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

In the Universal Access technical area, the sputum transport system became fully functional in five targeted rural districts, resulting in a doubling of TB suspects with a sputum examination in these districts. This is anticipated to make a significant impact on case finding. In the Programmatic Management of Drug Resistance Tuberculosis (PMDT) technical area, the DRS progressed from planning to pilot phase, with a total of 118 health workers from six pilot sites and the national level trained to participate in the pilot. The first course in the clinical management of multidrug-resistant (MDR) TB was conducted, with 31 clinicians from all eight provinces and three main cities participating in the training. This represents a significant development towards decentralization of DR-TB care to the provincial level. The Health Systems Strengthening technical area also made notable progress, with a total of 30 out of 37 districts visited and supported by provinces during the quarter. Support supervision visits and on-site mentoring motivated health workers, especially at peripheral health facilities, creating stronger teams. Additionally, a total of 29 district health workers from 10 provinces completed a one-week health management and finance course conducted by the International Management Development Program (IMDP). The Monitoring and Evaluation technical area focused on data audit and performance review workshops. Data verification missions were conducted to assess data quality in five districts, with an improvement in data quality in four of the districts visited. Performance review workshops were held in 24 districts, with discussions focusing on key performance indicators such as notifications, treatment outcomes, and TB/HIV collaborative activities. The Operations Research technical area made progress on seven planned studies, including the maximum time that sputum samples can be kept at room temperature and still give reliable results, factors associated with tuberculosis treatment delay among sputum-positive patients in Chegutu district, and the prevalence of smear-negative culture-positive TB among adult HIV-positive patients attending Mpilo hospital HIV clinic. The overall implementation status of the work plan is at 76%. Technical challenges were faced in the areas of technical capacity, including PMDT, operations research, and Xpert roll-out. Administrative challenges were also encountered, including weak partnership coordination. The implementation of Global Fund Round 8 phase 2 is in progress, with a total amount available for grant implementation of $50,150,355. Activities such as training and support supervision are geographically split between Global Fund and TB CARE at subnational level. However, TB CARE Zimbabwe does not normally support activities such as the purchase of vehicles and drugs, which are covered by Global Fund. In the quarterly technical outcome report, the indicator for eligible children younger than 5 years (contacts of ss+ adults) that were put on IPT showed a value of 30% in 2012, with draft recording and reporting tools developed to capture the IPT information for under-five-year-old children. The indicator for patients receiving community-based support by trained supporters during treatment showed a value of 13% in 2012, with the community DOT supporters continuing to observe and support TB patients at the community level.