TB CARE I - Nigeria OP Year 2 Quarterly Report April-June 2012

The report covers the progress of TB CARE I in Nigeria during the second quarter of 2012. The overall work plan completion rate for the quarter was 26%, with most activities taking place in the earlier part of July. TB CARE I commenced PCA activities in selected states, including Ogun and Osun States, as well as the control State of Ekiti. Sensitization of stakeholders was conducted, and ethical approval was received from the national ethics committee. Additionally, 40 DOTS and 20 Laboratory centers were established as PPM sites in 2 States, Kano and Benue. Trainings were conducted for a total of 78 GHCWs and 29 laboratory staff. TB CARE I supported the coordination of the implementation of GeneXpert/NTB Rif by all partners and stakeholders during the quarter. Meetings were held to ensure strategic expansion and utilization of standardized R&R and training materials. Although TB CARE I has taken delivery of 4 new GeneXpert machines, states for expansion were identified and are currently being assessed for installation and training in July and August. Mentoring visits were conducted to five challenged states within the quarter, with follow-up visits scheduled for July and August. Upstream support was provided to the NTP in the organization and conduct of the State program managers retreat. The meeting discussed DR TB, particularly the need for referral for diagnosis and enrollment for treatment at designated centers. TB CARE I also provided technical assistance to the TB/HIV strategic framework development workshop, which resulted in a draft national TB/HIV strategic framework. The organization supported the harmonization of DR TB R&R tools to align with GeneXpert/MTB Rif and global WHO and TB CARE I reportable indicators. The tools were finalized and are currently awaiting printing and distribution. In addition, TB CARE I supported the Nigerian Thoracic Society (NTS) conference on TB and other chest infections. The conference provided an opportunity for the NTP to update participants on TB programmatic approaches and the current management of MDR TB, including the use of GeneXpert/MTB Rif. Issues on childhood TB were also discussed. Community mobilization, sensitization, and referrals by CVs were implemented in some supported LGAs, primarily led by umbrella CBOs with support from FHI 360 staff. The community mobilization activities witnessed a sizeable turnout of the general population, providing a forum to educate them on TB and other related disease areas. The infection control equipment currently being procured for all supported treatment centers will help in instituting international standards of infection control. The upgrade of MDR TB wards at Kano and Mainland Hospital will accommodate newly diagnosed MDR TB patients during the intensive phase of treatment. MDR TB treatment has started in Mainland Hospital, Lagos, following the commissioning by the Honorable Minister of Health on 24th March, 2012. A major challenge was the insecurity in major parts of the country, affecting the implementation of activities, especially those of the mentor/mentee organizations. Those in the far North were not able to access funds and thus are yet to commence program implementation. There is a need to outsource implementation of such activities to partners or professional bodies operating within the challenged regions. The quarterly technical outcome report highlights the progress made in various technical areas, including Universal and Early Access, Laboratories, and Health Systems Strengthening. The report also discusses the challenges faced and the next steps to reach the targets. The expected outcomes and outcome indicators are also presented. In the Universal and Early Access technical area, the baseline was 43%, and the target was 100%. The highlights of the quarter include the commencement of PCA activities and the sensitization of stakeholders. The challenges and next steps to reach the target include the need to increase the demand for and use of high-quality TB services and improve the satisfaction with TB services provided. In the Laboratories technical area, the baseline was 29%, and the target was 100%. The highlights of the quarter include the development and implementation of a national strategic plan for providing TB laboratory services needed for patient diagnosis and monitoring. The challenges and next steps to reach the target include the need to introduce new technologies, such as GeneXpert, and to conduct rapid tests. Overall, the report highlights the progress made by TB CARE I in Nigeria during the second quarter of 2012. The organization has made significant strides in implementing PCA activities, establishing PPM sites, and introducing new technologies. However, challenges remain, including the insecurity in major parts of the country and the need to outsource implementation of activities to partners or professional bodies operating within the challenged regions.