TB CARE I Zimbabwe PEPFAR Year 2 Quarterly Report April-June 2012

The program is led by The Union, with collaborating partners including the World Health Organization (WHO) and the Kenyan National Tuberculosis and Leprosy Control Programme (KNCV). The program's technical areas of focus include universal and early access, laboratories, infection control, TB/HIV, health systems strengthening, and monitoring and evaluation. In the second quarter of 2012, the program made significant progress in several areas. In the universal and early access technical area, the program engaged provincial medical directors and directors of health services to facilitate the implementation of integrated TB and HIV care projects. All provincial medical directors and directors of health services for cities and towns were visited to discuss implementation modalities of the integrated TB/HIV plan. In the laboratories technical area, the program procured two Gene Xpert machines and 1,000 cartridges, which are awaiting delivery. The Gene Xpert technology is a rapid diagnostic tool for TB that can provide results in a matter of hours. In the infection control technical area, the program conducted initial health facility assessments for TB infection control in all sites. The assessments revealed inadequate infrastructure layouts in several clinics for effective integrated care for HIV and TB services and infection control. The respective facilities developed plans for renovations to improve layout. The program also made progress in the health systems strengthening technical area, with onsite mentorship of staff at project sites. Two health workers were trained per site through attachments to existing and well-established integrated care sites. A total of 13 health workers (4 females and 9 males) from 6 sites completed the attachment. The program's overall work plan implementation status was at 24% as of the end of the second quarter. The majority of sites were still in the setting-up stage due to the delayed start of the work plan in February 2012. Technical and administrative challenges were identified, including the lack of a written policy for TB/HIV integrated care, the limitation of ART initiation by nurses, and the absence of a formalized system for screening health workers for tuberculosis. The program also reported on several technical outcome indicators, including the number of TB patients enrolled in the integrated TB/HIV care program, the number of OI/ART clinics providing TB screening services, and the number of eligible children younger than 5 years who were put on IPT. However, most sites were not yet ready to report on these indicators, and the program noted that outcomes are traditionally reported after at least one year later. The program's quarterly technical outcome report highlighted several challenges and next steps to reach the target, including the need to strengthen TB IC monitoring and measurement, ensure optimal use of new approaches to laboratory confirmation of TB, and scale up implementation of TB-IC strategies. The program also reported on several outcome indicators, including the number of selected urban areas using the GeneXpert machine, the number of key facilities with IC focal persons, and the number of facilities providing HIV prevention messages at TB services.