TB CARE I – South Sudan Annual Report Year 2

The country is re-building the health structure which was destroyed during the war. Three quarters of the health facilities require some kind of renovation to be functional; while a third need to be completely rebuilt. The National TB Program was established in 2006 to coordinate TB activities. So far, NTP key positions at central and state level have been filled, though a huge gap exists at the county level. The role of County TB coordination is being played by implementing partners at health facility level. Through the support of partners and donors, the number of TB diagnostic and treatment centers have increased from 32 in 2006 to 65 in 2012. The program outcomes have continued to improve with case notification of all forms of TB increasing from 4844 in 2006 to 7599 in 2011. The treatment success rate has remained constant at about 79% from 2008 – 2011. The TB CARE I has been strengthening the capacity of the NTP to coordinate all TB control efforts in South Sudan. Using success and lessons learnt in the implementation of TB CAP project 2005-2010, TB CARE I has continued to strengthen the existing system through implementation of new approaches and scale-up of TB interventions identified in the NTP strategic plan. The focus has been on priority areas: 1) Universal and early access of TB treatment; 2) Strengthening of laboratory services; 3) Programmatic management of Drug Resistant TB (PMDT); 4) Collaborative TB/HIV activities; and 5) Health system strengthening. TB CARE I has supported expansion of TB diagnostic and treatment services through refurbishment of the laboratories and training of health workers (clinicians and laboratory staff) to build their capacity diagnose and treat TB. So far, three PHCC have benefited from renovation and integrated services while seven are under renovation. This will bring to 10 the number of laboratories refurbished under TB CARE I. In addition, the staff have been trained in diagnosis and treatment and mentorship and on-job training is on-going. The assessment tool that was developed has helped to identify facilities for refurbishment and integration of services. TB CARE I will continue to strengthen laboratory services by improving access to TB diagnosis through strengthening peripheral laboratory network and establishing EQA system. TB laboratory manuals and guidelines have been printed and distributed during support supervision. MDR-TB cases are emerging; 9 cases have been identified since 2010. However, due to lack of SLDs, three of the nine have died. With this challenge, TB CARE I has supported NTP to develop PMDT and TB IC guidelines. Both are in draft form and will be finalized and disseminated. In addition, 3 staff have been trained regionally on PMDT and 2 on TB IC. TB/HIV quarterly review meetings have been supported where challenges have been discussed and action plans developed for each respective state. Health care workers have been trained on PITC though TB patients tested for HIV have declined due to lack of HIV test kits. One of the key strategies to expand TB diagnostic and treatment services in South Sudan is to ensure that TB services are integrated into Primary Health Care (PHC). TB CARE I supported NTP to develop framework for integrating TB into PHC. This approach will ensure rapid, efficient expansion of TB services in a sustainable and cost-effective way. TB CARE I has supported development of GF TB TFM proposal and also review of the proposal based on TRP comments. In addition, NTP and TB CARE I staff will be supported to attend international trainings and conferences. The National TB Programme established in 2006 has been strengthened to coordinate all TB activities in the country. Currently, the NTP has all the key staff position at the national level filled and TB coordinators in all the 10 states. TB services are provided by the government in collaboration with many different NGOs. With the Global Fund, USAID and other partners' support, the country has made tremendous progress in TB control. The number of notified TB patients has increased from 4,844 in 2006 to 7,599 in 2011 (nearly a 57% increase) while treatment success rate has remained above 75% over the years. TB services (diagnostic and treatment centers) have increased from 32 in 2006 to 65 in 2012. TB CARE I has strengthened the NTP human resource capacity through trainings of health care workers at central, state and facility levels. The HIV/AIDS prevalence in South Sudan has already reached epidemic levels at 3% in the general population and as high as 30% among high risk groups in border areas. NTP routine HIV testing data of 2011 among TB patients showed 12.6% HIV positive. An HIV prevalence survey among TB patients [in all ten states] revealed that 14.7% is co-inf