community based dots - mozambique_dr. paul robinson
TRANSCRIPT
Findings from mid-term evaluation of CSGHP – TB Project in Mozambique
Dr. Paul Robinson, MBBS, MTS, MPH
Director, Health and Social Development Team
World Relief
CORE Group Spring Meeting/TB Working GroupBaltimore, MDApril 24, 2013
Community Based DOTS…accomplishments and challenges
Project background
Key mid-term results
Major constraints
Questions and Answers
Overview
Vurongha CB-DOTS project
Trained volunteers educate community members
TB patient with medicine
Project profile
6 Rural Dist
Population:
226,523
3 Urban Dist
Population:
354,689
Project Area
Population:
581,212
Increase CNR by 50%
Achieve 85% treatment
success
Community Based DOTS
Intermediate results
IR1: Empower people with TB to seek & complete
treatment with support from their communities
IR2: Strengthen provincial TB control program to
improve TB service delivery and treatment outcomes
IR3: Decrease burden of HIV in patients with TB and
decrease burden of TB in PLWHA
Project inputs
Project inputs
TB testing
80.9
95.7
81.8
80
70
75
80
85
90
95
100
Baseline (2010) Q3, 2011 Q4, 2011 Target
Per
cen
tSuspected Cases Examined by Sputum Smear
TB case notification
128.3
139.5
107.7
0
20
40
60
80
100
120
140
160
Baseline
(2010)
Q4, 2010 Mid-Term
(2012)
CN
R p
er 1
00,0
00 p
op
ula
tio
n
Case Notification Rate
TB patients cure rate
71.4
75.5
69
70
71
72
73
74
75
76
Baseline (2010) Mid-Term (2012)
Per
cen
tag
e
Cure Rate
0
20
40
60
80
100
TB is transmitted
through coughing
TB is curable
20.7
85.3
61.3
91.7
Per
cen
t
Baseline
Mid-Term
Community knowledge about TB
0
5
10
15
20
25
Treated by traditional healers
21.1
0.7
Per
cen
t Baseline
Mid-Term
Treatment by traditional healers
0
20
40
60
80
100
Drug stock-out
87.5
62.5
Per
cen
t Baseline
Mid-term
TB drug stock-out at health centers
0
20
40
60
80
Screening for TB
44.8
71.860
Per
cen
t Baseline
Mid-term
Target
TB screening for HIV+ patients
Village Health Committees with local data on TB cases increased from 0% to 100%
Quarterly assessment of all health centers by Dist. TB Supervisor using M-DRAT is 100%
Quarterly supervision of health posts by District TB Supervisor fell from 83.3% to 50%
Major errors in lab diagnosis is <1%
Health facilities with sputum bottle stock-out declined from 25% to 0%
Health centers with TB drug stock-out reduced from 87.5% to 62.5%
Other mid-term findings
Case notification has declined from 128.3 to103.7 per 100,000 population
Default (treatment interruption) rate decreased from 3.6% to 3.2%
All TB patients screened for HIV (100%)
TB/HIV+ patients on cotrimoxazole preventive therapy is maintained at 98.8%
Other mid-term findings
Modified District Rapid Assessment Tool (MDRAT) uses data from (1) dist. TB register and (2) lab registers.
VHC maintains community level data using village TB registers, which informs Proj. M&E.
Some health centers did not record if patients are on CB-DOTS, thereby compromising the accuracy of TB case registration.
The MOH plans to introduce a revised TB register for HCs nationally, which will have a column for reporting on patients who are on CB-DOTS.
Constraints and challenges
Unknown but a significant proportion of men migrate to S. Africa for working at mines. They return home sometimes with TB and HIV/AIDS. These semi-nomadic sub population may not have consistent access to TB and HIV/AIDS services
Use of volunteers empowers communities with low access to services
Challenge is to keep the volunteers motivated with satisfying tasks, perhaps through increasing scope of voluntary work without over burdening them
Constraints and challenges
Constraints and challengesProject office after worst flooding in a
decade, followed by looting
• Henk Eggens, MD, MPHMid-Term Team Leader/External Consultant
• Adolfo E. Cambule, MD, CB-DOTS Manager, World Relief, Mozambique
• Pieter Ernst, MDDirector of Program Integration, World Relief, Mozambique
• Debbie DortzbachSr. Health Advisor, World Relief, Baltimore, MD
• Melanie MorrowDirector of MCH programs
• Meredith Crews, MPHHealth Advisor, CSHGP, USAID
• Nazo KureshyTeam Leader/AOR, CSHGP, USAID
Acknowledgement
Questions? Comments?
Thank You!