of CTBC to TB control efforts in Botswana. The research will guide the NTP in adopting an appropriate CTBC approach to be scaled up, taking into consideration the decline in funding in the near future. TB CARE I, in collaboration with partners, supported the roll-out of Gene Xpert to six facilities, with plans to expand to 14 facilities. The program also trained 21 laboratory technicians, with 11 being female. The Gene Xpert instruments are being used to improve case detection among the MDR risk group and HIV-positive TB suspects. The in-country Senior Technical Advisor supported the NTP in finalizing agendas, presentations, and an opening speech for the combined Team TB/HIV and ARV site managers national biannual review meeting. The meeting focused on progress of implementation, challenges, and way-forward for TB/HIV activities. Recommendations included scaling up coverage of gastric aspirate collection for optimizing diagnosis of childhood TB. TB CARE I also supported a successful Green Light Committee mission to Botswana, coordinating the mission's visits and meetings with partners. The program supported the MDR clinical meeting, which was well attended by 57 participants, including in-country partners and representation from all TB treatment sites. The Chief Medical Laboratory Technician supported district laboratories with on-site visits to strengthen external quality assurance and implementation of acid-fast bacilli smear microscopy. Site assessments were conducted, and recommendations on identified gaps were shared with district laboratory teams. Two key issues noted were that recording and reporting still remain a challenge in the network and new members of staff who have been recently hired will need AFB microscopy training. The National Reference Laboratory (NTRL) quality management system was supported with the annual review of safety SOPs and technical input in providing feedback to the South Africa National Accreditation System (SANAS) for addressing recommendations of another successful annual SANAS external audit. The NTRL retained its status as an ISO 15189 accredited laboratory. TB CARE I's support to Global Fund implementation in Year 4 included preparation for the development of a concept note for the new funding mechanism. The Country Coordinating Mechanism (CCM) indicated that it will submit a joint proposal for TB, HIV, and Malaria. Two MoH staff, including the GF manager, will attend the National Strategic Plan (NSP) workshop in France, arranged by WHO, in preparation for aligning the national strategic plan with the Global Fund's new funding model (NFM) requirements. In terms of MDR-TB cases diagnosed and started on treatment, the total number of cases diagnosed in 2013 was 58, with 53 cases put on treatment. The program also supported international visits, including a technical visit by Jerod Scholten from KNCV. Overall, TB CARE I's efforts in Year 4 contributed to improved TB control efforts in Botswana, with a focus on universal access, laboratory strengthening, and MDR-TB management. The program's achievements and challenges will inform future efforts to improve TB control in the country.