TB CARE I Zimbabwe PEPFAR Year 2 Quarterly Report July-September 2012

The project's overall work plan completion was at 52% at the end of year two. Technical areas with the highest completion rates included Universal and Early Access, with 68% completion, and Laboratories, with 58% completion. Training was a key component of the project, with 7 TB and TB/HIV training workshops conducted in 6 out of 9 selected urban areas. A total of 217 health workers, including 138 females and 79 males, received training on the detection and management of adults and children with TB and HIV co-infection. The training focused on proper management of TB/HIV co-infected patients seeking care and treatment at the selected 13 sites and neighboring health facilities. Various materials were procured to facilitate implementation of planned activities, including audio-visual equipment for health education, water containers for health facility DOT, Xpert MTB/Rif equipment and cartridges for diagnosis of sputum-negative TB, mobile phones, computers, internet equipment, and basic clinic furniture. These materials will facilitate proper patient management, monitoring, education, recording, and reporting at the integrated care sites. Renovations for infection control were also undertaken, with an infection control-trained architect engaged to support the development of plans and renovations at the integrated TB/HIV care sites. This will ensure minimum renovation standards for infection control and patient flow. However, the absence of a project coordinator, combined with the late start and competing priorities, resulted in a low implementation level. A coordinator was recruited to commence duty in October 2012. The project successfully engaged all relevant health workers at national, provincial, district, and municipality levels and obtained strong buy-in, paving the way for implementation of the rest of the activities. The project also made progress in engaging partners in integrated TB and HIV care, with all 56 OI/ART clinics in the selected urban areas providing TB screening services. Additionally, 59 out of 72 eligible children younger than 5 years (contacts of ss+ adults) were put on IPT, with a 82% success rate. However, challenges were faced in the implementation of some technical areas, including the establishment of new microscopy centers, with no new centers established during the quarter. The reassessment of need for laboratories is ongoing, and implementation will start from mid-November. The project also faced challenges in reporting outcomes, with no reported outcomes for the project yet, as outcomes are traditionally reported after at least one year later. The project is working on a recording and reporting approach that will facilitate earlier reporting. The Gene Xpert instruments were procured but have not been installed yet, and the national implementation plan and Gene Xpert were drafted during the quarter by an established Gene Xpert implementation committee. The training materials and reporting forms for Gene Xpert were not yet finalized, and the reporting tools will be finalized next quarter. Installation of the instruments is planned for mid-November. The project also made progress in scaling up the implementation of TB-IC strategies, with 1 out of 13 key facilities with all three interventions in place. Support visits will be conducted to the remaining 12 sites for capacity building in infection control. The project also strengthened TB IC monitoring and measurement, with draft tools developed to capture the indicator of annual reporting on TB disease (all forms) among HCWs, but not yet put into use.