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USAID ERADICATE TB PROJECT QUARTERLY PROGRESS REPORT Reporting Period: January 1 to March 31, 2019

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USAID ERADICATE TB PROJECT QUARTERLY PROGRESS REPORT Reporting Period: January 1 to March 31, 2019 GABE BIENCZYCKI FOR PATH USAID ERADICATE TB PROJECT QUARTERLY PROGRESS REPORT Reporting period: January 1 to March 31, 2019 Submission date: May 3, 2019 Submitted to: Submitted by: Dr. Nancy Kasese-Chanda Dr. Joseph Nikisi Contracting Officer Representative Chief of Party USAID Zambia USAID ETB Project Email: [email protected] Email: [email protected] PROJECT SUMMARY Program Name: Eradicate TB Activity Start Date and May 26, 2017 to May 25, 2022 End Date: Name of Prime PATH Implementing Partner: Contract Number: Eradicate TB Activity _AID-611-C-17-00003 CITAM+, Afya Mzuri, African Society for Laboratory Medicines Names of Sub-partners (ASLM), Initiatives Inc., Zambart Major Counterpart Ministry of Health/National Tuberculosis and Leprosy Program Organizations: Copperbelt, Central, Northern, North-Western, Luapula, Geographic Coverage: Muchinga Reporting Period: January 1, 2019 to March 31, 2019 TABLE OF CONTENTS PROJECT SUMMARY 1 ABBREVIATIONS 4 EXECUTIVE SUMMARY 6 KEY ACHIEVEMENTS 6 INTRODUCTION 12 PROJECT OPERATION 12 PROJECT PARTNERSHIP ROLES AND RESPONSIBILITIES 12 TASK 1: PURSUE HIGH-QUALITY DIRECTLY OBSERVED THERAPY, SHORT- COURSE (DOTS) EXPANSION AND ENHANCEMENT. 13 SUB-TASK 1.1: PROVIDE AN ENABLING ENVIRONMENT FOR TB CONTROL EFFORTS. 15 1.1.3. CONVENE AN ORIENTATION MEETING FOR THE ZAMBIA PARLIAMENTARY CAUCUS ON TB. 15 1.1.5. ENGAGE PRIVATE MEDICAL PRACTITIONERS AND PHARMACIES. ERROR! BOOKMARK NOT DEFINED. 1.1.6. STRENGTHEN TB LEADERSHIP AND MANAGEMENT TO IMPROVE COORDINATION OF TB SERVICES AND INTERVENTIONS. 16 1.1.7. BUILD CAPACITY FOR INCREASED TB AWARENESS AND COMMUNITY-BASED FINDING AND TREATMENT SUPPORT IN COMMUNITIES. 16 SUB-TASK 1.2: INCREASE TB CASE DETECTION THROUGH IMPROVED DIAGNOSTICS. 17 1.2.1. QUALITY-ASSURE DIAGNOSTIC SERVICES THROUGH GENEXPERT®. 17 1.2.3. PROVIDE TECHNICAL ASSISTANCE FOR QUALITY ASSURANCE. 18 1.2.4. IMPLEMENT INNOVATIVE LABORATORY MENTORING PROGRAM. 18 1.2.5. STRENGTHEN THE LABORATORY SPECIMEN COURIER SYSTEM. 19 1.2.6. PROVIDE TECHNICAL ASSISTANCE TO THE NTRL TO STRENGTHEN ITS CAPACITY TO PROCESS SPECIMENS (ESPECIALLY TO DIAGNOSE DR-TB). 21 1.2.7. PROCURE LABORATORY SUPPLIES AND EQUIMENT. 21 SUB-TASK 1.3. STANDARDIZE TB TREATMENT, SUPPORT, AND CARE. 21 1.3.1. SUPPORT THE UPDATING, PRINTING, AND DISSEMINATION OF TB TREATMENT GUIDELINES. 21 1.3.3. TRAIN CBVS TO SUPPORT PATIENTS RECEIVING TREATMENT. 21 1.3.4. INCREASE TB CASE DETECTION THROUGH ACTIVE TB CASE FINDING. 22 SUB-TASK 1.4. SUPPORT THE EXISTING NTLP MONITORING AND EVALUATION (M&E) SYSTEMS. 22 1.4.2. COLLECT AND REPORT TB, DR-TB, TB/HIV, AND COMMUNITY DATA. 22 1.4.3. STRENGTHEN THE HEALTH MANAGEMENT INFORMATION SYSTEM. 24 ETB’S PROJECT DATABASE 24 ETB’S DATA COLLECTION INSTRUMENT 24 MOH SHIFT TO DHIS2 24 NATIONAL TRAINING DATABASE 24 1.4.5. PARTICIPATE IN ACTIVITIES THAT SHARE PROJECT EXPERIENCES AND FACILITATE LEARNING. 25 TASK 2. INCREASE ACCESS TO TB/HIV AND DR-TB SERVICES FOR POOR AND VULNERABLE POPULATIONS IN TARGET PROVINCES. 25 SUB-TASK 2.1. REDUCE THE BURDEN OF TB/HIV COMORBIDITY. 25 2.1.1. SUPPORT PROVISION OF TPT. 25 2.1.2. SUPPORT ICF IN PLHIV AND HIV SCREENING IN TB PATIENTS. 25 USAID.GOV USAID ERADICATE TB PROJECT | 2 2.1.4. PROVIDE TECHNICAL AND ADMINISTRATIVE SUPPORT. 26 SUB-TASK 2.2. STRENGTHEN SYSTEMS TO HALT DR-TB EXPANSION. 26 2.2.1. BUILD HCW CAPACITY IN DIAGNOSIS AND CLINICAL MANAGEMENT OF MDR-TB.26 SUB-TASK 2.3. INCREASE TB DETECTION AND TREATMENT AMONG CHILDREN AND PREGNANT WOMEN. 27 2.3.1. STRENGTHEN CHILDHOOD TB MANAGEMENT. 27 2.3.2. CONDUCT CHILDHOOD TB SCREENING. 27 SUB-TASK 2.4. PROVIDE SUPPORT TO INCREASE TB DETECTION AND TREATMENT AMONG PRISONERS. 27 2.4.1. SUPPORT CAPACITY-BUILDING. 27 2.4.2. SUPPORT TB SCREENING AMONG INMATES. 28 2.4.3. COORDINATE PARTNERS WORKING WITH ZCS. 32 TASK 3. ENGAGE ALL CATEGORIES OF CARE PROVIDERS. 33 SUB-TASK 3.1. ENGAGE TRADITIONAL PROVIDERS. 33 SUB-TASK 3.2. IMPROVE CBV ENGAGEMENT IN TB CASE FINDING AND TREATMENT SUPPORT. 33 TASK 4. INTENSIFIED RESEARCH AND INNOVATION. 33 SUB-TASK 4.1. BUILD CAPACITY IN OR AND ESTABLISH NATIONAL TB OR PRIORITIES. 33 4.1.5. DISSEMINATE OR FINDINGS. 34 4.1.6. SUPPORT QUARTERLY MEETINGS FOR THE OR SUBCOMMITTEE OF THE TB TWG. ERROR! BOOKMARK NOT DEFINED. 4.2. DEVELOP STRATEGIC PARTNERSHIPS FOR OR. 34 FINANCE AND ADMINISTRATION 35 CHALLENGES 35 LESSONS LEARNED 35 PLANNED ACTIVITIES FOR FY19 Q3. 36 TASK 1. PURSUE HIGH-QUALITY DOTS EXPANSION AND ENHANCEMENT. ERROR! BOOKMARK NOT DEFINED. SUB-TASK 1.1. PROVIDE AN ENABLING ENVIRONMENT FOR TB CONTROL EFFORTS. ERROR! BOOKMARK NOT DEFINED. SUB-TASK 1.2: SCALE UP QUALITY-ASSURED DIAGNOSTIC SERVICES THROUGH GENEXPERT®. ERROR! BOOKMARK NOT DEFINED. SUB-TASK 1.3. STANDARDIZE TB TREATMENT, SUPPORT, AND CARE. ERROR! BOOKMARK NOT DEFINED. SUB-TASK 1.4. SUPPORT THE EXISTING NTLP M&E SYSTEMS. ERROR! BOOKMARK NOT DEFINED. TASK 2. INCREASE ACCESS TO TB–HIV AND MDR-TB SERVICES FOR POOR AND VULNERABLE POPULATIONS IN TARGET PROVINCES.ERROR! BOOKMARK NOT DEFINED. SUB -TASK 2.3. INCREASE TB DETECTED AND TREATED AMONG CHILDREN AND OTHER VULNERABLE GROUPS. ERROR! BOOKMARK NOT DEFINED. TASK 3. ENGAGE ALL CATEGORIES OF CARE PROVIDERS. ERROR! BOOKMARK NOT DEFINED. SUB-TASK 3.4. IMPROVE CBV ENGAGEMENT. ERROR! BOOKMARK NOT DEFINED. TASK 4. INTENSIFIED RESEARCH AND INNOVATION ERROR! BOOKMARK NOT DEFINED. 3 | USAID ERADICATE TB PROJECT USAID.GOV USAID.GOV USAID ERADICATE TB PROJECT | 4 ABBREVIATIONS AIDS acquired immune deficiency syndrome ART antiretroviral therapy ASLM African Society for Laboratory Medicine CBV community-based volunteer CDL Chest Diseases Laboratory CIDRZ Centre for Infectious Disease Research in Zambia CITAM+ Community Initiative for Tuberculosis, HIV/AIDS, Malaria plus related diseases DATIM Data for Accountability, Transparency, and Impact Monitoring DHIS2 District Health Information System 2 DHO district health office DISCOVER-Health District Coverage of Health Services Project DOT directly observed therapy DOTS directly observed therapy, short course DQA data quality assessment DR-TB drug-resistant tuberculosis DTLC district tuberculosis and leprosy coordinator EQA external quality assessment ETB Eradicate Tuberculosis Project FM fluorescent microscopy FY Fiscal Year GRZ Government of the Republic of Zambia HCW health care worker HIV human immunodeficiency virus ICF intensified case finding IPT isoniazid preventive therapy M&E monitoring and evaluation MCH maternal and child health MDR-TB multidrug-resistant tuberculosis MOH Ministry of Health MP Member of Parliament MPH Master of Public Health NHRA National Health Research Authority NSP National Strategic Plan for Tuberculosis Prevention, Care, and Control, 2017–2021 NTLP National Tuberculosis and Leprosy Program NTRL National Tuberculosis Reference Laboratory OPD outpatient department 5 | USAID ERADICATE TB PROJECT USAID.GOV OR operational research PEPFAR United States President’s Emergency Plan for AIDS Relief PLTFU primary loss to follow-up PY project year Q quarter RIF rifampicin RR rifampicin-resistant RR-TB rifampicin-resistant tuberculosis SAFE Supporting an AIDS-Free Era SOP standard operating procedure TB tuberculosis TSS technical supportive supervision TWG technical working group UNZA University of Zambia UNZA-SPH University of Zambia School of Public Health USAID United States Agency for International Development ZAMBART Zambia AIDS Related Tuberculosis Project ZCS Zambia Correctional Service ZPA Zambia Pediatric Association USAID.GOV USAID ERADICATE TB PROJECT | 6 EXECUTIVE SUMMARY The United States Agency for International Development (USAID) Eradicate Tuberculosis (ETB) Project is pleased to share the Fiscal Year (FY) 2019 Quarter (Q) 2 Performance Report covering the period January 1 through March 31, 2019. Data presented in this report were collected from all facilities in 60 districts from the six project-supported provinces. This includes data from three additional new districts which originated from the 60 districts noted above; the data from the three new districts are reported under the districts from where they originated. Key achievements for this reporting quarter are highlighted below; these and additional achievements are described in further detail in the body of the report. KEY ACHIEVEMENTS During FY19 Q2, ETB-supported provinces notified 3,753 tuberculosis (TB) patients, constituting a 74% achievement against the quarterly target of 5,103 (Figure 1Error! Reference source not found.). This includes 3,331 TB notifications from 35 directly-supported districts. Of the 3,331 TB patients notified by ETB-supported districts, 2,201 (66%) were male and 1,130 (34%) were female. This marked improvement of 12 percentage points against the quarterly notification target between FY19 Q1 and Q2 may be attributed to improved diagnostic support (GeneXpert® machines and cartridges), enhanced health care worker (HCW) training in TB management, technical support and mentorship provided by ETB to the project-supported provinces, and the focused intensified case finding (ICF) activities that the project supported at facility and community levels. Figure 1. TB notifications by quarter from 60 ETB-supported districts, January 2018 to March 2019. 6,000 5,000 5,103 5,103 4,603 4,603 4,603 4,000 3,753 3,000 (74%) 3,110 3,184 2,854 2,863 (68%) (62%) (62%) (62%) 2,000 1,000 0 (Jan 18—March 18) (Apr 18—Jun 18) (Jul 18—Sep 18) (Oct 18—Dec 18) (Jan 19—March 19) Target No. of cases notified During the reporting period, Copperbelt province notified the highest number of TB patients (1,729 notifications), and Central province notified the second-highest number of TB patients (510 notifications). These two provinces account for 60% of the total TB notifications from ETB- supported provinces. The National Tuberculosis and Leprosy Program (NTLP) declared the month of March 2019 as a period to intensify case finding activities; ETB played an active role in TB awareness-raising campaigns and TB screening activities in order to find the missing patients. ETB continues to monitor closely the proportion of TB patients notified who are children.
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