tb care annual work plan and budget
Post on 01-Oct-2021
3 Views
Preview:
TRANSCRIPT
USAID TB CARE II Project
Bangladesh Funded by United States Agency for International Development, Bangladesh
Quarterly Report January – March, 2014
April 30, 2014
University Research Co., LLC Bethesda, Maryland
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 2
TABLE OF CONTENTS
1 EXECUTIVE SUMMARY ........................................................................................... 4
2 INTRODUCTION ....................................................................................................... 5
2.1 Implementation Approach ................................................................................................. 5
3 MAJOR ACCOMPLISHMENTS ................................................................................ 5
4 ACCOMPLISHMENTS BY RESULTS ...................................................................... 6
4.1 Improved Access to quality TB and MDR-TB Services ................................................ 6
4.2 Improved Knowledge and Practices on TB and MDR-TB ........................................... 12
4.3 Increased Adherence to TB and MDR-TB Treatment .................................................. 14
4.4 Improved Capacity for Governance and Management of TB at all levels ................... 15
4.5 Increased Private Sector Participation in TB Prevention and Control ......................... 15
4.6 Strengthened Support Systems for effective delivery of TB services .......................... 16
5 SPECIAL EVENTS .................................................................................................. 18
6 CHALLENGES ENCOUNTERED AND ADDRESSED ............................................ 19
7 PERFORMANCE MONITORING PLAN ................................................................ 19
8 PLANS FOR THE NEXT QUARTER ...................................................................... 21
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 3
LIST OF ACRONYMS ACSM Advocacy, Communications, and Social Mobilization
AFB Acid-Fast Bacilli
AIDS Acquired Immune Deficiency Syndrome
APW Agreement of Performance of Work
BIRDEM Bangladesh Institute of Research & Rehabilitation for Diabetes, Endocrine
and Metabolic Disorders
cPMDT Community based Programmatic Management of Drug Resistant TB
CDC Chest Disease Clinic
CDH Chest Disease Hospital
CHWs Community Health Workers
COPD Chronic Obstructive Pulmonary Disease
DAB Diabetic Association of Bangladesh
DOTS Directly Observed Treatment, Short-course
DST Drug Susceptibility Test
EQA External Quality Assurance
FAST Finding TB patients, Actively, Separating safely, Treating effectively
GFATM Global Fund to Fight AIDS, TB and Malaria
GLC Green Light Committee
GOB Government of Bangladesh
HIV Human Immunodeficiency Virus
IC Infection Control
IPT Isoniazid Preventive Therapy
MDR-TB Multi drug-resistant TB
MOH Ministry of Health and Family Welfare
NASP National AIDS and STD Program
NGMP Non-graduate Medical Practitioner
NIDCH National Institute of the Diseases of the Chest and Hospital
NTRL National TB Reference Laboratory
NTP National Tuberculosis Control Program
PMP Performance Monitoring Plan
PPM Public Private Mix
QA Quality Assurance
RTRL Regional TB Reference Laboratory
TB Tuberculosis
TLCA TB and Leprosy Control Assistant
UH&FPO Upazila Health and Family Planning Officer
UPHCSDP Urban Private Health Care Service Delivery Project
URC University Research Co., LLC
USAID United States Agency for International Development
USG United States Government
WHO World Health Organization
XDR Extremely Drug Resistant
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 4
1 EXECUTIVE SUMMARY
This report presents progress made in implementation of the planned activities towards achieving the
project objectives in the second quarter of FY 2014 (January-March 2014). As outlined in the work plan,
the implementation focused on developing capacity of NTP and NGOs in screening, diagnosis and
management of all forms of TB, expanding access to diagnosis and management of MDR TB,
strengthening health systems especially laboratory services and systems, improving knowledge and
awareness about TB, and strengthening private sector participation in the TB control program.
The total case notification of new and relapse cases at the national level has increased significantly over
the past 2 years. The total notification increased by 12% in 2012 over 2011 and by 13% in 2013 over the
preceding year. Increase in notification of smear negative and extra-pulmonary TB has mainly contributed
to this change. Detection of child TB remained a challenge with no noticeable change in overall
notification.
Currently, the project has been providing technical and financial support to ten local NGOs sub-grantees
for increasing detection of TB cases and improving knowledge and awareness about TB. The sub-grant
programs are implemented particularly in underperforming districts and targeted to vulnerable
populations. The DAB project contributed to detection and treatment initiation of 174 TB cases of all
forms among the DM patients. Case detection has continued to increase through other sub-grantees
supported by the project. HEED and six other sub-grantees detected an additional 1,395 TB cases among
their target populations. Apart from behavior change communication and social mobilization activities, the
networking developed with 2,897 private providers through NGO sub-grantees contributed to
identification of 13,955 presumptive TB cases during the current quarter.
Detection and enrollment of DR TB patients have been increasing steadily against all odds since 2012
when the MDR TB intervention was started. In the current quarter, 172 patients have been enrolled to
treatment. The project PMDT strategy has been remarkably successful in Chittagong district. In less than
two years after the intervention has started, the detection of MDR TB increased to 54% of estimated
yearly case load of MDR-TB in Chittagong. Enrollment has reached 100% of the diagnosed cases leaving
no patients waiting for the life-saving treatment. Expansion of community based treatment of patients is
proceeding as per work plan. During this quarter, the project has trained 345 field level health
professionals of the Outpatient DR TB teams from twelve new districts to develop their capacity for
management of patients. A total of 102 patients have been enrolled in to cPMDT for continuation phase
treatment in this quarter.
The project completed the calibration process of 12 Xpert machines by certified engineer during this
period. The Xpert MTB/RIF test has become the primary diagnostic tool for Bangladesh in detection of
MTB Rif resistant cases. The project has plans to procure and install 35 GeneXpert machines to
decentralize and increase detection of RIF resistant and smear negative pulmonary cases. The project has
already procured 12 of these machines and the remaining will be procured subject to USAID approval.
Currently, GeneXpert testing services are available through 27 sites. In this quarter, Xpert tests were
performed for a total of 8,702 samples including 1,945 DR TB presumptive cases. This helped detection
of 229 RIF resistant cases as well as 866 smear negative pulmonary TB cases.
Counseling of MDR TB patients is taking place on a routine basis. At NIDCH, the project staff provided
pre-admission counseling informing the patients about treatment duration, intensive and continuation
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 5
phase treatment, release from hospital, transfer to home for continuation phase, treatment services at
home, and infection prevention practices. Individual and group counseling were also organized for the
patients during the in-patient treatment period. At the community level, the DR TB DOT providers
regularly counseled the patients on cPMDT during home visits.
As part of health system strengthening, the project continued its effort to develop capacity of NTP and
NGOs lab technicians in the operation and management of GeneXpert, LED microscopes and culture and
DST. The project supported to jointly organize the 2nd SEAR Conference on TB and Lung Health in
Dhaka with The Union and NATAB.
Implementation of the FAST approach for active screening of presumptive TB cases especially at large
hospitals went as planned. The project has expanded this approach to all TB and non-TB wards of the
NIDCH. This initiative has contributed to identifying 1,075 presumptive TB cases this quarter and
detection of 131 TB including 7 RIF resistant cases. The project also scaled up the FAST approach in
BIRDEM.
2 INTRODUCTION
TB remains a major public health problem in Bangladesh. The country ranks sixth among 22 highest
burden TB countries in the world. It is estimated that more than 350,000 new TB cases of all forms
emerge each year (WHO 2013 report). In 2012, 161,790 new TB cases were notified to NTP. The case
detection rate for all cases has increased from 45 in 2011 to 49 in 2012 per 100,000 populations. The
proportions of smear-negative and extra-pulmonary cases are still low. The detection of childhood TB is
also low at 3% although childhood TB is estimated to be 11% of the total disease burden.
The burden of multi-drug resistant (MDR) TB is a considerable threat for Bangladesh. According to WHO
report 2012, MDR TB is estimated at 1.4% among new and 28.5% among retreatment cases.
Approximately 4,200 MDR TB cases are generated every year. Child TB remains under-diagnosed due to
lack of health system capacity. Approximately 70,000 people die from TB every year and many of these
deaths could be prevented through universal and early access to TB services.
2.1 Implementation Approach
The TB CARE II Bangladesh project works with National TB Control Program (NTP) as well as with
local NGO partners to implement the project. Technical assistance is provided to NTP to expand and
strengthen universal and early access to TB services, strengthen diagnosis and management of DR TB,
enhance capacity and quality of the lab services, and strengthen health systems.
The project also supports a grants program through the local NGO implementing partners to implement
community based activities to increase case detection through active screening of vulnerable populations
and contact tracing, public-private mix (PPM), and integrating TB with the existing MCH and FP services.
The grants program also supports a combination of ACSM activities to improve people’s knowledge and
awareness about TB, make behavioral changes in care seeking practices, improve adherence to treatment
and infection prevention.
3 MAJOR ACCOMPLISHMENTS
The project has successfully implemented a number of the activities planned for this quarter. Major
accomplishments are presented below:
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 6
National case notification of all forms of new TB cases increased by 13% from 2012 to 2013.
Notification of smear negative pulmonary TB cases increased by 73% during the same period;
Project sub-grantee DAB detected 174 TB cases among diabetes of all forms during this reporting
quarter;
Tested 1,805 DR TB presumptive cases by GeneXpert and diagnosed 172 MTB RIF cases;
Tested 6,827 smear negative presumptive cases by GeneXpert and diagnosed 866 MTB positive
including 57 MTB/RIF resistant cases;
Enrolled 172 new MDR TB patients in to treatment and transferred 102 patients to community for
continuation phase treatment;
Conducted basic and refresher training on cPMDT for 394 Outpatient DR TB team members from
Upazila Health Complexes;
Provided training on the operation and management of GeneXpert for 11 lab technicians;
Conducted training on culture and DST for 7 lab staff from RTRLs;
Organized training for 23 lab staff on AFB sputum smear microscopy using LED;
Conducted orientation including refresher on mHealth application for 244 NTP and NGO staff
including 87 DOT providers from upazilas and districts;
Provided orientation on waste management for 438 health professionals from NTP and NGOs;
Conducted training for 10 CDH staff from CDH Barisal on management of MDR TB patient to
support enrollment of MDR TB patients;
Trained 241 physicians on diagnosis and management of childhood TB and 781 health workers on
screening and referral of presumptive child TB cases;
Installed 10 solar panels in selected microscopy centers to ensure uninterrupted operation of labs for
quality and quick diagnosis;
Completed procurement of 12 Xpert machines;
Oriented 404 health professionals on TB Infection Control;
Organized networking meetings covering 1,092 graduate and 1,805 non-graduate private providers
through the NGO grants program;
Collaborated with NATAB and The Union to jointly organize the 2nd SEAR Conference on TB and
Lung Health in Dhaka;
Organized quarterly workshop to review Xpert lab data to monitor quality and performance of DR TB
diagnostics and monitoring services;
Organized EQA workshops to review the EQA procedures and developed actions for improvement;
4 ACCOMPLISHMENTS BY RESULTS
4.1 Improved Access to quality TB and MDR-TB Services
4.1.1 Increase detection and management of TB through NGOs sub-grantees
The TB control program in Bangladesh is implemented by NTP through a partnership with the local
NGOs. The NGOs are primarily responsible for the community level screening and suspect identification
which are the first two steps in the diagnosis of TB. The NGOs are also responsible for providing DOTS
to the patients, counsel patients on treatment adherence, and conduct awareness and social mobilization
activities.
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 7
Currently, the project has been supporting nine different sub-grants with local NGOs to implement
community based TB control activities particularly in underperforming districts and targeted to
populations living in urban slums and rural inaccessible areas. The results achieved through the sub-grant
programs are discussed below.
BRAC Wave 1 Grant
BRAC has been implementing the largest grants program in 12 districts of the country with a population
of 29 million. The project support to BRAC districts addresses the gaps in Global Fund supported
activities to increase detection of all
forms of TB. The major focus of the
project support is to increase detection of
smear negative TB and EPTB cases.
Financial support is given to poor
patients to reimburse diagnostic and
transportation costs incurred for detection
of smear negative and EPTB cases.
The case notification by BRAC in the
current quarter has slightly increased
compared to the previous quarter (Oct-
Dec 2013); EPTB cases have increased
by 14% as shown in the Figure 1 above.
BRAC has provided financial support to
857 smear negative and 237 EPTB
patients. The project also supports BRAC to provide TB services in 12 prisons. This effort contributed to
testing sputum samples of 326 prison inmates and detection of 9 TB cases. Treatment has been initiated to
all the patients.
BRAC Wave 3 Grant
BRAC has been awarded a new sub-grant under Wave 3 in December 2013. The objective is to increase
additional case detection in 71 sub-districts under 10 new districts covering a population of 20.5 million.
The project has just completed the first quarter of implementation. Out of 59,240 presumptive TB cases
identified, 6,177 TB cases of all forms were detected. The rate of smear negative cases detected in the
three month period is more than 50% of the yearly target set for these 10 districts under project support.
Contact tracing in the households of index cases is a focus of this project. The project screened 9,660
close contacts of TB patients, identified 1,039 of presumptive TB cases and detected 70 TB cases. The
following Table 1 shows the proportion of targets achieved in the second quarter. The baselines represent
case detection with Global fund support.
Table 1: Wave 3 BRAC Project: Case Detection Performance
Category Baseline 2014 Target Achievements Qtr 2 % Achieved of Target
Smear Positive 14,754 15,455 3,730 24%
Smear Negative 1,769 2,686 1,707 64%
EP 2,116 3,213 709 22%
Child TB 341 615 102 17%
0
2000
4000
6000
8000
10000
12000
Figure 1: Trends in case notification in 12 BRAC districts
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 8
Diabetic Association of Bangladesh (DAB)
The project has been supporting Diabetes Association of Bangladesh (DAB) to increase access to TB
services by the diabetes patients through an integrated approach with a focus on active screening of
diabetes patients for detection and
management of TB. A referral
system has been established between
diabetes service facilities and DOTS
centers for diagnosis and
management of co-morbidities.
In the January-March quarter, the
DAB project detected 174 TB cases
of all forms among the DM patients.
Treatment has been initiated for all
the diagnosed patients through the
DOT center at the BIRDEM hospital.
Figure 2 shows the case detection
trends of TB cases since beginning of the project in April 2013. DAB provides regular counseling of DM
patients to improve their knowledge about increased risks of TB among DM patients, prevention and early
care seeking for TB services. In this quarter, DAB staff counseled 6,640 DM patients.
In this quarter, the project assisted DAB in providing training to the doctors, nurses and other health staff
of the BIRDEM and affiliated facilities. A total 112 doctors and nurses from the BIRDEM General
Hospital, National Health Care Networks (NHN), Bangladesh Institute of Health Sciences (BIHS) and
other affiliated centers participated in this training on diagnoses and management of TB among diabetic
patients. The participants also received practical knowledge on DOTS strategy, its applicability and
methods of quick screening and referral.
HEED
The sub-grant with HEED Bangladesh supports implementation of DOTS and ACSM activities targeted to
650,000 people living in 157 tea gardens of Sylhet, Habiganj and Moulvibazar districts. HEED
Bangladesh has set up 25 sputum collection and smearing centers in the tea garden areas. All these centers
are linked to the labs where the sputum slides are sent for microscopy test. The case detection in the
HEED areas has steadily increased since the beginning of the project in April 2012. During this quarter,
HEED detected 198 smear positive, 128 smear negative and 66 EPTB cases. The case notification of all
forms of TB has slightly declined from the previous quarter. Poor economic conditions and low literacy
rates among the tea garden workers and limited access to health care services are major barriers to
improving and sustaining TB control activities among this target population.
Wave 3 Sub-grantee Performance
In addition to BRAC, the project also awarded 6 (six) sub-grants to local NGOs for increasing detection
and management of TB cases in low performing districts in Wave 3. The project support through these
NGOs is aimed at complementing the Global Fund activities by way of addressing the programmatic and
geographic gaps. During this quarter, 1,003 TB cases of all forms have been detected and initiated on
treatment with project support. Table 2 summarizes the performances of these NGOs for this quarter.
15
62
48
78
14
54
35
64
21
52
36 32
0
10
20
30
40
50
60
70
80
90
Apr - Jun’13 Jul – Sep’13 Oct– Dec’13 Jan-Mar'14
Figure 2: Detection of TB Among DM Patients
DM patients diagnosed as sputum positive for pulmonary TB
DM patients diagnosed as sputum negative for pulmonary TB
DM patients diagnosed as EPTB case
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 9
Table 2: Case Detection by Wave 3 NGO Sub-grantees
Name of NGO Q1 FY14 Q2 FY14
Smear positive
Smear Negative
EP TB Total Smear positive
Smear Negative
EP TB Total
BCCP 94 66 83 243 98 104 110 312
Leprosy Mission 180 15 11 206 179 34 16 229
Lepra Bangladesh 228 9 9 246 241 23 17 281
Nari Maitree 45 5 9 59 48 5 12 65
FIDA 69 33 6 108 64 47 3 114
PIME Sisters - - - - 2 0 0 2
Total 616 128 118 862 632 213 158 1003
4.1.2 Case Notification at the National Level
The total case notification of new and relapse cases at the national level has increased significantly over
the past 2 years (Figure 3). The total notification increased by 12% in 2012 over 2011 and by 13% in
2013 over the previous year. Increase in notification of smear
negative and extra-pulmonary TB has mainly contributed to this
change. Detection of child TB remained a challenge with no
noticeable change in overall notification. There has been a slight
increase in detection from 4,842 to 5045 between 2012 and
2013.
The notification of smear positive pulmonary cases has slightly
dropped in 2013 over the previous year (Fig 4). Over the past
two years, notification of smear negative pulmonary cases has
shown the highest increase (Fig 5). The total number of smear
negative cases notified increased from 24,451 in 2013 to 42,361 in 2013, an increase of 73%. Among
other factors, TB CARE II strategies geared to detection of smear negative cases using GeneXpert and
targeted community based effort through the NGO grants program have partially contributed to this
change.
Detection of extra-pulmonary TB cases has also increased over the past years (Fig 6). The notification of
EPTB increased from 27,329 in 2011 to 33,671 in 2013, an increase of 23%. The increase is 10% between
2012 and 2013. Increasing detection of EPTB is also a primary focus of the grants program supported by
the project through the NGOs.
25000
26000
27000
28000
Q1 Q2 Q3 Q4
Fig 4:Notification of SS (+)
2012 2013
5000
7000
9000
11000
13000
Q1 Q2 Q3 Q4
Fig 5: Notification of SS (-)
2012 2013
5000
6000
7000
8000
9000
10000
Q1 Q2 Q3 Q4
Fig 6: Notification of EP
2012 2013
2010 2011 2012 2013
153471 150899 164855
186481
Figure 3: National Case Notification New and Relapse
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 10
4.1.3 Detection and management of child TB cases
Strengthening and scaling up pediatric TB services will remain a major focus of TB CARE II Bangladesh
project. The project through its partnership with the Bangladesh
Pediatric Association is supporting training of pediatricians,
doctors, general physicians and health workers from the upazila
level to develop their capacity in screening, referral and diagnosis
of TB cases. In the current quarter, 241 doctors including Upazila
Health and Family Planning Officer (UHFPO), Medical Officer
(Disease Control), pediatricians and general physicians from
different upazilas of Dhaka division have been trained. As part of
this training, participants are
also required to develop local
level plans with targets for detection of child TB cases in their
respective areas. During this quarter, the project has also supported
BPA to orient 781 health workers from the upazilas on screening and
referral of presumptive child TB cases.
Detection of child TB has also been incorporated as a focus of the
grants program. The project has been supporting the NGOs to
conduct systematic contact tracing at the households of index patients
and targeted communication activities through community outreach mass media to address this challenge.
Providing IPT to eligible children living in the families of active TB patients is also part of the grants
program. As part of this program, the NGO partners evaluated 961 children and registered 72 children for
IPT in the current quarter. Also in this quarter, 13 children among the 14 registered children for IPT
during April-June 2013 quarter have completed the full course of prophylaxis.
4.1.4 Diagnosis and Management of Smear Negative and EPTB cases
Smear Negative Cases
Use of GeneXpert test for diagnosis of smear negative TB is making a significant difference in detecting
smear negative pulmonary TB as well as RIF resistant TB cases. The project has established referral
systems to enable the peripheral microscopy labs to refer smear negative cases to the GeneXpert sites for
testing. During the reporting period, a total of 6,827 smear negative presumptive TB cases have been
tested, and detected 866 MTB positive including 57 MTB/RIF resistant cases. The proportion of smear
negative cases detected is 13% of the total number smear negative presumptive cases tested by
GeneXpert. The Table 3 shows the project progress for testing and detection of smear negative TB cases.
Table 3: GeneXpert Test Results for Smear Negative TB
Period Total Tested MTB MTB Positive % MTB+RIF RIF Positive %
Oct-Dec’13 2,447 344 14 15 .61
Jan-Mar’14 6,827 866 13 57 .83
Extra-Pulmonary TB (EPTB)
The project has been supporting community level screening and awareness building activities to increase
detection of EPTB. The project also support diagnostic and transportation costs for the poor people
Local Level Planning for Child TB
Contact Tracing at a Household
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 11
suspected of EPTB. The result of this effort is showing gradual increase in the detection of EPTB cases in
the project supported areas. More than 500 EPTB cases have been detected by the NGO sub-grantees
during this quarter. The project is also continuing its work with CLA to field test and finalize the
screening and diagnostic algorithms adapted to Bangladesh context for increasing detection of EPTB
cases.
4.1.5 Expand Capacity for Detection and Management of DR TB Services
Detection of MTB and MTB/RIF by GeneXpert
In this reporting period, GeneXpert test was performed for a total of 8,702 samples including 1,805
presumptive DR TB cases.
This helped detection of 229
RIF resistant cases including
172 from among DR TB and
57 from among smear negative
presumptive cases. Of the total
samples tested, 22% were
MTB positive and 3% were
MTB RIF positive. The
detection of MTB positive and
RIF resistant TB among the presumptive DR TB cases (retreatment, Cat I and II failures, late converters)
is 9.5%. Figure 7 and 8 show the GeneXpert test results.
4.1.6 Strengthening Programmatic Management of DR TB (PMDT)
The project assisted NTP to develop a national plan for expansion of PMDT. According to this plan, the
target for NTP is to expand MDRTB treatment coverage for 70% of the estimated number of cases that
develop annually by the year 2017. In order to implement this plan, the TB CARE II project adopted a
two-pronged strategy designed to expand both facility and community based capacity for decentralized
management of MDR TB.
Improve Community Level Management of MDR TB
The community based model has been rolled out to 19 districts and three city corporation areas in the last
two years. In FY14, the project plans to expand this model to another 20 districts and consolidate the
program in the existing districts to continue increasing access to treatment. During this quarter, the project
trained 345 field level health professionals of the Outpatient DR TB teams on cPMDT from twelve new
districts to develop their capacity for management of cPMDT patients. In addition, the project organized
refresher training for 49 participants of Outpatient DR TB team. The training aims at developing
programmatic and clinical capacity of the team members to be able to provide on-going treatment and side
effects management support to the MDR TB patients.
Enrollment of patients to DR TB treatment
The project strategy seeks to ensure that all detected MDR TB patients are enrolled to treatment without
any delay. The limited number of hospital beds for treatment of MDR TB remains a challenge although
the project support has enabled NTP to double the capacity over the last two years.
60% 9%
31%
Fig 7: Xpert Test Result - DR TB Suspect
MTB+
MTBRIF
GXNeg
22% 3%
75%
Fig 8: Xpert Test Result All
MTB+
MTBRIF
GXNex
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 12
Detection and enrollment of DR TB patients have been increasing steadily against all odds since 2012
when the MDR TB intervention was started. Figure 9 shows the diagnosis and enrollment of MDR TB
patients for the last six calendar years. In the current quarter, 172 patients have been enrolled to treatment.
The project PMDT strategy has been remarkably successful
in Chittagong district. According to NTP report 2012, new
notified PTB cases were 8,646 and retreatment cases were
302. This translates to approximately 207 MDR-TB cases per
year in Chittagong district (at 1.4% of the notified new
pulmonary TB cases and 28.5% of the retreatment cases.) In
less than two years after the project has started the
interventions, the detection of MDR TB increased to 54% of
the estimated yearly
case load of MDR-
TB in Chittagong.
Most importantly, the project strategy has been effective to reach
100% enrollment of the diagnosed cases leaving no patients
waiting for the life-saving treatment.
The project has planned to expand DR TB treatment through 4
CDHs in this year. A preliminary assessment has been completed
to estimate the renovation works that will start from the next
quarter. The project has completed renovation of an XDR TB
ward with 4 beds at NIDCH. The project also conducted training
of 10 staff including doctors, nurses and other support staff from CDH Barishal to develop their skills in
clinical and programmatic management of DR TB.
The project routinely organizes performance review meetings at the district level with the DR TB DOT
providers to improve coordination of cPMDT activities and provision of DOT services for the DR TB
patients. During this quarter, the project staff facilitates review meeting in Chittagong and Gazipur
districts. These meetings are organized to identify implementation issues including coordination of
cPMDT activities, availability and supply of drugs, patient compliance with treatment, patient support,
side effects management, generation of social support for the patients, and roles and responsibilities of the
DOT providers and project staff in resolving these issues.
4.2 Improved Knowledge and Practices on TB and MDR-TB
4.2.1 Communication Activities at the National Level
The project supported 6-month long communication campaign through TV and Radio channels to improve
mass knowledge and awareness about child TB and MDR TB has ended in this quarter. A total of 1,800
TV spots and 3,000 Radio spots were aired on child TB and MDR TB through different TV and Radio
channels. A survey will be conducted in April-May to evaluate the effectiveness of this campaign in
raising knowledge and awareness about TB and its impact on care seeking for TB services.
As per the FY 2014 work plan, the project has selected a local media agency in planning and
implementing a comprehensive communication campaign on “We Want Zero TB Deaths in our Life
Time” theme. New media materials with focus on MDR TB, child TB, treatment adherence, infection
2008 2009 2010 2011 2012 2013
448 360
480
612
701
807
231 351
356 390
503
685
Fig 9: Diagnosis and Enrollment of MDR TB
Diagnosed
Enrolled
15
70
108 112
0
40
88
112
2010 2011 2012 2013
Fig 10: Diagnosis and Enrollment in Chittagong District
Diagnosed Treatment Enrollment
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 13
prevention, and referral by private providers will be developed and aired through TV and Radio channels
and displayed through bill boards. Talk shows and health programs will also be aired to inform and
educate the public about TB, and initiate discussions for a wider understanding of the disease burden and
its consequence. The campaign is expected to start beginning the third quarter.
In this quarter, the project supported DAB to organize a television program on TB-DM that was aired on
private local television channel (RTV). The live program was aired for 15 minutes and the discussion
covered different critical issues on TB-DM co-morbidities. Besides the TV program the project has also
conducted two radio programs through “Abc Radio.” Discussion aimed to sensitizing people about the
increased risk of TB for diabetes patients, benefits of early detection, and management of co-morbidities.
The viewers also joined the discussion through phone and asked questions for expert opinions.
4.2.2 Community-based Awareness Activities
The project sub-grantees conducted different behavior change communication and social mobilization
activities to increase people’s knowledge and awareness about TB and promote early care seeking for TB
services. The project partner HEED conducted orientation for 959 tea factory workers and 826 tea garden
women workers to reach TB messages. The sub grantee also arranged advocacy meetings with tea garden
management staff, local health managers and community leaders; enter-educational events such as pot
show, drama and gombhira in the tea gardens to communicate TB messages. The project also oriented 183
cured TB patients as peer educators to support existing TB patients in treatment adherence as well as to
identify and refer presumptive TB cases from the community.
The grants program through Bangladesh Center for Communication Programs (BCCP) oriented 25
graduate private practitioners on identification and referral of presumptive TB cases, organized 105 video
shows in the slums and 10 street dramas at different locations, conducted 207 community group meeting
and 34 advocacy meetings with local community leaders. BCCP also organized orientation on the use of
BCC materials for 50 NGO service providers. This generic guideline for the use of BCC materials on TB
screening will be used as a job aid by the field workers of all the NGOs working on TB.
TLMI Bangladesh oriented 10 graduate private practitioners on identification and referral of presumptive
TB cases. Project staff visited household of TB patients for contact investigation. During these visits,
7,426 family members investigated for TB screening, 431 suspects identified and 21 TB cases were
detected. The sub grantee conducted 9 advocacy meetings for 119 union council members and government
senior health staff, 5 community group meetings, 7,595 courtyard meetings, and 4 events of folk songs
and drama to raise community awareness about TB.
The project sub-grantee Lepra oriented 515 non-graduate private practitioners, 197 government. health
staff and 220 MCH health workers on screening and referral of presumptive TB cases. This NGO also
conducted orientation for 1,300 school students on signs and symptom of TB using different IEC
materials. The NGO staff conducted household visits for contact tracing, 820 community group meetings
and 11 film shows in the evening reaching more than 8,000 people with messages on TB.
Nari Maitree conducted orientation on FAST approach for 80 staff of different Primary Health Care
Centers (PHCC). The project volunteers conducted 6,111 household visits in the specified slum areas to
identify people with TB symptoms, 3 community awareness meetings and 5 advocacy meetings with local
community leaders and teachers from religious institutes and orphanages to generate their support to and
participation in the project activities.
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 14
The project staff of FIDA made 4,622 household visits and conducted 359 courtyard meetings with the
community people to sensitize them about TB disease and promote early case detection. FIDA installed 45
sign boards with TB messages at Union Parishad premises and distributed 100 festoons in different
institutions. The sub-grantee conducted 90 STOP TB forum meetings with community leaders to raise
awareness on TB.
PIME Sisters has started the project in December 2013. The sub-grantee completed recruitment of project
staff in the reporting period. During the quarter, the project staff conducted 2,023 household visits and
contacted 8,092 family members for TB screening. A two-day long orientation for 10 field workers and 2
supervisors was conducted by the project staff on program implementation, recording and reporting.
4.2.3 Promotion of TB Messages through Print Media
The project printed and distributed different communication materials, e.g., posters, stickers, and leaflets
with TB messages to raise public awareness about TB. The materials are displayed at the government and
NGO health facilities, DOTS centers, and sub-grantee working areas. During this quarter, the project
printed 2,000 posters on infection control, MDR TB brochure, 2,000 child TB poster and 40,000 stickers.
The project also developed and printed 10,000 Bangla child TB booklets for field health workers to assist
them in community screening for identification of child TB presumptive cases.
4.3 Increased Adherence to TB and MDR-TB Treatment
4.3.1 Counseling of DR TB Patients
The DR TB patients are counseled at the time of admission, during inpatient treatment at the hospital and
continuation phase of treatment at the community. The project has been supporting a Counselor at the
NIDCH where the largest number of DR TB patients is enrolled for treatment. During the current quarter,
all the patients received pre-admission counseling informing the patients about treatment duration,
intensive and continuation phase treatment, when patients are released from hospital and shifted to home
for continuation phase, how the patient will receive treatment services at home, and infection prevention
practices.
The counselor also organizes individual and group counseling for the patients. The counseling is tailored
to ensure treatment adherence by the patients and to provide psychological and emotional support to help
patients manage the side effects and overcome depression and stress due to prolonged and complicated
treatment. During this quarter, the Counselor conducted 79 individual counseling sessions at the NIDCH.
The counseling during the continuation phase of the treatment is provided by the DR TB DOT providers
who visit the patients at their homes for administration of drugs. During home visit, the DOT providers
also provides counsel tailored to individual patient needs with emphasis on helping the patients to adhere
to the treatment regimen, manage the side effects and complete the treatment successfully. Almost all the
patients on continuation phase of treatment received counseling by the DT providers.
4.3.2 Vocational training for MDR-TB patients
The project continued to support a Vocational Trainer at the NIDCH for providing training on cutting and
sewing dresses. The training is intended to help the patients manage depression and stress and complete
the treatment, and develop vocational skills that they would be able to use for income generation. A total
of 31 DR TB patients, mostly female, participated in this training. The trainer also helped patients make
protective masks which are used by the patients themselves.
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 15
4.3.3 Education and counseling for the DM patients
The education and counseling of the diabetic patients are routinely conducted at the BIRDEM hospital.
DAB with project support has integrated TB counseling with diabetes and uses audio-visual materials for
interactive and effective counseling. Following each sessions, counselors and health assistants operate
active screening to identify presumptive TB cases among DM patients and refer them to the DOTS center
located at the hospital for microscopy test. During this quarter, DAB organized 72 counseling sessions and
counseled 6,640 diabetes patients at the BIRDEM hospital.
4.4 Improved Capacity for Governance and Management of TB at all levels
4.4.1 Exposure to best practices and innovations
The project supported NATAB and The Union to jointly organize the 2nd SEAR Conference on TB and
Lung Health in Dhaka from 9-12 March, 2014. The project supported NTP and sub-grantee staff to
participate in the conference to expose them to the best practices and innovative models and share their
experience on TB and MDR TB management.
The project staff made oral presentations on scaling up of community based management of MDR TB and
rolling out Xpert MTB RIF in Bangladesh. Several poster presentations were made covering project
experience in improving drug adherence using smartphone application, increasing case detection among
vulnerable populations, and potentials for diagnosis of smear negative and extra-pulmonary TB using
GeneXpert. The project sub-grantees Bangladesh Pediatric Association and Diabetic Association of
Bangladesh made oral presentations to share their experiences in management of childhood TB and
management of TB-Diabetes Co-morbidities which are being implemented by these two partners with
technical support of the TB CARE II project.
4.5 Increased Private Sector Participation in TB Prevention and Control
4.5.1 Expanded Public Private Mix (PPM) network through NGO Sub-grantees
The project has been supporting PPM activities through the grants program to engage formal and informal
private sector service providers in TB control program. In order for enhancing functional linkage and to
increase suspect referral, the NGOs conducted orientation of graduate and non-graduate private providers
on screening and referral of presumptive TB cases. The project also supported BRAC to conduct
networking meetings with these providers to strengthen linkage and referral of cases to the DOTS centers
for diagnosis and management.
During this quarter, the project supported NGOs oriented 35 graduate doctors and 515 non-graduate
doctors. Networking meetings were conducted with 1,057 graduate and 1,290 non-graduate private
providers. The PPM effort contributed to identification and referral of 13,955 presumptive TB cases to the
DOTS centers for diagnosis and management during this quarter. The progress in PPM activities by NGOs
comparing the current quarter with the previous period is presented in the Table 4 below.
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 16
Table 4: Orientation and Referrals through PPM
Oct-Dec 2013 Jan-Mar 2014 Sub-Grantee Orientation/
Networking with
Graduate PPs
Orientation/ Networking with Non-
graduate PPs
Presumptive TB case referrals
by PPs
Orientation/ Networking
with Graduate PPs
Orientation/ Networking with Non-
graduate PPs
Presumptive TB case
referrals by PPs
BRAC 1,055 1,207 11,989 1,057 1,290 12,353
FIDA 20 0 15 0 0 118
BCCP 4 16 298 25 0 227
Lepra 0 417 319 0 515 347
Leprosy Mission 0 60 133
10 0 842
Nari Maitree 0 0 38 0 0 68
PIME Sisters 0 0 0 0 0 0
Total 1,079 1,700 12,792 1,092 1,805 13,955
4.6 Strengthened Support Systems for effective delivery of TB services
4.6.1 Strengthen laboratory capacity and performance
Support to NTRL, RTRL and NIDCH
The project has continued its assistance to NTRL Dhaka and RTRL Chittagong with equipment e.g., AVR
for auto generator and autoclave, reagents and consumables, minor renovations and technical support that
were necessary for smooth functioning of the lab as well as for expanding and ensuring quality of
diagnostic services. The project continued to support 4 Microbiologists based at the NTRL and RTRL to
enhance its capacity to provide lab services including DST and culture services. Table 5 shows the
performance of lab services provided through the NTRL for the reporting quarter.
Table 5: NTRL Laboratory Performance
Type of service Laboratory Performance (January-March 2014)
October November December Total
Routine Microscopy 4,921 5,592 5,341 15,854
Routine TB culture 29 47 46 122
Number of 1st line DST 10 10 9 29
Number of 2nd
line DST 5 3 5 13
Improve staff capacity on GeneXpert, Culture and DST
During this quarter, the project assisted NTP to organize GeneXpert training for 11 lab staff. The training
was intended to develop participants’ skills in the new diagnostic tool and use of the national guidelines
for routine screening of MDR TB suspects and smear negative cases. The project also supported the NTP
to organize training on culture & DST for 7 lab staff including microbiologists from RTRLs. Orientations
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 17
on GeneXpert and national guidelines for routine screening of MDR TB presumptive cases were
conducted at CDC Shaymoli, Dhaka and in Cox’s Bazar district. A total of 178 participants including
district and upazila level health managers, Chest Disease Consultants, Medical Officers, Lab
Technologists, nurses and NGO staff attended these orientations.
The project organized a workshop to review Xpert lab data to monitor quality and performance of DR TB
diagnostics and monitoring services. An SOP was developed for culture and DST for diagnosis of
TB/MDR TB and organized workshop to finalize SOP. The project supported NTP to organize EQA
workshops to review the EQA procedures, findings and recommended actions for improvement.
Coverage of GeneXpert Services
Expansion of the GeneXpert technology is a project priority for this year as well. The project completed
the calibration process of 12 Xpert machines by certified engineer during this period. The project procured
12 GeneXpert machines to improve nationwide coverage of the service. The installation will be completed
by early of next quarter after necessary renovation works have been completed. During this period, 28,000
cartridges have been procured and distributed to Xpert sites.
Installation and Operation of LED Microscopes
During this quarter, the project conducted a two-week training course for 23 lab technologists on sputum
microscopy using LED fluorescence microscope. Work is in progress for procurement and installation of
100 LED microscopes planned for FY 2014. These microscopes in additional 200 installed in FY 2013
will be an important resource for NTP to make a system wide improvement in quality and capacity for
smear microscopy for increased and more reliable diagnosis of TB. The 100 LED microscopy sites have
been finalized in discussion with NTP.
Facilitate completion of Khulna RTRL
Commissioning of the Khulna RTRL is one of the priorities of the project. During this quarter, the project
completed renovation works and also completed the procurement of reagents, consumables and glassware
required for Khulna RTRL. Equipments procured with project support have been transported to the lab
site and the operation of the center is expected to start next quarter.
4.6.2 Improve capacity for TB Infection Control
Implementation of FAST
Implementation of the FAST approach for active screening of presumptive TB cases especially at large
hospitals is part of project’s strategy for active case finding. With technical support from PIH, the project
has expanded this approach to all the TB and non-TB wards of NIDCH. This initiative has contributed to
testing 1,075 current TB, other lung diseases patients and lung disease with previous TB patients and
detection of 131 TB cases and 7 RIF resistant cases at NIDCH. The project also scaled up this approach at
BIRDEM.
Capacity development on IC
Training on TB Infection Control is now integrated with other regular training programs on TB. With the
project support, a booklet in Bengali on TBIC has been finalized. During this quarter, the project
organized TB IC orientation for 404 health professionals including doctors, nurses, health assistants, lab
technicians and other staff associated with TB services. The orientation was also designed to update the
participants on waste management procedures for lab and health facilities.
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 18
Waste Management
Managing bio hazardous waste is another area which has never received due attention as it needed. The
project conducted orientation for 438 hospital staff to update them on the essential waste management
procedures and requirements. In addition, the project has plans to extend technical and logistics support to
improve waste management systems at 4 hospitals providing DR TB services. During this quarter, the
project has already functionalized waste management system at RTRL and CDH, Chittagong.
4.6.3 Improved Monitoring and Evaluation of TB control activities
Monitoring cPMDT activities
The project has set up an intensive monitoring and supervision system for effective implementation of
cPMDT activities. The Outpatient DR TB Team members regularly monitor and supervise the DR TB
DOT providers. In addition, project field staffs made monthly visit
to patient’s home to monitor treatment compliance, assess patient
management needs and take follow up actions in discussion with the
Outpatient MDR TB Team.
During this quarter, all the 378 patients under cPMDT treatment
have been visited. Joint monitoring team consisting of
representatives from NTP, WHO and the project also visited the field to
monitor the performance of the Outpatient Team, DR TB DOT providers and patients’ compliance with
treatment.
mHealth for monitoring DOT providers
Currently, mHealth is operational in 16 districts and will be scaled up to cover the remaining other
cPMDT districts in FY14. During this quarter, the project conducted orientation including refresher on
mHealth in Dhaka, Chittagong, Pabna and Sylhet districts. The orientation was attended by 244
participants including 87 DR TB DOT providers and other relevant government and NGO staff. At
present, 229 DOT providers including 71 in this quarter are using mHealth.
As of now, a total of 376 DR TB patients including 108 patients in this quarter have been registered in to
mHealth. Out of them, 19 patients got cured, 4 died in this period and remaining patients are being
supported and monitored through the mHealth. The project is in process of updating the mHealth
applications, expand it to all the cPMDT districts, and use it as a tool for routine monitoring of the DOTS
for patients, administration of drugs, and treatment adherence by patients. The system changes will enable
the project to analyze and generate reports and graphs on patient data by geographic units, treatment
status, gender, etc.
5 SPECIAL EVENTS
Observation of World TB DAY 2014
The theme of the World TB Day 2014 was “Reach the 3 million. Find, Treat and Cure TB”. The project
supported NTP to observe the World TB Day in various ways including organized rallies at national and
divisional levels to raise mass awareness about TB. At regional level mikings and street songs were
organized at different public places to disseminate TB message.
DR TB patient monitoring
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 19
The project also printed and distributed T-Shirts with TB message, distributed leaflet on TB and sticker on
Child to improve awareness about child TB, the project distributed printed entry ticket in two amusement
parks with child TB messages. Using mobile, voice messages were distributed to 600,000 mobile phone
subscribers using the mobile phone network.
USAID Mission Director Visit Project Sites
USAID Bangladesh Mission Director, Ms. Janina Jaruzelski,
visited Kajuri Chora Tea garden in Srimangal to observe the TB
control activities implemented by HEED Bangladesh with TB
CARE II project support. The Mission Director observed two
different ways of TB awareness raising program; group
orientation on TB for local women, and TB awareness raising
outreach activity through "pot song," a popular type of local folk
songs.
6 CHALLENGES ENCOUNTERED AND ADDRESSED
Utilization of GeneXpert is satisfactory in large metropolitcan cities, RTRLs and some Chest Disease
Hospital. Challenges remain to increasing utilization particularly at the district level facilities. Many
physicians at these facilities do not fully comply with the policy guidelines that require referral of
presumptive MDR TB and smear negative cases for GeneXpert test. Referral from the peripheral
microscopy centers on which the uilization of GeneXpert depends to a large extent is also a challenge
either because the doctors are not fully aware of the availability of the test or the patients are unwilling to
come to the Xpert facilities as they are unable to bear the transportation costs. The project has planned
advocacy meetings at the district levels involving physicians from the districts and upazilas to update them
on the national policy and expand sputum collection and transportation system to address these issues.
The limited number of MDR TB beds continues to be an issue with regard to increasing enrollment of
diagnosed patients across the country and reducing treatment initiation delay. The project is supporting
NTP to increase inpatient management capacity through district level chest disease hospitals. Besides, the
project staff is enaged in continuous dialog with NTP to initiate ‘zero day’ treatment for all diagnosed
patients unless the clinical assessment indicate the need for hospitalization.
The proportion of child TB cases detected is very low. Acute shortage of skilled staff both at the facilities
and field level and limited or no availability of diagnostics at the local level are major barriers to change
the situation. The project strategies to address this challenge include training of doctors and fields
workers on screening and diagnosis of child TB cases, systematic contact tracing, developing referral
linkages with diagnostic facilities, and supporting communication activities at the community level and
through mass media.
7 PERFORMANCE MONITORING PLAN
The TB CARE II project is designed to strengthen and improve performance of National TB control
program. Except for some project specific indicators, the project has adopted the NTP service delivery
indicators for reporting its performance. Therefore, the project exclusively relies on NTP Management
Information System (MIS) for collection and reporting of TB case detection, treatment outcomes, and
laboratory performance data. At this time, the NTP MIS has completed compilation of data for the
USAID mission director visits HEED project
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 20
October-December quarter of 2013. The project used this data for analysis and reporting the performance
as presented in Table 6.
Table 6: Indicators reported using NTP Management Information System
Outcome Indicators Baseline
2010
Target
CY 2013
Result
CY 2013
CY 2013
Qtr 1
CY 2013
Qtr 2
CY 2013
Qtr 3
CY 2013
Qtr 4
Notification Rate of all forms of TB cases 100 104 119.73 Annually Annually Annually Annually
Number of all forms of new TB cases
notified
155,138 163,802 181,436 43,951 48,250 45,677 43,558
Notification Rate of new smear-positive
(SS+) TB cases
70.5 65 68.47 67.7 71 69 65.9
Number of smear Positive (SS+) patients
notified
105,772 106,471 105,404 26,064 27,448 26,534 25,358
Number of smear negative (SS-) patients
notified
21,625 24,196 42,361 9,856 11,600 10,622 10,283
Number of extra pulmonary patients
notified
23,506 26,213 33,671 8,031 9,202 8,521 7,917
Number of child TB patients notified 4,235 6,045 5,045 1,137 1,409 1,341 1,158
Number of children under 5 registered for
IPT
0 0 0 0 0 0 0
Number of new multi-drug resistant-TB
(MDRTB) patients diagnosed and initiated
to treatment
183 600 685 162 170 181 172
Cure Rate of notified SS+ TB cases
90.80% >90% 91.82% 91% 92% 92% 92.1%
Treatment Success Rate of notified SS+ TB
cases (disaggregated by sex)
92.30% >90% 92.9% 92% 93% 93% 93.2%
Treatment Success Rate for MDR-TB cases
65% >65% 69% 77% 56% 69% 68.8%
Percent of labs participating in EQA for
smears
100% 100% 100% 100% 100% 100% 100%
Percentage of concordant slides under EQA
system (high false positive, high false
negative, scanty false positive, scanty false
negative)
99% >95% 98% 98.5% 99% 98% 98.2%
Percent of labs performing TB microscopy
with over 95% correct microscopy results
100% >95% 94.7% 94% 94.8% 94% 94.5%
Smear Conversion Rate of new smear
positive TB cases.
87.1% >75% 85% 86% 85.5% 81% 85.8%
The TB CARE II project also maintains Project Management Information System (PMIS) for monitoring
and reporting on project specific data that is not generated by NTP. The PMIS specifically tracks outputs
of US government investments in capacity building and NGO contributions to TB suspect identification
and referrals as shown in Table 7 below:
Table 7: Indicator reported using TB CARE II Project Management Information System
Indicators Target FY
2014
FY 2014
Qtr 1
FY 2014
Qtr 2
FY 2014
Qtr 3
FY 2014
Qtr 4
1 Number of people trained in DOTS with USG funding 9,235 3,831 3,891
2 Number of service providers trained on management of 16,765 87 1,072
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 21
child TB with USG funding
3 Number of people trained in MDR-TB (clinical care,
MDRTB DOTS, ambulatory care) with USG funding
1,800 197 404
4 Number of private providers participating in TB
program through referrals, diagnosis, treatment, and
follow up
30,000 3,634 3,497
5 Number of TB suspects referred by health care provider
(e.g., health assistant, shasthya shebika, private
practitioners, others) with USG funding
65,000 13,204 14,790
6 Number of lab technologists trained on AFB, LED and
other new diagnostic technology with USG funding
300 33 41
7 Number of service providers trained on Infection
Control with USG support
2,500 67 404
8 Number of people trained in other strategic information
management with USG funding
500 137 258
9 Number of children under 5 registered for IPT with USG
funding
3,000 85 72
10 Number of DR TB suspects tested by GeneXpert 0 1,425 1,805
11 Number of smear negatives sputum samples tested
GeneXpert
0 2,447 6,827
12 Number of HIV patients tested for TB by GeneXpert 0 69 70
13 Number of MTB positive identified by GeneXpert 0 1,311 1,945
14 Number of MTB RIF identified by GeneXpert 0 196 229
8 PLANS FOR THE NEXT QUARTER
Starting next quarter, the project will expand its grants program to support community level activities for
increasing case detection especially in low performing districts. The grants program will have major focus
in conducting systematic contact tracing at households of active TB patients to increase detection of child
TB cases. Communication activities to improve knowledge and awareness about TB and MDR TB and
care seeking for services will be supported at the community level as well as through mass media.
Training of physicians and field workers on screening and diagnosis of child TB will be expanded to other
divisions.
Procurement and installation of GeneXperts at the district facilities will be a major initiative in the
following quarter. Besides, the project has planned to conduct a number of advocacy meetings at the
district levels to update physicians on national guidelines and algorithms for Xpert test. Expansion of
sputum collection and transportation system will be a priority in the next quarter. The system will link the
peripheral microscopy centers with the GeneXpert sites for referral of presumptive DR TB and smear
negative TB cases.
In this quarter, project will support an international expert to develop a bio-safety manual and to
support repair, maintenance, calibration and certification of equipments to improve diagnostic
quality at reference labs. The consultant will provide training of RTRL and NTRL staff on bio-
safety and maintenance of laboratory equipment. Trainees who will serve as bio-safety officers at
their respective laboratories will also receive 2-day training on the development and
implementation of a bio-safety manual. These manuals will be developed by them over the next 5
months. The consultant will also certify 14 bi-safety cabinets during this quarter.
January-March 2014 Quarterly Report, USAID/Bangladesh TB CARE II Project; University Research Co., LLC 22
Procurement and installation of additional 100 LED microscopes, training of lab technologists on sputum
microscopy and strengthening supervision and monitoring of labs are major tasks planned for
implementation in the next quarter. Actions will be planned to review the quality of reagents prepared at
the EQA centers for LED microscopy and take corrective measures.
The project has selected 4 (four) district TB hospitals for expansion of NTP capacity for inpatient
management of MDR TB patients. These facilities need minor renovation works which will be completed
in the next quarter. Developing capacity of staff from these facilities in programmatic management of
MDR TB patients is also planned to start soon.
top related