USAID TB CARE II Project Quarterly Report April – June 2016

The project provided technical assistance to the National Department of Health (NDOH), Provincial Departments of Health (PDOHs), and non-governmental organizations (NGOs) to further improve the implementation of TB and MDR TB programs. The project supported the activation of five decentralized sites in KwaZulu-Natal (KZN) Province, increasing the number of DR-TB treatment sites. Through the connectb.org patient retention application, over 328 patients received adherence support, with 97% patient retention achieved in the three districts. The innovative Tackling TB in Schools partnership with the Department of Basic Education (DBE), Department of Social Development (DSD), and Department of Health (DoH) reached over 59,000 school children in KwaZulu-Natal Province with TB messages, diagnosed 70 learners with TB, identified 170 family members with TB, and successfully linked them to care. The project focused on improving the quality of TB services, increasing the availability of TB treatment, increasing demand for TB services, improving management of TB support systems, and testing new approaches for expanding Directly Observed Treatment, Short Course (DOTS) coverage. The project provided training to clinicians on the management of DR-TB, including managing side-effects and use of newer second-line regimens (Bedaquiline). The national Pharmaco-vigilance Committee, in collaboration with the USAID TB CARE II Project, rolled out training on pharmaco-vigilance, focusing on the increasing number of clients reporting adverse events, particularly hearing loss. TB in Children: The project, through its innovative approach aimed at reaching and evaluating children, in collaboration with the Department of Basic Education (DBE), reached 59,480 children. The unique treatment adherence adjunct developed by the project has been introduced to pediatric patients in DR-TB hospitals in the Western Cape and Gauteng provinces, with plans to introduce the pediatric treatment adherence package (Buddy Beat TB comic, 'How To Guide' and video) to hospitals in these provinces through partnerships with the DBE countrywide. District Implementation Plans 90/90/90 strategy: The nationally adopted 90/90/90 Strategy, which integrates both HIV and TB strategies to ensure that district management teams (DMT), via reporting dashboards, report progress towards achieving set targets. The project provided seamless, hands-on support to further build on USAID and NDOH investments to build highly effective TB control systems, working closely with national and provincial partners to close gap areas identified and further develop sustainable systems which can carry forward long-term TB diagnosis, treatment, and care. Engaging Community-Based Organisations: The project successfully closed out the six supported non-governmental organizations (NGOs). The National Department of Health (NDOH) adopted the USAID TB CARE II NGO/CBO evaluation criteria for engaging NGOs, significantly strengthening the community TB response. During this quarter, the TB CARE II South Africa project focused on the following technical areas: improved quality of TB services; increased availability of TB treatment; increased demand for TB services; improved management of TB support systems; and new approaches for expanding Directly Observed Treatment, Short Course (DOTS) coverage. The project supported the training of clinicians on the management of DR-TB, as a result of gaps identified in supported DR-TB review meetings. The national Pharmaco-vigilance Committee, in collaboration with the USAID TB CARE II Project, rolled out training on pharmaco-vigilance, with focus on the increasing number of clients reporting adverse events, in particular hearing loss. The project provided didactic instruction to 253 clinicians on MDR-TB management, including managing side-effects and use of newer second-line regimens (Bedaquiline). The improved side-effect profile and enhanced management of DR-TB have contributed to improved treatment outcomes. During the period under review, supported districts reported an average treatment success rate of 84.1%, with nine supported districts reporting a treatment success rate of above 85%. Over 1,300 of Drug-Resistant TB (DR-TB) clients were enrolled on newer second-line drugs (i.e. Bedaquiline) in the supported districts. The project's efforts to improve the quality of TB services, increase the availability of TB treatment, increase demand for TB services, improve management of TB support systems, and test new approaches for expanding DOTS coverage have contributed to improved treatment outcomes and increased access to TB services.