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The National Tuberculosis and leprosy Programme Annual report for 2016

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The United Republic of Tanzania

Ministry Of Health Community Development, Gender, Elderly and Children

The National Tuberculosis and leprosy Programme

Annual report for 2016

National TB and Leprosy Programme (NTLP)Department of Preventive Services

Ministry of Health, Community Development, Gender, Elderly and Children


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Table of content

1 GENERAL BACKGROUND 11.1 Demographic and social economic profile 11.2 Summary of health services 11.3 Summary of NTLP activities 11.4 Financial Support 2

2 HUMAN RESOURCE DEVELOPMENT 32.1 Staff establishment 32.2 Capacity building: Training and coordinative meetings 5

3 TUBERCULOSIS CONTROL SERVICES 73.1 Tuberculosis case notification in 2016 73.2 Tuberculosis treatment outcome for cohort notified in 2015 113.3 TB/HIV Services 123.4 Paediatric TB 133.5 MDR-TB 14

4 LEPROSY CONTROL SERVICES 174.1 Leprosy Case Notification 174.2 Leprosy treatment outcome 224.3 Activities related to acceleration of leprosy elimination efforts 234.4 Activities related to prevention of disabilities (POD) 24

5 LABORATORY SERVICES 295.1 Laboratory workload 295.2 Culture analysis 305.3 External Quality Assurance of Drug Resistance 325.4 TB Laboratory Network 33

6 PROGRAMME SUPPORT ACTIVITIES 346.1 Procurement and Supply Management of Anti-TB and Anti-Leprosy Medicines 346.2 Community empowerment activities 356.3 Advocacy, Communication and Social Mobilization (ACSM) activities 366.4 Public and Private Partnership (PPP) 37


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6.6 Quality Improvement in TB case detection 386.7 Supportive Supervision 406.8 Data Quality Assessment (DQA) 40


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List of Table

Table 1: NTLP Source of Funds 2016 2Table 2: Summary Training Provided during 2016 5Table 3: Tuberculosis cases notified in Tanzania 2015 – 2016 7Table 4: TB treatment outcome of new and relapses TB cases notified in 2015 11Table 5: Treatment outcomes of previously treated (except relapse) cases notified in

201512

Table 6: Interim Outcomes, 2015 16Table 7: leprosy cases reported in 2015 and 2016 17Table 8: New leprosy cases detected by indicators in 2016 by regions 19Table 9: Endemic districts with prevalence rate greater than 1/10,000 Population in

201621

Table 10: Treatment outcome of PB leprosy reported in 20150 22Table 11: Treatment outcome of MB leprosy notified in 2014 23Table 12: The number of targeted index cases and contacts screened in the project dis-

tricts during August 2015 – December 201624

Table 13: Leprosy cases started treatment with corticosteroid in 2016 25Table 14: Number of leprosy admissions in hospitals 2016 26Table 15 : Protective Footwear distributed/ produced to PALs in regions by type in 2016 27Table 16: Materials distributed for fabrication of special and local shoes production per

region in 2016 28

Table 17: Number specimens received in 2016 29Table 18: Summary analysis of the Xpert MTB RIF in 2016 31Table 19: Total Isolates for LPA 32Table 20: Summary Participation of EQA for CTRL 33Table 21: stocks of anti-TB and anti-leprosy drugs distributed in the country in 2016. 35Table 22: Trend of community contribution (%) in TB case notification in Tanzania from

2012-201636


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List of Figures

Figure 1: Distribution of TB cases notified by regions in 2016 8Figure 2: Age and Sex distribution of new and relapse TB cases notified in 2016 8Figure 3: Notification rate TB new and relapses cases notified by region for 2016 9Figure 4: Trends of Previously Treated TB cases notified form 2006 to 2016 10Figure 5: TB Notification rates by regions - 2016 10Figure 6: Trend of TB patients counselling and testing for HIV, initiated CPT and ART:

2007 – 201612

Figure 7: HIV testing among TB patients in 2016 by regions 13Figure 8: Distribution of MDR/RR-TB cases enrolled on treatment by regions in 2016 15Figure 9: Trends of treatment Success rate of DR-TB enrolled for MDR-TB treatment:

2010 –201416

Figure 10: Distribution of leprosy cases notified by region in 2016 18Figure 11: Trends of new leprosy cases reported: 2006 – 2016 19Figure 12: Trends of MB cases, children and females among new leprosy cases: 2006 -2 20Figure 13: Trend of disability grade 2, percentage among new cases and rates per

1,000,000 populations20

Figure 14: Trends of new leprosy cases detected and registered: 2006 – 2016 21Figure 15: Culture analysis at CTRL 2016 31Figure 16: Showing Mbeya Quarterly TB notification comparison for quarters 1 and 2 of

2015 and 2016 (intervention facilities)39

Figure 17: Dodoma referral regional hospital Monthly TB case notification, 2016 39


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List of Annexes

Annex 1: List of DTLCs 2016 42

Annex 2: Change in Case Notifications by regions between 2015 and 2016 47

Annex 3: Comparison of Case notifications Rates by regions between 2015 and 2016 48

Annex 4: Contribution of pediatric notification by regions between 2015 and 2016 49

Annex 5: Regional Community contribution 50

Annex 6: contribution from private health facilities with the proportion of health facilities 51

Annex 7: TB/HIV cases notified in 2016 52


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TB burden at a glance


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Leprosy burden at a glanceTrends of new leprosy cases reported from 2006 to 2016

Distribution of leprosy cases notified by region in 2016


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Acknowledgement

The successful completion of this Annual report for the year 2016 was made possible by joint efforts from a number of dedicated individuals at facility, regional and national level. The data presented in this report is generated by the general health workers and compiled by the district TB and leprosy coordinators under the supervision of the regional and national levels officers. First, I want to thank the Monitoring and Evaluation Unit within the central level for their dedication in ensuring accuracy of the reported data. I also like to thank the health workers at regional and health facility levels who by recording and timely reporting of TB and leprosy data to the central level has made possible the contents of this report. To them I say keep up the good work and dedication to the call for a healthy Tanzania nation. The focal persons from all the TB and leprosy service and diagnostic sites are especially thanked for their immense contribution to the work of the program.

I extend my gratitude to the Government of Tanzania particularly the Ministry of Health Community Development Gender Elderly and Children and the President office for Regional administration and local governments for the dedicated commitment to TB and leprosy control and mobilization of resources from development partners to support the programme. I would like to recognize, in particular, the support from Germany Leprosy and Tuberculosis Relief Association (DAHW/GLRA), World Health Organization (WHO), The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM), Centre for Disease Control (CDC) United State Agency for International Development (USAID), Novartis Foundation (NF), Global Drug Facility (GDF), ITECH, International Organisation for Migrant (IOM) and The Netherlands Tuberculosis Foundation (KNCV).

On behalf of the programme, I would like to express my sincere gratitude for the support and encouragement given to us by the Permanent Secretary, Chief Medical Officer and all of the directors.

Dr Beatrice MutayobaProgramme Manager (NTLP)September 2017


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1 GENERAL BACKGROUND

1.1 Demographic and social economic profile

The population of Tanzania in 2016 was projected to be 50,055,411 based on 2012 national census. According to projected population, female make up is 51% (25,528,260) of the total while male are 49% (24,527,151) the population of urban inhabitant was 29.6 % of total population. About 52% of the population are the working age (15 – 64); 44% are young (0 – 14 years) while 4% are elderly (65+ years).The annual growth rate is estimated at 2.7% from 2002 to 2012 census. The population of Zanzibar is projected at 1,424,689 with a growth rate of 2.8%. Agriculture is still a major source of livelihood for majority of the population in Tanzania.

1.2 Summary of health services

The Health care delivery system in the country is well established with more than 7,992 health facilities.TB control is fully integrated into the primary health care services. 49% (3,911) of the facilities provide TB treatment services while 1199 (15%) provide TB diagnostic services. The Government is the major provider of health services owning and/or run 69% of the health facilities including the face based facilities which are Designated District Hospitals (DDH). On leprosy services there are 1,500 health facilities that provide leprosy treatment services and have a leprosy unit registers, these health facilities are known as MDT centres.

Data from Health Information Management System (HMIS) of the Ministry of Health and Social Welfare shows that communicable diseases are still the major cause of morbidity and mortality in the country driven by HIV epidemic with national prevalence of 5.3%1 in the population aged 15-49 years. TB has continued to be among the top ten cause of death and among admission aged five years and above in the country.

1.3 Summary of NTLP activities

In the period of January – December 2016, NTLP continued to implement its 5th Strategic plan (2015-2020). All activities conducted focused on addressing the NSP strategic objectives i.e. (i) Achieve universal access to quality DOTS and MDT services in both public and private sectors. (ii) Reduce the burden of TB/HIV and drug resistant TB with special emphasis on vulnerable populations. (iii) contribute to health system strengthening based on primary health care (iv) scaling up involvement of more private health care providers (v) empowering patients and community members to take active participation in

1 Tanzania HIV/AIDS and Malaria Indicator Survey 2011-2012


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TB and Leprosy prevention and care (vi) reducing new Leprosy cases with disability grade 2 (vii) collaborating with internal and external partners in conducting relevant operational research.

1.4 Financial Support

The Ministry of Health Community Development, Gender, Elderly and Children through National Tuberculosis and Leprosy Program (NTLP) received approximately USD 7,713,651.29 through government consolidated funds, external grants and loans in year 2016. Government resources channeled through the program for program management and support the health system and infrastructure maintenance as well as staff remuneration at all levels.

Direct cash was received from Centers for Disease Control and Prevention (CDC) grant, The Global Fund-NFM grant, German TB and Leprosy Relief Association (GLRA) grant and World Health Organization (WHO) grant as detailed below.

Other key stakeholders were active partners/collaborators in various Program interventions through different grants. These include Implementing partners such as KNCV-Challenge TB,local research institutions, academia, private sector organizations and community based Civil Society Organizations (CSSOs).

Table 1: NTLP Source of Funds 2016

S/N Source of Funds Amount in US$1 Government Contribution -2 Germany Leprosy Relief Association GLRA 206,661.003 Centre for Disease Control and Prevention CDC 1,221,383.844 World Health Organization – TDR (carried forward from

previous period)22,735.45

5 GFATM (carried forward from previous period) 6,251,351.006 World Bank (IDA) 11,520.00

TOTAL FUNDS 7,713,651.29


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2 HUMAN RESOURCE DEVELOPMENT

The Programme is composed of both permanent and contractual employees at the central unit (TLCU) with focus on strengthening TB and Leprosy services in the country. Contract employees were recruited through various grant support including GFATM and CDC/PEPFAR.

2.1 Staff establishment

In this reporting year there were 42 staffs at central level and 30 Regional TB and Leprosy coordinators. At District level 196 DTLCs and 92TB/HIV Officers. In the councils which were not fully established, DTLCS from the mother councils continued to oversee and coordinate TB and leprosy control activities. One contract staff left the program at Central unit for other opportunities, one retired and five new officers joined the program.

The list of TLCU staff by December 2016 was as follows:

1. Dr Beatrice Mutayoba - Programme Manager2. Dr Liberatus Mleoh – Deputy Programme Manager3. Mr.Cornel Wambura – Health Secretary4. Mr Didas Kayumba – Programme Administrator5. Dr Johnson Lyimo - MDR TB Coordinator 6. Dr Deusdedit Vedastus Kamara – Leprosy and TB care and Prevention Coordinator7. Ms Diana Kasembe – Training Coordinator 8. Dr Joyce Wanze Kohi - TB/HIV Coordinator9. Dr Allan Tarimo – Public Private Partnership Coordinator 10. Dr Zuweina Kondo-Sushy – Monitoring and Evaluation Officer11. Mr Emmanuel Nkiligi – Data Manager12. Mr Jumanne Mkumbo – Pharmacist13. Mr. Bariki Brown - Pharmacist 14. Mr Jirabi Masige - Pharmacist15. Ms Lilian Ishengoma – Community TB care Coordinator16. Ms Agatha Mshanga – ACSM Coordinator17. Mr Paul Shunda – Orthopaedic Technologist18. Ms Donatha Koko – Procurement and Supplies Coordinator 19. Ms Elda Magawa - Procurement and Supplies20. Ms Basra Doulla – Head, National TB Reference Laboratory21. Mr Salim Bossy – Senior Laboratory Technician 22. Ms Daphne Mtunga – Laboratory Technician23. Mr. Amri Kingalu – National TB Reference Laboratory Manager24. Ms Christine Chipaga - Data entry clerk25. Ms Grace Tairo - Data entry clerk


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26. Ms Khadija Kassim - Data entry clerk27. Mr Mashaka Penza - Data entry clerk28. Mr Abbakari Msafiri – Data Analyst29. Mr. Baraka Onjare – ICT Manager30. Mr Lugano Ross – Accounts Assistant31. Ms Sophia Temba - Accountant32. Mr Joachim Kizzuri - Accountant33. Mr. Augustus Machumi – Accountant34. Ms Amina Ponera - Secretary35. Ms Martha Haule - Secretary36. Mr Paulo Kalombora – Office Attendant37. Mr Raymond Shirima – Data Analyst38. Mr Eneas Mdika - Driver39. Mr Abdallah Shabani – Driver40. Mr David Kanyandeko – Driver41. Mr Beno Tayari - Driver42. Mr Komba - Driver

2.1.1 Regional Tuberculosis and Leprosy Coordinators (RTLCs)

During this period one RTLC from Singida region retired from the government employment. By the end of 2016 there were 30 RTLCs who coordinated TB and Leprosy control services at regional level in Tanzania mainland and 2 RTLCs from Zanzibar. Their names and respective regions are listed below:

1. Dr Edna Ntulwe – Arusha2. Dr Ackim M. Mwandobo – Dar Region3. Dr Mrisho Lupinda - Kinondoni 4. Dr Mary Kenedy Chiryamkubi – Temeke5. Dr Seif Mbarouk – Ilala I6. Dr Ibrahim. Mteza – Ilala II (Muhimbili & Private Hospitals, Dar es Salaam)7. Dr Martin Massimba – Dodoma8. Dr Tecla Orio – Iringa9. Dr Mussa Ndyeshobora/Martin Mujuni - Kagera10. Dr Festo Baranuba – Kigoma11. Dr Geoffrey Chelangwa – Kilimanjaro12. Dr Abasi Pegwa – Lindi13. Dr Martin Khan – Mara14. Dr Qamara Qawoga – Manyara15. Dr Yahaya Msuya – Mbeya16. Dr Emmanuel Tenga – Morogoro17. Dr William Byemelwa – Mwanza18. Dr Mohamed Kodi - Mtwara


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19. Dr Aden Mpangile – Pwani20. Dr Dismas Buhili - Rukwa21. Dr Xavier Mbawalla – Ruvuma22. Dr John Majigwa – Shinyanga23. Dr Mussa Kimala – Singida24. Dr Sebastian Honorati Pima - Tabora25. Dr Sakeo Kiluwa – Tanga26. Dr Emmanuel John - Simiyu27. Dr Deus Kalaso - Njombe28. Dr Abdul Majid - Katavi29. Dr Michael Mashalla - Geita30. Dr Obed Mshana - Unguja31. Dr Said Alli Hamad - Pemba

See Annex I for a List of DTLCs

2.2 Capacity building: Training and coordinative meetings

2.2.1 Trainings

Trainings continued to be an integral part in ensuring quality delivery of services to the community. During this year several trainings were conducted to the healthcare providers on TB case detection (Quality Improvement in TB case detection), Collaborative TB/HIV Management activities, Comprehensive HIV/AIDS Management, Paediatric TB and TB/HIV management and MDRTB management. In addition the providers were also oriented on the use of the new monitoring and evaluation tools which were rolled up in the previous year.

Table 2: Summary Training Provided during 2016

S/N Name of the Training Regions covered No. of HCWs1. QI in TB case detection 16 1,2282. Collaborative TB/HIV management 4 313. Comprehensive HIV/AIDS Management 5 2004. Paediatric TB Management 16 8285. Sputum fixing 16 3256. DTLC course 13 227. TB/HIV induction course 21 548. Sensitize prison authorities 14 3159. Laboratory Trainings 16 150010. Drug Dispensers - ADDO 16 54011. X-ray reading interpretation 4 12012. Pharmacovigilance 12 60013. TB/HIV to HCWs 6 125


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S/N Name of the Training Regions covered No. of HCWs14. Gene-Xpert 5 7015. TB & Lep Logistic system 20 400015. DR-TB Management 16 214

2.2.2 Coordination Meetings

The Quarterly regional meetings for the RTLCs and DTLCs were conducted in most of the regions. The NTLP Annual meeting was conducted in Dodoma in November 2016 which provided the platform to share the lessons learnt during the first year of the implementation of the 5th NSP. Main Resolutions which made were on:

i. Improving Communications between TLCU,MSD,LMU and the Regional and District coordinators to ensure constant supply of medicines

ii. Implementing Partners coordination specifically planning and monitoring of key interventions

iii. Improve specimen referral by adopting other existing modalities in other programs in the districts e.g integrating with the Dry Blood Spot samples transportation

iv. Continue to champion the budgeting of the program key activities in the Regional and Councils plans

v. Plan for M&E capacity build to all coordinators


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3 TUBERCULOSIS CONTROL SERVICES

3.1 Tuberculosis case notification in 2016

A total of 65,902 cases of all forms were notified in 2016, which shows an increase of 5.6 % or 3507 cases compared to the year 2015. Among the cases notified, new and relapse cases were 64,404 (95.5%) of which 27,655 (39%) were bacteriological confirmed. Table 2 below shows the comparison of TB notification in 2015 and 2016 by TB classification groups.

Table 3: Tuberculosis cases notified in Tanzania 2015 – 2016

Indicators 2015 2016 ChangeCases % Cases % numb. %

All forms 62,180 65,902 3,580 5.9New Cases Bacteriological confirmed TB cases 24,290 39.1 25,955 39.4 1,665 6.9Pulmonary Clinically diagnosed TB cases

22,777 36.6 23,539 35.7 762 3.3

Extra-pulmonary Clinically diagnosed 12,679 20.4 13,336 20.2 657 5.2Total 59,746 96.1 62,830 95.3 3,084 5.2Previously treated Relapse 1,149 1.8 1,779 2.7 630 54.8Treatment after Failure 99 0.2 143 0.2 44 44.4Return after lost to follow up 244 0.4 268 0.4 24 9.8Other previously treated 942 1.5 882 1.3 -60 -6.4Total 2,576 4.1 3,072 4.7 496 19.3

3.1.1 Tuberculosis notification by regions

Dar es Salaam city has remained as the major contributor of TB cases notification contributing making 20% of all cases notified. There was considerable regional variation as in the previous years with 50% of cases being contributed by only 6 regions - Dar-es-Salaam, Mwanza, Mbeya, Morogoro, Arusha and Tanga. The data indicated that 15 regions notified below the national average of 129 cases per 100,000 population.


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Figure 1: Distribution of TB cases notified by regions in 2016

3.1.2 Tuberculosis case notifications disaggregated by sex and age

The age-sex distribution of the new and relapse TB cases notified in 2016 shows that 39,2017 (61%) cases were males and 24,694 (39%) females with a sex ratio of over 1:1.5. The number of children aged 0–14 years old notified among new and relapse cases were 6,351 (10%). Age-sex distribution of the new and relapse cases also shows that, the highest number of TB cases notified was in the age groups of 25-34 years and 35-44 years for both males and females as summarised in Figure 2 below

Figure 2: Age and Sex distribution of new and relapse TB cases notified in 2016


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3.1.3 Tuberculosis notification rate

The notification rate of new and relapses TB cases was 129 cases per 100,000 population which was slightly higher compared to that of 2015 that was 125 per 100,000 population. Dar es Salaam region had the highest TB notification rates in the country at 244 cases per 100,000, Kigoma region has the lowest TB case notification rate of 45 cases per 100,000, followed by Unguja (46) and Katavi and Rukwa at 59. Ten regions has notification rate of above national average are: Dar es Salaam; Iringa; Pwani; Arusha; Manyara; Njombe; Lindi; Mtwara Kilimanjaro and Mbeya. The notifications rates for Unguja and Pemba have been presented separately but in comparison to administrative regions in the Mainland. The figure below shows notification rate of TB cases by regions and Zanzibar.

Figure 3: Notification rate TB new and relapses cases notified by region for 2016

3.1.4 Previously treated cases of Tuberculosis

Previously treated TB cases notified in 2016 were 3,051 cases which is 4.6 % of all cases notified in the country. Among them relapse cases contributed 58% of all previously treated cases.


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Figure 4: Trends of Previously Treated TB cases notified form 2006 to 2016

Figure 5: TB NOTIFICATION RATES BY REGIONS - 2016


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3.2 Tuberculosis treatment outcome for cohort notified in 2015

3.2.1 New and relapse cases

Analysis of the 59,293 TB cases notified in 2015 shows that the overall treatment success for new and relapse cases was 90%. 3,531 (5.8%) died while still on treatment, 106 (0.2%) failed treatment and 1,091 (2%) lost to follow up. During the same reporting year, the number of TB cases which were not evaluated due to being transferred out of their respective regions was noted still higher at 1,602 (2.6%).

The treatment outcomes for individual groups of TB vary from 90% treatment success rate for new smear positive TB to 81% of TB relapses. The table below summarizes treatment outcomes of groups

Table 4: TB treatment outcome of new and relapses TB cases notified in 2015

Treatment Outcomes

B. Confirmed Clinically diagnosed Pulmonary

Clinically diagnosed -Extra Pulmonary

Relapse All forms - new and relapse

number % number % number % number % number % Cured 19,884 82 0 0 808 70 20,692 34Treatment Completed

2,052 8 20,338 89 11,356 90 127 11 33,873 56

Treatment Success 21,936 90 20,338 89 11,356 90 935 81 54,565 90Failure 91 0.4 0 0 15 1 106 0.2Died 1,032 4.2 1,527 7 898 7 74 6 3,531 5.8Lost to follow up 533 2 353 2 181 1 24 2 1,091 2Evaluated 23,592 97 22,218 98 12,435 98 1,048 91 59,293 97Notified 24,290 100 22,777 100 12,679 100 1,149 100 60,895 100

The trend of treatment outcomes of the new and relapse cases for over decade, the treatment success rates have improved from about 80% in 2001 to 91% in 2014 and consistently maintained above 85% since 2005. Similarly the death rate has progressively been declining since 2006 from 8% to 6% in 2014.

3.2.2 Treatment outcome of previously treated TB cases notified in 2015

In 2015, 1,292 previously treated TB cases excluding the relapse were notified, 1,200 (93%) cases their treatment outcomes are available. Among the evaluated cases: 1,037 (80%) were treated successfully; 14 (1.1%) failed treated while 103(8%) cases died while in still on TB treatment almost similar proportions as for the year 2013. Number of TB cases lost to follow up were 46 (4%) of all previously treated cases. Table 4 and figure 5 below summarizes the treatment outcomes for each category of the re-treatment cases.


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Table 5: Treatment outcomes of previously treated (except relapse) cases notified in 2015

Treatment Outcomes Treatment after Failure

Treatment after Loss to follow up

Other previously treated

All forms

number % number % number % number % Cured 54 52 111 45 5 1 170 13Treatment Completed 24 23 99 40 744 79 867 67Treatment Success 78 76 210 85 749 80 1,037 80Failure 12 12 2 0.8 0 0.0 14 1.1Died 11 11 10 4 82 9 103 8Loss to follow up 2 2 25 10 19 2 46 4Evaluated 103 100 247 100 850 90 1,200 93Notified 103 100 247 100 942 100 1,292 100

3.3 TB/HIV Services

3.3.1 TB/HIV case finding 2016

In the year 2016, 63,753 (97%) of all TB cases notified had their HIV test results recorded at time of notification, which was slightly higher than that of 2015 data which stood lower at 93%. Among those who tested for HIV , 21,720 (34%) cases were found to be co-infected with HIV. The co infection has slightly decreased compared to 2015 whereby the co infected cases were at 36%. Furthermore, analysis shows that among co-infected cases 20,709 (95%) cases were registered at HIV care and Treatment clinics (CTCs) for care and treatment services. Furthermore 20,895 (96%) were put on Co-trimoxazole Preventive Therapy (CPT) while 19,814 (91%) were initiated ART in at both TB clinic and CTCs. Figure 5 below summarizes the trend of TB/HIV indicators in the country from 2007 to 2016 with significant gains in the proportion of those initiated ART especially after the year 2011.

Figure 6: Trend of TB patients counselling and testing for HIV, initiated CPT and ART: 2007 – 2016


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3.3.2 Regional performance on HIV testing and counselling and ART uptake

HIV counselling is entry point for accessing HIV care, treatment and preventive services. In 2016 the national average was 97% which is still below the WHO target of 100%. The majority of the regions are above the national average and Unguja in addition to few regions are below the average which included: Dar Kinondoni, Dodoma, Geita, Kigoma, Lindi, Mara, Mbeya, Morogoro, Njombe, Dar Ilala II, Kilimanjaro, Mwanza, Simiyu and Rukwa.

Figure 7: HIV testing among TB patients in 2016 by regions

3.3.3 TB treatment outcomes of TB/HIV case notified 2015

Analysis of the 21,232 co-infected TB/HIV cases notified in 2015 shows that treatment success rate of all forms was 83.2% which is almost similar to the rest of other notified TB cases. 1,908 (8.4%) died and 419 (1.8%) lost to follow up. During the same reporting year, the number of TB cases which were not evaluated due to being transferred out of their respective regions was noted still higher at 1443 (6.4%)

3.4 Paediatric TB

3.4.1 Childhood TB notifications 2016

In 2016, 6351 (10%) of the new and relapse TB cases notified were children under the age of 15 years. Among children (under 15 years) notified, 3,054 (48%) were children under


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the age of 5, while 1,674 (26%) cases were children between age group of 5 -9 years and 1,679 (26%) were children in the age-group 10 – 14 years.

3.4.2 Childhood TB/HIV notifications 2016

Testing and counselling for HIV is also done to children (under the age of 15) attending the TB clinics. In 2016 data shows that 6,194 (96%) of notified children were tested for HIV and 1,687 (27%) were HIV and TB co-infected cases. Among all the co-infected children notified, 1,663 (99%) were started on CPT and 1,589 (94%) were on or started ART at time of diagnosis.

3.4.3 IPT provision to Children

All children younger than 5 years in contact with a sputum smear-positive PTB patient are investigated for TB. Children with signs and symptoms suggestive of active TB are registered and treated with a full anti-TB course. If there are no signs of active TB, the children are put on preventive treatment with isoniazid for six months. In the year 2016, a total of 6,311 children in contact of smear positive TB cases were provided with IPT.

3.5 MDR-TB

In 2016 a total of 196 MDRTB cases were notified country wide among which 158 (82%) were started on MDR TB treatment from 21 regions. The enrollment is an increment of 28% compared to that of 2015. As in previous years, the majority of MDR TB cases detected and enrolled on treatment were from Dar es salaam (41%) followed by Mbeya (9%), Geita (7%), Mtwara (6%), Morogoro (5%) and Simiyu (5%). The graph below shows number of MDR/RR-TB patients started second line treatment in 2016

Overall, there is improvement in enrollment as compared to last year with an increase of 35 cases. This could be due to the kick off of the decentralization of the services to other facilities. This is implemented guided by the Decentralization plan (2015) of which by Dec 2016 a total of 22 sites2 had already begin offering initiation of the MDRTB treatmentAmong the enrolled patients, a male predominance continued to be observed with 88 (71%) being male. As in the previous year, the age groups bearing the brunt of MDR TB among, was the younger, economically active age group from 25 – 44.

2 Kagera (Bukoba Hospital 1,Rubya1 and Ndolanga Hospitals1),Dar es salaam (Sinza Hospital 8, Rangitatu3 Hospital, Ukonga Dispensary 10,Tambukareli Dispensary2 and Amana1),Geita(Bukombe1 and Mbogwe Hospital1),Mtwara (Newalla Hospital1) ,Mbeya (Mbeya region-al1 and Ruanda Dispensary1 ),Pwani (Bagamoyo Hospital1),Tanga (Ngamiani Hc 1),Morogoro (Sabasaba HC1,Kibaoni Hospital 1,1Kilosa and 1 malinyi) Zanzibar 1 in Unguja,1Tabora at Utete Hospital and 1 Kigoma at Kibondo


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Figure 8: Distribution of MDR/RR-TB cases enrolled on treatment by regions in 2016

End of Treatment Outcomes for 2014 Cohort:

A total of 143 patients were enrolled in 2014, with age of enrolled cases ranged from 2 to 84 years old with a median age of 39 years old. Those aged from 15 – 35 yrs were the most affected with MDR TB disease. Among MDR patients 38% (35) were HIV co-infected, while 62% (57) were HIV negative.

Of all enrolled 143 patients 108 (76%) were successfully treated (cured + treatment completed). Those with unfavorable outcome include; 25 (17%) patients died, 10(7%) patients defaulted and 2 (1%) were not evaluated. A review of trends of treatment outcomes from 2009 (figure 11) showed the treatment success rate to have dropped in 2013 with the most contributory factor being a spike in mortality. Further review of the mortality data revealed that most deaths occurred at older and younger groups, in more males than females and patients who had been in treatment for less than 6 months. HIV status was not a significant contributor as most deaths occur among the HIV negatives 14 (78%) than the HIV positives 4 (22%). The extreme of age groups and the early timing of deaths may be a result of lack of monitoring tests for second line drugs toxicities since most of these reagents are out of stock at the admitting hospital and peripheral decentralized sites. The programme should mobilize funds to ensure that all enrolled MDR-TB patients have access to these tests.


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Figure 9: Trends of treatment Success rate of DR-TB enrolled for MDR-TB treatment: 2010 –2014

Available 6 month interim results for 23 patients enrolled in quarter two 2015 showed the target of loss to follow at 6 months as met (Table 5), also for these patients the early trend data still showed a higher than normal mortality rate that is partly contributed by lack of toxicity monitoring test.

Table 6: Interim Outcomes, 2015

6 months interim outcomesIndicator Target Results%(n ) Target achieved?

The percent of patients who default within the first six month of treatment

<10% 0% (0) MET

The percent of patients with an unknown culture and smear status

<15% 4.3% (1) MET

The percent of patients with culture conversion within the first six months

>=80% 78.3% (18) NOT MET

The percent of patients dying within the first six months

<10% 17.4% (4) NOT MET


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4 LEPROSY CONTROL SERVICES

4.1 Leprosy Case Notification

In years 2016, a total of 2,164 leprosy cases (all forms) were notified and reported in the country, which shows a decline of 258 cases or 11% compared to the year 2015. Among the notified leprosy cases, new leprosy cases were 2,047 (95%), relapses were 60 (3.2%) cases while return after defaulter were 57 (1.8%) of all reported cases of leprosy. The number of relapses in Tanzania has persistently remained very high as of the past 15 years and this pose a challenge of whether the notified cases were all truly leprosy diseased. In the year 2016, over 50% of notified relapse cases were reported from in six regions of Morogoro (15%), Lindi (9%), Tanga (7%), Mtwara (6%), Kigoma (6%) and Rukwa (6%) as shown in figure 9 below.

Table 7: leprosy cases reported in 2015 and 2016

Leprosy Classification2015 2016 ChangeCases % Cases % cases %

All forms 2,422 2,164 -258 -10.7New cases MB 1,902 82.8 1,793 87.6 -109 -5.7PB 395 17.2 254 12.4 -141 -35.7Total 2,297 94.8 2,047 94.6 -250 -10.9Re-treatment Return after default 45 36.0 57 48.7 12 26.7Relapse after MDT 46 36.8 40 34.2 -6 -13.0Relapse after DDS/Others 34 27.2 20 17.1 -14 Total 125 5.2 117 5.4 -8 -6.4


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Figure 10: Distribution of leprosy cases notified by region in 2016

4.1.1 New leprosy cases notified in 2016

In 2016, a total of 2,047 new leprosy cases were detected in the country, the annual notification rate (case detection rate) was calculated at 4.1/100,000. These figures show that, Tanzania continue to be one of the leprosy high burden countries in the world which notify more than 1000 cases a year. The data shows that Lindi region had the highest leprosy notification rates in the country at 21 cases per 100,000 population. Arusha has the lowest leprosy notification rate of 0.2 cases per 100,000, followed by Kilimanjaro (0.4) and Simiyu (0.5). Ten regions with notification rate of above national average were: Lindi; Rukwa; Mtwara; Morogoro; Pwani; Tanga; Unguja; Katavi; Ruvuma and Kigoma.

Among the new cases notified, 1,793 (88%) were MB. Females were 781 (38%) giving a female to male ratio of 1:1.5 suggesting that being male continues to be suggestive of risk factor. The number of children among the new cases was 38 or 2% like those reported in 2015. New leprosy cases notified with disability grade II were 267 or 13% which was slightly higher than the previous two years, indicating that many cases continue to be detected late. Table 8 below summarizes indicator data on new leprosy cases notified in 2016 by regions and those having disability grade II according to WHO classification. However, the trend of new leprosy cases detected for the past 10 years shows tremendous decline country wide as is displayed in figure 10.


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Table 8: New leprosy cases detected by indicators in 2016 by regions

Figure 11: Trends of new leprosy cases reported: 2006 – 2016


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Since 1,990, the proportion of new MB cases detected annually has been slowly increasing from 68% to over 88% while the proportion of females and children detected has been declining slowly from 44% down to below 38% and 10% to 2% respectively. The changes in proportion of MB cases and children notified annually suggest reduction in the prevalence of the disease in the country with reduced disease transmission. Moreover, the data also suggest that females could be utilizing less the available leprosy services compared to their male partners. Figures 11 and 12 summarise the above findings for the past 10 years.

Figure 12: Trends of MB cases, children and females among new leprosy cases: 2006 -2016

During this reporting period, the proportion of disability grade 2 among new detected cases has remained higher at 13%, however, there has been a gradual decrease in rates due to change and growth of population as shown in figure 12 below.

Figure 13: Trend of disability grade 2, percentage among new cases and rates per 1,000,000 populations


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4.1.2 Registered prevalence

Overall, the prevalence of leprosy has showed a steady decline since 2002. The registered leprosy prevalence rate for years 2016 was 0.43/10,000 population as it was last year 2015. The prevalence detection ratio has remained around 1 since 2004 suggesting that patients are timely removed from the registers after completing their MDT treatment.

The 2016 data shows that, there are still 20 districts with prevalence rates higher than 1/10,000. These endemic districts were yet to achieve elimination targets and came from 9 different regions as shown in table 9 below. Lindi and Morogoro had most of their districts still endemic and remain at high risk of increased disease burden.

Figure 14: Trends of new leprosy cases detected and registered: 2006 – 2016

Table 9: Endemic districts with prevalence rate greater than 1/10,000 Population in 2016

S/N District Region Population Registered cases

Prevalence Rate

1 Liwale District Council Lindi 94,714 71 7.52 Nkasi District Council Rukwa 318,958 199 6.23 Ruangwa District Council Lindi 135,863 40 2.94 Nanyumbu District

CouncilMtwara 158,230 40 2.5

5 Shinyanga Municipal Council

Shinyanga 175,381 40 2.3

6 Kilombero District Council Morogoro 448,469 100 2.2


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S/N District Region Population Registered cases

Prevalence Rate

7 Mafia District Council Pwani 50,661 11 2.28 Pangani District Council Tanga 58,938 10 1.79 Mvomero District Council Morogoro 343,168 57 1.710 Masasi Town Council Mtwara 107,715 16 1.511 Lindi District Council Lindi 201,227 29 1.412 Kilwa District Council Lindi 197,704 28 1.413 Mpanda Town Council Katavi 116,717 16 1.414 Nachingwea District

CouncilLindi 184,976 23 1.2

15 Rufiji District Council Pwani 237,034 29 1.216 Korogwe District Council Tanga 338,571 40 1.217 Mkinga District Council Tanga 128,803 15 1.218 Ulanga District Council Morogoro 291,594 32 1.119 Morogoro District Council Morogoro 314,733 31 1.020 Chato District Council Geita 414,155 40 1.0

4.2 Leprosy treatment outcome

4.2.1 Treatment outcome of PB leprosy

The treatment outcome of PB leprosy cases who started treatment in 2015 shows that, 344(84%) completed treatment while 6 (1%) were transferred out, 1 cases (0%) died while receiving treatment and 8 defaulted from treatment as shown in 10 below

Table 10: Treatment outcome of PB leprosy reported in 2015

Treatment outcomes New cases Relapse after MDT

Relapse after DDS/Others

Total

number % number % number % number %Treatment Completed

333 84 2 50 9 75 344 84

Died 1 0 0 0 0 0 1 0Out of Control 8 2 0 0 8 2Transferred Out 6 2 0 0 6 1Evaluated 348 88 2 50 9 75 359 87Notified 395 24 4 7 12 26 411 24


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4.2.2 Treatment outcome of MB leprosy

Treatment outcome of MB leprosy cases notified in 2014 shows that, 1,632 (93%) completed treatment while 11 (1%) patients died during treatment period. However, the data also shows that 96 patients did not complete their treatment due to various reasons: 46 (3.0%) defaulted from treatment and 50 (3%) cases were transferred out during treatment. Table 11 below summarizes treatment results of MB cases notified in 2014.

Table 11: Treatment outcome of MB leprosy notified in 2014

Treatment outcomes New cases Relapse after MDT

Relapse after DDS/Others

Total

number % number % number % number %Treatment Completed

1,535 94 52 88 45 96 1,632 93

Died 9 1 1 2 1 2 11 1Out of Control 41 2 4 7 1 2 46 3Transferred Out 49 3 1 2 0 0 50 3Evaluated 1,634 100 58 98 47 100 1,739 100Notified 1,641 100 59 100 47 100 1,747 100

4.3 Activities related to acceleration of leprosy elimination efforts

Tanzania is among 17 countries in the world reporting high number of leprosy cases of more than 1,000 cases per year. The planned activities to accelerate leprosy elimination efforts include; elimination campaigns in targeted areas, leprosy post exposure prophylaxis (LPEP) and implementation of the Bangkok declaration special fund (BDSF). During this reporting year, only LPEP continued to be implemented with financial and technical supports from Novartis Foundation (NF) and Germany Leprosy and Tuberculosis Relief Association (GLRA). Towards the end of the year, NTLP received approval note of BDSF grant from WHO-AFRO.

4.3.1 Leprosy Post Exposure Prophylaxis (LPEP)

The Leprosy Post-Exposure Prophylaxis (LPEP) is a study project implemented in three districts of Nanyumbu, Liwale and Kilombero to demonstrate the impact of PEP added to contact tracing activities as a strategy to interrupt transmission of leprosy. The LPEP study is a multinational exercise implemented in seven countries across Asia, Africa and Latin America and Tanzania is representing the Africa continent. The three year project in Tanzania was launched in August, 2015. The project involve identification of index case households and the corresponding health facility, contact tracing, leprosy screening and provision of a single-dose rifampicin (SDR) to those who screen leprosy negative and eligible. The study involve all new leprosy cases diagnosed in 2014-2017 and is


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fully integrated into the national leprosy control program and district health care delivery system. Funding is provided by the Novartis Foundation. The project has completed 15 months of implemented and reports show high level of community acceptance with good performance of over 102.1% as shown in the table 8 below.

Table 12: The number of targeted index cases and contacts screened in the project districts during August 2015 – December 2016.

Index cases/ households Targets Reached %ageKilombero 190 177 93.2%Liwale 220 219 99.5%Nanyumbu 70 104 148.6%Total 480 490 102.1%CONTACTS Targets Reached %age No. of New Cases

detectedKilombero 1140 771 67.6% 9Liwale 1320 1438 108.9% 19Nanyumbu 490 482 98.4% 11Total 2950 2691 91.2% 39

Most of the planned index case households were visited, 2691 contacts screened and over 2380 people at risk given prophylaxis of a single dose rifampicin. At the same time, 39 confirmed new leprosy cases were detected from the 490 households visited.

4.3.2 Project to Implement Bang’kok Declaration Special Fund (BDSF)

Protocol to access funds to implement Bang’kok declaration to promote early case detection and addressing challenges facing PALs with disabilities amounting US$ 161,450 was approved for the next three years starting 2017. The project will be implemented in three districts of Mkinga and Muheza in Tanga region and Chato in Geita region. The funds to implement the Bang’kok declaration were donated by the Nippon Foundation of the Sasakawa Memorial Health Initiative and are being managed by the WHO Leprosy Global Programme (LGP).

4.4 Activities related to prevention of disabilities (POD)

The programme continue to collaborate with key stakeholders, namely GLRA, social welfare commission, care centres, referral hospitals, MDT clinics and health management teams all around to strengthen efforts of preventing disabilities among people affected by leprosy (PALs). The main activities implemented during this reporting year include; regular assessments, management of reactions, care of wounds and ulcers, constructive septic surgeries, specialized eye care, provision of prosthesis and special boots. Other services included supporting shoe making workshops and referrals to consultant hospitals and


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rehabilitation institutions.

4.4.1 People with leprosy related disabilities

In 2016, a total of 893 people affected by leprosy (PALs) with disabilities were registered. A total of 1591(83.3%) were reviewed to assess their physical impairments and only 27(1.7%) PALs had their condition deteriorated and 373(23.4%) did not change on the course of their treatment.

4.4.2 Leprosy reactions

A total of 936 leprosy patients were reported with reactions and started on corticosteroid treatment. Out of them, adults MB cases were 89.9% (842) and for PB 94 (10%). Of all the reported cases, only 93 required hospital admission because of severe reactions. The table below shows patients reported with reactions by region per category. The availability of sufficient prednisolone drugs for PALs in need at health facilities in the country remain a big challenge. The district medical officers in all councils are reminded to include the requirement of prednisolone for PALs in their routine health facility drug need estimates and orders.

Table 13: Leprosy cases started treatment with corticosteroid in 201

Region MB (A) MB ( C) PB (A) PB ( C) TotalDar Ilala I 16 2 2 2 22Dar Ilala II 6 0 0 0 6Dar Kinondoni 44 0 1 0 45Dar Temeke 16 0 1 0 17Dar Es Salaam 82 2 4 2 90Dodoma 9 1 0 2 12Geita 21 1 0 0 22Iringa 4 1 0 0 5Kagera 6 0 0 0 6Katavi 17 0 1 0 18Kigoma 13 0 1 0 14Kilimanjaro 10 0 0 0 10Lindi 110 0 26 0 136Manyara 2 0 1 0 3Mara 10 0 18 0 28Mbeya 1 0 0 0 1Morogoro 66 0 11 1 78


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Region MB (A) MB ( C) PB (A) PB ( C) TotalMtwara 31 0 1 0 32Mwanza 31 0 1 0 32Njombe 2 0 0 0 2Pwani 38 0 5 0 43Rukwa 202 3 2 1 208Ruvuma 2 0 0 0 2Shinyanga 19 0 3 0 22Simiyu 2 0 0 0 2Singida 10 0 1 0 11Tabora 18 0 0 0 18Tanga 74 1 1 8 84Mainland 780 9 76 14 879Pemba 6 1 0 0 7Unguja 44 2 4 0 50Zanzibar 50 3 4 0 57Tanzania 830 12 80 14 936

4.4.3 Specialized care of people with disabilities

During the year 2016, a total of 287 persons affected by leprosy (PALs) were admitted requiring some specialized care at different consultant hospitals in the country. Ulcers and wounds ranked high as the main reason for admission by 94 (32.7%) followed by reactions 133(46.3). Eye pathology ranked third and accounted for 27(9.4%). and the least was constructive surgery 13(4.5%). Eye pathology which was 27(9.4%). In addition to these, 23 PALs were fitted with prostheses.

The table 14 below summaries the number of surgeries done, prosthesis fitted and prostheses repaired for people affected by leprosy in 2016 by regions.

Table 14: Number of leprosy admissions in hospitals 2016

Number of leprosy admissions in hospital(s)

Indications for admission

Ulcers/wound treatment 94Reactions 133(Reconstruction) Surgery 13eye pathology 27Others 20

Number of Amputation done 2Number of referred for rehabilitation outside the regions 4Number of PALs given Prosthesis 23


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4.4.4 Footwear Programme

In 2016, a total of 3150 pairs of special boots were produced centrally and distributed to regions country wide. By the end of the year 2049 pairs of protective sandals were distributed to people affected by leprosy. This is only 65% of the protective sandals reaching PALs in need. To complement these efforts, 156 pairs of shoes were made locally in several regions by the local shoemakers. In the case of special boots 99 pairs were fabricated and 315 footwear repairs were done for PALs with foot deformities. The table below shows the amount of footwear distributed to people affected by leprosy by region in 2016. This includes factory made sandals, locally produced shoes, special boots and repairs done.

Table 15 : Protective Footwear distributed/ produced to PALs in regions by type in 2016

S/N REGIONS Protective footwear distributed to region

Protective footwear distributed to PALs per region

Protective footwear on site produced

Special boots

Prostheses provided

Protective footwear repair

1 Ilala I 12 23 4 0 0 02 Ilala II 20 0 0 0 0 03 Temeke 60 63 0 0 0 04 Kinondoni 60 60 0 0 0 05 Arusha 5 0 0 0 0 06 Dodoma 95 209 0 0 0 07 Iringa 40 26 0 0 0 08 Kigoma 75 24 4 0 4 09 Kilimanjaro 5 5 0 0 0 010 Kagera 56 35 0 0 0 011 Lindi 150 191 16 0 0 012 Mara 100 39 13 0 6 1313 Mbeya 40 25 0 0 0 014 Morogoro 300 169 0 25 5 4815 Mtwara 150 193 55 0 0 016 Pwani 240 226 0 54 0 4117 Rukwa 109 42 0 0 0 018 Ruvuma 201 74 0 5 2 019 Shinyanga 310 51 0 5 0 1220 Singida 145 105 0 0 0 3321 Tabora 290 239 30 8 6 7322 Tanga 139 104 0 5 0 0


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S/N REGIONS Protective footwear distributed to region

Protective footwear distributed to PALs per region

Protective footwear on site produced

Special boots

Prostheses provided

Protective footwear repair

23 Manyara 0 2 0 0 0 024 Mwanza 320 144 39 0 0 9125 Zanzibar 150 0 0 0 0 0

Total 3,072 2,049 161 99 23 311

Table 16: Materials distributed for fabrication of special and local shoes production per region in 2016

Regions Leather MCR H.rubber GLUE L.Leather Thread S.RivertsKigoma 30 1 1 2 0 3 100Morogoro Nazareth 30 2 2 4 50 3 300Tanga Misufini 30 1 1 3 0 2 100Mara Shirati 30 1 1 3 0 3 200Kagera Biharamuro 30 1 1 2 10 3 200Pwani Kindwitwi 40 2 2 4 40 3 200Tabora Sikonge 40 2 2 4 40 3 200 Mwanza Bukumbi 40 2 2 3 30 3 200Ruvuma 30 2 1 2 30 3 200


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5 LABORATORY SERVICES

The program continued to strengthen its laboratory services by increasing the number of diagnostics centres from 945 in 2015 to 1100 in 2016, Sensitize the use of the zonal laboratory culture laboratories and scaling up the use of the Gene Xpert in the country. In addition, during this year the second drug resistant survey has been initiated.

5.1 Laboratory workload

In 2016, 3,895 specimens were received at the CTRL, out of these 42 (1.0%) were for studies/ projects and the remaining were from different parts of the country for AFB smear microscopy, culture and DST examinations.

Of these specimens 2008(51.55%) were from Muhimbili National Hospital (MNH) for routine diagnostic examinations only and 1887(48.44.%) were set for culture and DST as part of MDR-TB routine surveillance system. However, culture was done on 1589 for sputum specimens of which 1219 (76.71%) were culture negative while 333(20.96%) were positive and some of these positive isolates (Retreatment cases) were set for DST. DST results were available for 381 isolates.

Of these, 298(78.22%) of all isolates with DST results were sensitive to all four first line anti-TB drugs,.74 (19.4%) of the positive isolates had resistance to one or more anti-TB drugs and…45. Isolates were Multi Drugs Resistance (MDR), 130 specimens. Were subjected to second line drug susceptibility test and none was XDR.

Table: 17 Number specimens received in 2016

Region N %Dodoma 48 1.23Arusha 143 3.67Kilimanjaro 111 2.85Tanga 69 1.77Morogoro 69 1.77Pwani 68 1.75Lindi 49 1.26Mtwara 37 0.95Ruvuma 10 0.26Iringa 32 0.82Mbeya 4 0.1Singida 61 1.57


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Region N %Tabora 35 0.9Rukwa 2 0.05Kigoma 8 0.21Shinyanga 6 0.15Kagera 16 0.41Mwanza 75 1.93Mara 4 0.1Manyara 36 0.92Unguja 29 0.74Pemba 20 0.51Geita 36 0.92Njombe 3 0.08Kinondoni 193 4.96Ilala I 223 5.73Temeke 346 8.88Ilala II 2,079 53.38Unknown 83 2.14Total 3,895 100

5.2 Culture analysis

Percent of positive cultures that are smear positive (sensitivity) and the correlation smear-positive culture positive specimens (specificity) shows a lot of variations throughout the year. This ideally is measured for initial diagnostic specimens only; smears from patients already on treatment may be positive, but yield no growth on culture.

The culture analysis shows an increase on smear negative/culture positives, a decrease on smear positive/culture positive. There was decrease of false negative during quarter 1 to three and an increase in quarter four of almost equal magnitude which came close to 50% towards the end of the year as can be seen in the figure below.


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Figure:15 Culture analysis at CTRL 2016

5.2.1 Gene Xpert MTB/Rif Implementation– Rapid DST

Currently the program is in process of scaling up the use of Gene Xpert machines guided by the Xpert roll out plan launched during the last year.

In 2016 total 5 health facilities were installed with GeneXpert machines making a total of 71 machines in the country. The GX Alert system continues to be a source of the information to analyse the operations of the machines in the country

Table 18: Summary analysis of the Xpert MTB RIF in 2016

Values Grand Total Total # Xpert tests 52,583Total # Xpert MTB- 40,213Total # MTB+ RIF indeterminate 108Total # MTB+ RIF sens 8,147Total # MTB+ RIF res 399


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Total # error results 1,695Average Error rate 4%Average Rate of Rif resistance 3%Average Rate of Xpert MTB positivity 12%Average Instrument capacity being utilized 29%

5.2.2 Line Probe Assay (LPA)

A total of 103 positive isolates were tested for LPA at CTRL of these 54 (%), were sensitive to both Isoniazid and Rifampicin, 9 (%) were resistant to both Isoniazid and Rifampicin, 1 (%) was resistant to Isoniazid only and 4 (%) were resistant to Rifampicin only. Total number of isolates tested for LPA was too small due to the reason that for a long time there was a stock out of LPA reagents.

Table:19 Total Isolates for LPA

Results New Previous TotalSensitive to Isoniazid and Rifampicin

28 26 54

Resistant to Isoniazid and Rifampicin

1 8 9

Resistant to Isoniazid 0 1 1Resistant to Rifampicin 1 3 4No MTB Detected 2 15 17Invalid results 2 16 18Total tests 34 69 103

5.3 External Quality Assurance of Drug Resistance

In 2016 CTRL participated in an External Quality Assurance of drug resistance organized by supranational laboratory (SLN) Antwerp, Belgium, CDC Atlanta and WHO in collaboration with NICD. The laboratory has received GeneXpert panels, Smear Microscopy panels, Culture & DST Panels. The table below shows participation of EQA for the CTRL.


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Table 20: Summary Participation of EQA for CTRL

PT Provider Proficiency Panel

Survey # Date received Date results submitted

Results /Score

Acceptable /Unacceptable

NICD/WHO Microscopy 2016-02 10-Jul-16 YES 95% AcceptableNICD/WHO Microscopy 2015-3 23-Feb-16 24-Mar-16 90% AcceptableCDC/ATLANTA GeneXpert

MTB/RIF2016-A 20-May-16 23-My-16 100% Acceptable

CDC/ATLANTA GeneXpert MTB/RIF

2016-B 05-Aug-16 17-Aug-16 100% Acceptable

CDC/ATLANTA GeneXpert MTB/RIF

2016-C 01-Dec-16 YES 100% Acceptable

UK NEQAS MTB culture 3959 22-Aug-16 4-Oct-16 8/8 (100%) Acceptable

5.4 TB Laboratory Network

Tanzania TB Laboratory network comprise of 1100 diagnostic sites by 2016, five TB culture laboratory and the Central reference laboratory sites. Decentralization of Zonal TB culture laboratory was initiated on year 2015. By December 2016, five laboratory were recognized as TB culture laboratory which are Pemba Public Health Laboratory, Bugando Medical Centre Laboratory, Kibong’oto Infectious Disease Hospital Laboratory, Mbeya Referral Hospital and Dodoma Region Referral Hospital.

Accreditation process of the TB Laboratories has started since 2014 .By the end of 2016 total of five culture laboratories were involved in Strengthening TB Laboratories Quality Management Towards Accreditation (TB SLMTA) with total of 15 Participants trained from six TB laboratories, among them eleven participants successfully completed from five laboratory as one laboratory excluded from the training programme.

The program during this year has continued to use Tanzania Post Cooperation for transportation of samples from facilities to the Zonal TB culture laboratories and CTRL.


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6 PROGRAMME SUPPORT ACTIVITIES

6.1 Procurement and Supply Management of Anti-TB and Anti-Leprosy Medicines

Procurement of anti-TB and anti-leprosy medicines and commodities is done by the Government through the development partners such as; the World Health Organization (WHO), the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). First line and second line for adults and children anti-TB medicines are procured by Global Fund grant through Global Drug Facility (GDF). On the other hand, the GF through Medical Stores Department (MSD) supports procurement of ancillary medicines and laboratory reagents, equipment and supplies. Ancillary medicines are used for the management of side effects in patients taking anti-TB second line medicines. Furthermore, the GF through GDF procures single therapy Isoniazid tables for INH prophylaxis among PLHIV. Leprosy medicines are procured through the World Health Organization (WHO).

6.1.1 Stock status: National, and districts

The Program is responsible for forecasting and quantification of anti-TB and anti-leprosy medicines and laboratory reagents. MSD, which is an autonomous institution of the Ministry of Health and Social Welfare is responsible for the procurement (ancillary medicines and laboratory reagents), port clearing, storage and distribution of pharmaceuticals and medical supplies. Monitoring commodity availability at point of service delivery remains to be core function of NTLP as well as overseeing overall resource mobilization for anti-TB and anti-leprosy medicines.

NTLP has finalized roll out of The New Optimized TB and Leprosy Logistic System to all the regions including Zanzibar and Pemba. Using this system, facilities with TB and Leprosy patients are now required to fill in Facility Monthly Report Form (FMRF) every month indicating the number of patients in their facility, month of treatment and stock of medicines available at the facility in that respective month. This form is submitted to the district for them to be supplied with the required medicines. Each district compiles information from all the facilities and prepares quarterly order (District Quarterly R & R Forms) which is submitted to MSD for them to be supplied with medicines for specific quarter. Through thus optimized system, distribution of medicines solely depend on the demand of facilities. Medicines from MSD Central is transported to MSD Zones and Zones supplies all respective districts according to their order.

The new logistic system does not cover distribution of Laboratory Commodities and MDR TB medicines, these commodities continue using the old system where MDR-TB medicines are sent directly to Kibong’oto and Laboratory commodities are sent to the Regions through RTLC. NTLP is responsible for monitoring and supervision of anti- TB and leprosy drugs at all levels.


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One of the challenges facing drug management in most facilities is improper filling of FMRP where data filled in the form are inaccurate. Most districts still supplies medicines to facilities without following the stipulated Tb and Leprosy Logistic SOP. In addition during roll-out, some health facilities were not trained since they did not have TB patients.

During this period,(2016) the programme received through the MSD, consignments of Fixed Dose Combinations (FDCs) of anti TB drugs from the Global Drug Facility (GDF) and anti-leprosy blisters; MB Adult, MB child, PB adult and PB child from the WHO. The table below summarizes the

Table 21:stocks of anti-TB and anti-leprosy drugs distributed in the country in 2016.

S/No MEDICINE PACK SIZE QTY 1 Water for injection vial/100 2,196 2 RH 2FDC 60/30 84 2,580 3 RHZ 3FDC 60/30/150 84 3,503 4 E100mg 100 1,006 5 E400mg 672 8 6 RHZE 4FDC 150/75/400/275 672 17,929 7 RH 2FDC 150/75 672 33,467 8 RHE 2FDC 150/75/275 672 2,045 9 Streptomycin inj vial/100 2,730 10 Capreomycin Inj 1G VIAL 1,080 11 Cycloserine 250mg 100 581 12 Ethionamide 250mg 100 910 13 Kanamycin Inj 1G VIAL/50 400 14 Levofloxacin 250mg 100 1,297 15 Levofloxacin 500mg 100 18 16 Linezolid 600mg 20 31 17 MBA BLISTER 473118 PBA BLISTER 90819 MBC BLISTER 87220 PBC BLISTER 228

6.2 Community empowerment activities

The implementation of the community based activities has been implemented by the Program in collaboration with LGA’s, implementing partners, NGO’s (6) and NSA’s (2). The main focus was on community systems strengthening at all levels. Several activities such as organising a joint meeting with NACP, RHMT’s and implementing partners to discuss the implementation of grant activities with specific focus on Global Fund, sensitization of unengaged CSO’s on TB control, engagement of new CSO’s (69) and their capacity


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building took place at National level. Furthermore, a total of 247 CBO’s (out of 400) were supported to provide community TB care and prevention together with provision of enablers.

Training packages for CHW’s, Sputum fixers and HCWs were reviewed along with the standard operating procedures for sputum fixers. At regional and district levels, training were conducted to capacitate the CHWs (including sputum fixers) with the skills of conducting contact tracing, active case finding and sputum fixation. A number of CHWs (ex TB patients) and sputum fixers are distributed to various regions (see annex….). The Program also printed and distributed M&E tools and operational guideline for community TB, TB/HIV and DR-TB interventions.

The national average contribution from community was 9.7%, a decrease of 9.3% compared to 2015 (19%). This was contributed by the introduction of community TB referral component in the M&E tools where by most of districts were still using old TB registers of which did not accommodate this component. Other factors include lack of reliable financial support to some districts and inadequate capacity of HCWs to link TB cases contributed from community.

Home Based DOT still continued to be the most preferred mode of treatment as 90.4% of TB patients in 2016 were treated under this modality. Among them, …..% are successfully treated.

Table 22: Trend of community contribution (%) in TB case notification in Tanzania from 2012-2016

S/N Year Number of notified TB cases(all forms) contributed by community referrals1 2012 14%2 2013 15%3 2014 19%4 2015 19%5 2016 9.7%

6.3 Advocacy, Communication and Social Mobilization (ACSM) activities

Advocacy, Communication and Social Mobilization (ACSM) activities are integral part of implementing TB activities in the country. The World Leprosy day and World Tuberculosis Day were marked on 31st January 2016 and 24th March 2016 respectively. Activities including sensitization campaigns and active case finding by screening of people for TB were conducted during commemoration period in 17 regions. The remaining regions did not commemorate due to lack of resources. Eighty three (83) members of parliament were sensitized on TB and TBHIV and MDR-TB. During the sensitization the Tanzania TB Caucus was also launched and endorsed by the Minister of MoHCDGEC and the Parliamentarians.


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The program focus on increasing awareness of TB whre by Four TV and radio spots were developed and broadcasted in selected 8 media houses during this year. In addition panel discussions and talk shows were broadcasted by 14 media houses A total of 6 media personnel from different media houses were supported to document best practices on TB, TB/HIV and MDR TB in 2 regions of Iringa and Mbeya. Furthermore, review of Swahili training package on ACSM was undertaken and 30 TOT were trained and cascade trainings were done to 170 HCWs in 6 districts of Karatu, Meru, Kinondoni, Geita, Hai and Same.

TB, TB/HIV and MDRTB messages for key affected population were developed and pre tested. The Programme in collaboration with partners managed to print and distribute IEC materials on TB, TB/HIV and MDR TB. Materials distributed include 3,490,000 leaflets; 71,968 posters; 1,500 wheel covers; 56 street banners; 2102 job aid for school health and 50,000 copies of Patient’s Charter for TB care.

6.4 Public and Private Partnership (PPP)

The contribution of private health facilities in TB case detection has not change significant in 2016 compared to that of 2015 where by in this year 7098 (11%) cases were notified from these providers. To strengthen the collaboration of between the Government and the private providers developed an action plan spearhead by honourable Minister of Health Community Development Gender Elderly and Children to be implemented for the coming next three years of the Program Strategic plan implementation (2015-2020) were launched.The NTLP has continued to provide support to the implementation of TB services in private health facilities in terms of provision of free drugs and other commodities (lab. Reagents and supplies) and recording and reporting tools. Also provide trainings, mentorship and supervisions and sensitization activities.

6.5 TB in Mining sector

TB in the mining sector (TIMS) initiatives continues to be implemented in the mining areas of in the the country. Among the interventions include:

1. Sensitization campaign and systematic TB screening activities in collaboration with implementing partners such as IOM and KNCV

2. Engaging mining companies in mobilizing resources for TIMS.

3. Conduct rapid surveys in North Mara – Tarime and Geita to assess the current practices related to mining exploration and diseases vulnerabilities among key populations in these areas

4. Coordinate the multi sectorial Technical working group for of TB in the mining sector meetings aiming at reducing burden of TB in the mining.


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6.6 Quality Improvement in TB case detection

Basing on the Tanzania Quality Improvement Framework (TQIF), the NTLP has introduced an innovative approach focusing on improving the quality of TB, TB/HIV and DR-TB services at health facilities of various levels of health care system. The approach provides a direction for quality TB service provision to most vulnerable groups and those all in need at all levels in the country. To ensure it is well implemented, the programme has developed a toolkit to guide health facilities to efficiently utilize available resources and opportunities to strengthen TB screening and detect much more TB cases. The toolkit will also facilitate monitoring the impact and stimulate further innovations in service provision to stop TB transmission in the country. Some of key implemented activities include:-

departmental working teams

and health facility exchange working sessions

and that is being delivered on regular planned days

facilities during clinical meetings

facility and different sections

most appropriate position and time to institute TB screening to patients and clients at the clinic or ward

facilities

The NTLP is collaborating with GF to implement the initiative in the 16 phase I regions. During the first six months (January – December, 2016) of implementation, the programme managed to conduct TB services assessment in Arusha, Zanzibar, Mbeya and Dar es Salaam, developed a training package and toolkit, presumptive TB register, job aides, posters and brochures and preparing a grant request to support implementation of key interventions. At the same time, 30 ToTs and 1228 health facility managers were trained. Dodoma and Mbeya regions were selected to be closely monitored and the initial results on the efforts to increase TB case notifications at the selected health facilities were very impressive as shown in the figures below. The monitoring activities in the past six months


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were mainly conducted by consultants hired by GF. The phase II of implementation will start by mid next year, 2017 involving the remaining regions and the programme expects many other development partners like Boresha Afya-USAID to come in and support the initiative.

Figure: 16 Showing Mbeya Quarterly TB notification comparison for quarters 1 and 2 of 2015 and 2016 (intervention facilities)

Figure 17 Dodoma referral regional hospital Monthly TB case notification, 2016


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6.7 Supportive Supervision

The NTLP supportive supervision is cascaded in three levels that are: central unit supervise regions at least once per year; regions supervise districts once in every quarter; and district supervise diagnostic centres every month and DOT centres each quarter. The Ministry conducted and coordinate supportive supervision to all 28 regions in as per the plan.

Main strength identified include:

1. Good structured organisation and management to oversee the Program’s activities at Regional and Local Government levels

2. Regional and Councils levels plans to control the diseases

3. Good Collaboration with the NGOs and CSOs in the implementation of activities

Main weakness:

1. New Coordinators at Regional and Council level who are not yet trained Delayed submission of reports

2. Challenged EQA implementation

3. Poor capacity of the coordinators on data analysis and use

Recommendations

1. Plan for the training of the new coordinators

2. Review EQA activity to strengthen implementation

3. Plan for mentorship by the experienced coodinators

4. Plan for the capacity on M&E

6.8 Data Quality Assessment (DQA)

Data quality assessment was improved by reviewing the process and the tools. This resulted in the development of the guideline which was then oriented to the program coordinators.

During this year the routine assessment was conducted in seven regions including an MDRTB data quality assessment which was conducted by the USAID.The following were the general main findings:


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Strength

An average of less than 2% variation between the reported values and re-calculated valuesGood systems for the data management : focal persons for data management who are trained and have working tools

Weakness

Misclassification of cases : Understanding of new TB case definition among healthcare workers is still low, especially on groups of previously treated TB cases (relapse and other previously TB cases) Data quality checks are not performed at lower levelsIn appropriate use of registers

Recommendations

Data management guideline is needed to be in placeEnsure all treatment units in the region switch from using old to newly updated registers.POD register should immediately put in use for proper management of leprosy cases to prevent development of disabilities among registered cases.Review meetings should be essential in every region in order to discuss data management


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Annex 1: List of DTLCs 2016

NAME LOCATIONDr. AMANI HAULE LUDEWA DCDr. JONATHAN KITUNDU MAKETE DCDr. JAIROUS NJIKU WANGINGOMBE DCDr. JONATHAN SIHA NJOMBE DISTRICTDr.ISACK LULINDI NJOMBE TCDr.EMMANUEL F. KIWALE SONGEA MCDr.KANGEKA NDAWANA SONGEA DCDr.BRYSON MAPUNDA MBINGA DCDr.MKASANGE KIHONGOLE TUNDURU DCDr.ANTHONY NKWERA NAMTUMBO DC Dr.ATHANAS NDUNGURU NYASA DCDr.MAXENCIUS KAYOMBO MADABA TCDr.WENCE SLAUS SOCKY MBINGA DCDR MASANJA DWESE IGUNGA DCDr.DAVID MLAKI NZEGA DCDr JOHN BUSWELU SIKONGE DCDr. SINDABAKIRA SEREJIO UYUI DCDr.LUCAS MSANGI TABORA MCDr. WILLIAM B. KAIJAGE KALIUA DCDr JACOB KAMANDA URAMBO DCDr.MADENI KIZINGI GEITA DCDr.JEREMIAH NICANORY GEITA TCDr. Jephter Zacharia BUKOMBE DCDr.Polinatus Mwemezi Pantaline CHATO DCDr.Samwel S. Nchunga MBOGWE DCDr Phinias Ndaro NYANGHWALE DCDr.ALLEN MASIMBA ARUSHA DCDr.ELIPOKEA KAAYA MERU DCDr.SULEMAIN BIROLI LONGIDO DISTRICTDr.GODSON LEKASIO MONDULI DISTRICTDr.PAULINA CHALLE ARUSHA CN ZONEDr.THOMAS MGALULA KARATU DCDr.MICHAEL KINGAZI ARUSHA CITY EAST ZONEDr.JOEL MSUYA ARUSHA CITY WEST ZONEDr.EMANUELLE MALLANGE NGORONGORO


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Dr. Ramadhani Makange UkongaDr. Eliah Mmbando AmanaDr.Linda Mutasa Mnazi MmojaDr.John Mkombachepa TabataDr.Salapion Mutagwaba VingungutiDr.Cyrilo Mapunda BuguruniDr.Cristopher Mapunda ChanikaDR AMBILIKILE MSHANI SUMBAWANGA MCDr.FRANCIS MWASYEBULE SUMBAWANGA DCDR EVELADA SANANE NKASI UPLANDDR GODFREY MACHETA NKASI KIRANDODr.Festo Bernard Mpimbwe DCDr.Festus Fliminus Mlele DCDr.Jeremia Mollel Tanganyika DCDr.Gabriel Karumuna Nsimbo DCDr.Peres Ishengoma Mpanda DCDr. JOHN MASANJA MKURANGA DCDr.KASIMU SULEIMAN KIBAHA TCDr.JUSTINE MYALA KISARAWE DCDr.CHACHA DAUDI KIBAHA DCDr.ROGGER NNARY RUFIJI DCDr.JOAS MBAGA CHALINZE DCDr.ABDALLAH BHAI MAFIA DCDr.ALEX MLIGA KIBAHA TCDr.STANLEY ALFRED KIBITI DCDr.MWINYI KAMBI SALUMU B/MOYO DCDR. LAURENT MHEMBE SHINYANGA MCDr.DANIEL SINGOLILE SHINYANGA DCDr.PETER MAIGA MSALALA DCDR. PHILBRT NGWENDA KISHAPU DCDR. CONRALD B. WENCESLAUS USHETU DCDR. FREDRICK MALUNDE KAHAMA TCDR. JOYCE MGOHAMWENDE RANGITATUDR. SULTANI OMARI LUSAMBI MBAGALADR. TULIKIFRI MBAGA WAILES 1DR. SWALEHE KYONDA KIGAMBONIDR. SILVESTAR NGOWI WAILES 2DR. NANGENJWA MRUTU YOMBO VITUKADR. AMINA GAYAHIKA TAMBUKARELI


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DR. MRISHO KAMKANGA KEKO PRISONDR. DISMAS NHANDULE MEATU DCDR. NICHOLAUS MBASSA ITILIMA DCDR. PETER HENRY BARIADI DCDR.ESTHER JOHN BARIADI TCDR. STEVEN MUNUBI MASWA DCDR. GEOPHREY OBEID SHANI LUGALODr. Elamu Malekano RUANGWA DCDr.Victoria Kasanjala TBWRRD&PRIVETE HOSPITAL

MUHIMBLIDr. Sikujua Ally IDC -MuHIMBLIDr.Marcelina Mlay MWAISELA_MUHIMBILIDr Jackson Kileo SihaDr.Alfonce Shirima HaiDr Augustino Ngowi Moshi MCDr Clif Mushi Moshi DCDr.Ludovick Mashelle RomboDr Abdallah Kahuu MwangaDr.Alfred Seth Nyome SameDr.Anita Mallya MAGOMENIDr.Maliwaza Mganga MWANANYAMALA-1Dr.Hawa Mtutu MWANANYAMALA-2Dr.Theophilla Luhimbo TANDALE-1Dr.Bertila Kimaro TANDALE-2Dr.Maryam Mindu BUNJUDr. Pius Mndowa SINZADr.Timoth Batram Kayuni MBEZIDr.Sophia Kisoma MBURAHATIDR JAFARY THOBIASI;DTLC KILWA DCDr. FILBERT JOHN NDUNGURU NACHINGWEA DCDR GAUFRID MTENDACHI LINDI WESTDR ALLUTUPHINA DAMARU LINDI EASTDr. RICHARD KOMBA; LIWALE DCDr. ESTHER JOSEPHAT MUCHUNGUZI MUSOMA MCDr.REVOCATUS M. MUGETA BUNDA DCDr.HAMAD OMAR HAMAD SOUTH PEMBADr. ABDUL M. MSUYA MAFINGA TCDr.Wiston Kahumuza KyerwaDr. Abdiliian R Francis Muleba


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Dr.Johannes Jason KaragweDr. Simon L. Mugera NgaraDr. Pius Misunngwi BiharamuloDr. Ruta Bachubila MisenyiDR. SUFIAN MBELWA TANGA URBANDR. JOHN LUAMBANO MKINGADR. RAPHAEL MUMBA TANGA RURALDR. ELIGI MSECHU PANGANIDR.ERNEST KWINGWA KILINDIDR. BARAKA MBWAMBO KOROGWE DCDR. THERESIA MAUYA LUSHOTODR. RASHID MHINA HANDENIDR. JASON KAMALA KOROGWE TCDR. EVANCE O.MATATA BUMBULIDR. ELIABU BWATARE KWIMBA DCDR. ATHANAS KASUBI SENGEREMA DCDR.GABRIEL MASSAM MAGU DCDR KANIKI TITTUS UKEREWE DCDR. ESTHER MICHAEL MWANZA URBAN NORTHDR. DANIEL MAZENGO MISSUNGWI DCDR. PIUS NTABO MWANZA URBAN EASTDR. NGELEJA KHAMIS DTLC MWANZA SOUTHDr. Adam Masesa, , BUKOBA DCDR. Amani E Nkilingi Kilombero D.CDr. Dominatha Rutta Kyela DCDr. Mahuya M. Shibina Kasulu TCDr. ESTHER BASHASHA MBOZI DCDr. Mariam Msigwa MBEYA DCDr. Emanuel E Nelson Babati TCDr. KAWAMBWA KAWAMBWA KASULU DCDr. Nicholas K.Mwaipyana Busokelo DCDr. Musimu Makunja RORYA DCDR. SAID JUMANNE KITIKU IKUNGI DCDR. ATHUMAN STEPHEN SINGIDA DCDR.FERDINAND KUTIMWA MANYONI DCDR.EMMANUEL KATOSANI RUNGWE DCDR. JOHN SUNGI KONDOA DCDR. NOLASCO G. NGOLLOKA KILOLO DCDR. HERMAN KIMU SINGIDA REG. HOSP


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DR. MSENGI GYUNDA IRAMBADR. JAMES M. JUMANNE KIGOMA DCDR. FELIX M. BIGGI KIGOMA UJIJI MCDR. JAMES MIGUNGA BAHI DCDR. EMMANUEL M. WANDETI KONGWA DCDR. BONIFACE J. CHAPANGA KALAMBO DCDR. FARAJA S. MPOMBO CHEMBA DCDR. HAWA LESSO MPWAPWA DCDR. LAUREAN A. KANAGANWA KIBONDO DCDR. JOSEPH KOMBA DODOMA MCDR. EDWIN KONGOLA CHAMWINO DCDR. CHARLES HILARY MBOTA MAKAMBAKO TCDR. ANDREW P. MALELO BUSEGA DCDR. BONNY BANDA FERDNANDS MBEYA CITY FLACKSON M. KIBONA ILEJE DCDR. GEOFREY MINZI MBARALI DCDR. VEDASTUS P. LUMBALUMBA CHUNYADR. ASELI A. PWELE MOMBA DCDR. JOHN NADO MUSIBHA TARIME DCDR. JUMA KISINZA TARIME TCDr. Obby Kavasha Babati DCAlex Christopher Hanang DCDr. Mussa Perment Kiteto DCDr. Ally Fupi Mbulu DCDr. Samweli Wilson Simanjiro DCDr. PETER JENGELA Iringa DCDr. SIMON KESSY Iringa MCDr. VENANCE KIYEYEU Mufindi DCDr. Reuben Hebron Morogoro DCDr. Elias Mtungilwa Morgoro MCDr. Reuben Mfugale Gairo DcDr. Boniface Manditi Ifakara TCDr. Mayunga William Mvomero DCDr. Thabit Kibika Ulanga DCDr. Said Muhombolage Kilosa DCDr. Emmanuel Chogo Malinyi DCDr. Chacha P. Maroa Serengeti DCDr. Sarah Sanze Butiama DCDr. Samwel Matiko Peter Musoma DC


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Annex 2: Change in Case Notifications by regions between 2015 and 2016


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Annex 3:

Comparison of Case notifications Rates by regions between 2015 and 20162015 2016

Region CNR Partner Region CNR PartnerDar Temeke 288 CDC Dar Temeke 263 CDCDar Ilala I 222 KNCV Njombe 214 CDCDar Kinondoni 210 KNCV Dar Ilala I 213 KNCVIringa 182 CDC Dar Kinondoni 200 KNCVPwani 173 KNCV Pwani 187 KNCVArusha 166 KNCV Iringa 182 KNCVManyara 156 GF Arusha 179 KNCVNjombe 148 CDC Mtwara 144 CDCLindi 139 CDC Mbeya 143 CDCMorogoro 134 CDC Lindi 141 CDCMtwara 131 CDC Manyara 137 GFKilimanjaro 126 KNCV Kilimanjaro 135 KNCVTanzania (national average)

125 Tanzania (national average)

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Mbeya 125 CDC Morogoro 128 CDCShinyanga 122 CDC Mwanza 127 KNCVMara 121 GF Shinyanga 125 CDCTanga 118 CDC Tanga 124 CDCMwanza 114 KNCV Geita 116 KNCVGeita 106 KNCV Simiyu 114 CDCSimiyu 103 CDC Mara 111 GFRuvuma 95 CDC Dodoma 101 GFSingida 91 CDC Singida 88 CDCDodoma 88 GF Ruvuma 88 CDCTabora 82 CDC Tabora 80 CDCKagera 68 GF Kagera 77 GFKatavi 47 GF Rukwa 59 GFRukwa 43 GF Katavi 59 GFKigoma 40 GF Kigoma 45 GF


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Annex 4:

Contribution of pediatric notification by regions between 2015 and 20162015 2016Region % of pediatric

contributionRegion % of pediatric

contributionSimiyu 15.2 Iringa 14.6Arusha 15.0 Simiyu 14.4Mwanza 13.6 Arusha 13.9Kigoma 12.7 Pwani 13.4Manyara 12.4 Mwanza 12.6Dar Ilala II 11.4 Ruvuma 11.7Mbeya 11.3 Dar Ilala II 10.7Dodoma 11.0 Dar Temeke 10.5Pwani 11.0 Manyara 10.5Ruvuma 10.5 Dodoma 10.0Tabora 10.4 Mbeya 9.9Njombe 10.1 Tanzania 9.8Iringa 10.1 Kigoma 9.6Kilimanjaro 9.7 Singida 9.5Singida 9.7 Dar Es Salaam 9.2Katavi 9.6 Geita 9.1Tanzania 9.6 Tabora 9.0Tanga 8.9 Dar Ilala I 8.7Morogoro 8.5 Lindi 8.6Shinyanga 8.1 Kilimanjaro 8.4Dar Temeke 8.0 Njombe 8.3Lindi 7.9 Shinyanga 8.3Dar Es Salaam 7.6 Morogoro 8.2Mara 7.5 Mara 8.2Dar Ilala I 6.8 Dar Kinondoni 7.9Dar Kinondoni 6.7 Katavi 7.7Mtwara 6.6 Tanga 7.2Geita 6.3 Kagera 7.2Kagera 5.7 Mtwara 6.3Rukwa 4.0 Rukwa 6.3


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Annex 5:

Regional Community contribution

2015 2016REGION % of Community

ContributionREGION % of

Community Contribution

STC work since 2016

CTB work since 2014?

Dar Ilala II 52.3 Mara 55.0 Tanga 48.6 Dodoma 36.6 Yes Kagera 43.0 Tanga 28.9 Dodoma 36.0 Kigoma 26.6 Yes Mara 34.8 Dar Ilala II 21.7 Kilimanjaro 28.9 Kagera 18.0 Yes Lindi 25.8 Njombe 13.7 Geita 19.4 Tanzania 9.8 Kinondoni 17.0 Kinondoni 9.7 Dar Es Salaam 14.9 Dar Es Salaam 9.5 YesTanzania 14.9 Dar Temeke 9.4 Manyara 11.2 Manyara 8.6 Dar Ilala I 10.7 Singida 8.5 Mbeya 10.3 Rukwa 7.9 Yes Arusha 9.8 Katavi 7.4 Yes Kigoma 9.1 Lindi 7.2 Iringa 8.7 Shinyanga 6.6 Morogoro 7.6 Iringa 5.9 Pwani 6.8 Dar Ilala I 5.1 Dar Temeke 6.5 Simiyu 4.9 Njombe 6.4 Ruvuma 3.9 Mtwara 6.3 Arusha 3.2 YesRuvuma 3.8 Geita 2.7 YesSingida 3.4 Mbeya 2.4 Shinyanga 2.9 Tabora 2.2 Yes Simiyu 2.5 Pwani 1.7 YesMwanza 2.3 Mwanza 1.6 YesTabora 0.3 Kilimanjaro 1.3 YesKatavi 0.0 Morogoro 0.3 Rukwa 0.0 Mtwara 0.1


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Annex 6:

Contribution from private health facilities with the proportion of health facilities2015 2016REGION % of TB notified

by Private HFREGION % of TB notified

by Private HF% of Pvt HF out of total HF

Arusha 24.94 Arusha 35.32 46%Manyara 24.24 Dar Ilala II 25.79 94%Dar Temeke 20.10 Pwani 17.61 19%Singida 18.47 Mara 17.23 22%Tabora 15.66 Iringa 15.43 26%Pwani 15.35 Njombe 15.15 21%Iringa 15.31 Dar Kinondoni 15.12 75%Dar Es Salaam 12.55 Morogoro 13.43 31%Dar Kinondoni 11.66 Dar Es Salaam 13.36 77%Tanzania 10.84 Tabora 12.02 13%Mbeya 10.82 Shinyanga 11.26 25%Rukwa 9.70 Dar Temeke 11.21 79%Kigoma 9.43 Tanzania 10.81 Tanga 9.23 Dar Ilala I 9.58 76%Dar Ilala II 8.92 Lindi 9.09 5%Shinyanga 8.56 Kilimanjaro 8.23 41%Morogoro 8.31 Tanga 7.58 21%Simiyu 8.21 Manyara 7.32 23%Dodoma 7.98 Singida 7.25 18%Katavi 5.84 Kigoma 6.82 17%Lindi 5.47 Dodoma 6.76 15%Mara 5.19 Rukwa 6.73 14%Njombe 4.96 Mbeya 6.43 24%Kagera 4.50 Simiyu 6.42 12%Dar Ilala I 4.06 Kagera 6.02 23%Kilimanjaro 3.93 Mtwara 5.38 14%Mtwara 3.33 Katavi 3.18 17%Geita 2.90 Mwanza 2.80 23%Ruvuma 2.03 Ruvuma 2.58 19%Mwanza 1.57 Geita 0.26 28%


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Annex 7:

TB/HIV cases notified in 2016REGION Notified Tested

for HIV HIV +ve TB

Referred to CTC

Referred from CTC

Regis-tered for HIV Care

Started on ART

Started on CPT

Dar Ilala I 3,235 3,228 1,017 408 609 988 965 998Dar Ilala II 1,136 1,083 369 104 234 333 335 335Dar Kinondoni 4,391 4,368 1,381 514 875 1,341 1,350 1,370Dar Temeke 4,495 4,477 1,649 575 1,074 1,567 1,598 1,647Dar Es Salaam 13,257 13,156 4,416 1,601 2,792 4,229 4,248 4,350Arusha 3,443 3,420 855 294 565 838 784 778Dodoma 2,324 2,086 552 400 161 512 478 544Geita 2,288 2,196 837 288 540 737 690 801Iringa 1,834 1,756 840 224 632 795 748 815Kagera 2,191 2,158 778 371 401 756 669 741Katavi 377 373 138 59 92 133 127 128Kigoma 1,126 984 178 81 97 174 169 173Kilimanjaro 2,466 2,432 756 235 524 739 722 727Lindi 1,320 1,258 335 123 173 295 294 295Manyara 2,255 2,147 329 146 183 285 267 315Mara 2,395 2,147 601 152 411 509 462 546Mbeya 4,336 4,176 2,067 563 1,539 1,945 1,815 1,908Morogoro 3,194 3,046 873 567 306 784 763 825Mtwara 1,988 1,877 425 242 273 423 421 418Mwanza 4,289 4,253 1,624 442 1,175 1,595 1,533 1,603Njombe 1,611 1,540 885 483 464 829 786 855Pwani 2,271 2,252 784 162 620 772 727 774Rukwa 684 670 175 91 109 178 171 158Ruvuma 1,355 1,340 554 216 345 545 520 552Shinyanga 2,132 2,035 1,040 220 820 1,006 968 975Simiyu 1,745 1,674 482 134 395 463 444 461Singida 1,351 1,319 339 111 234 343 329 342Tabora 2,105 2,056 869 323 559 869 802 850Tanga 2,851 2,688 880 389 520 859 782 862Mainland 65,188 63,039 21,612 7,917 13,930 20,613 19,719 20,796Pemba 247 246 26 4 22 25 24 26Unguja 473 468 82 33 49 71 71 73Zanzibar 720 714 108 37 71 96 95 99Tanzania 65,908 63,753 21,720 7,954 14,001 20,709 19,814 20,895


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d&&,2.$6#+06($106$efgh - ntlp · figure 4: trends of previously treated tb cases notiÞed...

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