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Quarterly Narrative Report October - December 2013

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USAID TB CARE II Project Malawi Quarterly Narrative Report October - December 2013 Funded by United States Agency for International Development, Malawi University Research Co., LLC Bethesda, Maryland 1 TABLE OF CONTENTS 1 EXECUTIVE SUMMARY .......................................................................................... 5 2 INTRODUCTION ...................................................................................................... 6 3 MAJOR ACCOMPLISHMENTS ................................................................................ 6 4 ACCOMPLISHMENTS BY RESULTS ....................................................................... 8 4.1 Result Area 1: DOTS Expansion and Enhancement ....................................................... 8 4.2 Result Area 2: Strengthening the Laboratory Network for TB .................................... 10 4.3 Result Area 3: TB/HIV ..................................................................................................... 11 4.4 Result Area 4: MDR-TB Management ............................................................................ 12 4.5 Result Area 5: Health System Strengthening ................................................................. 13 5 CONCLUSION ......................................................................................................... 13 6 ACTIVITIES FOR NEXT QUARTER ...................................................................... 13 October- December 2013 Quarterly Report, USAID/Malawi TB CARE II Project; University Research Co., LLC 2 LIST OF ACRONYMS AAFB Acid alcohol Fast Bacilli ART Anti-Retroviral Therapy CHAM Christian Health Association of Malawi COP Chief of Party CPT Co-trimoxazole Prophylaxis Therapy CRL Central Reference Laboratory CSCP Community Sputum Collection Point DHMT District Health Management Team DHO District Health Officer DIP District Implementation Plan DOTS Direct Observation Treatment Strategy DQA Data Quality Assurance EQA External Quality Assurance EPTB Extra- pulmonary Tuberculosis HCW Health Care Workers HIV Human Immuno Deficiency Virus HRH Human Resource for Health H.SA Health Surveillance Assistants HTC HIV Testing and Counseling MDR-TB Multi-Drug Resistant Tuberculosis M&E Monitoring and Evaluation MOH Ministry of Health MTB Mycobacterium Tuberculosis NAPHAM National Association of People Living with HIV and AIDS in Malawi NTP National Tuberculosis Control Program NLSP National Laboratory Strategic Plan PLHIV People Living with HIV/AIDS PMDT Programmatic Management of Drug resistant Tuberculosis PMT Program Management Team PTB Pulmonary Tuberculosis PY Project Year October- December 2013 Quarterly Report, USAID/Malawi TB CARE II Project; University Research Co., LLC 3 RH Rifinah (Rifampicin &Isoniazid) Rif Rifampicin SLD Second Line Drug SOP Standard Operating Procedures SSDI Support for Service Delivery Integrated TAT Turn Around Time TB/HIV Tuberculosis/Human immunodeficiency virus TB IC Tuberculosis Infection Control Tx Treatment USAID United States Agency for International Developments ZN Zeihl Neelson October- December 2013 Quarterly Report, USAID/Malawi TB CARE II Project; University Research Co., LLC 4 1 EXECUTIVE SUMMARY This report covers activities completed during TB CARE II’s PY4 Quarter 1 (October - December 2013). A particular focus for this quarter was: decentralization of TB services; TB screening in pre-ART, ART, PMTCT and ANC settings; and strengthening of TB/HIV collaboration and services. TB CARE II continues to support the decentralization policy to improve access to TB diagnosis and treatment. In this quarter, 11 new TB initiation and registration sites were opened as follows: two each in Ntcheu, Nsanje, Zomba and Nkhotakota districts and three sites in Balaka. Each center established was linked to at least two Community Sputum Collection Points (CSCPs) managed by volunteers from Community-Based Organizations (CBOs) in the areas. TB CARE II intensified collaboration with CBOs already involved in TB/HIV work. During the quarter, 12 new CBOs were added and 55 (24M &31F) CBO volunteers in Phalombe, Zomba and Neno districts were orientated. They came from the following CBOs: Chikapa, Msamba in (Thondwe, Zomba); Chigwirizano in Matawale - Zomba; and Chiyanjano, Liwoni, Magareta and Ligowe Health Centres in Neno and Phalombe. As a result of these collaborative efforts the project is now working with a total of 31 CBOs (Nsanje (4), Mulanje (3), Mzimba (1) Neno (10), Phalombe (4) and Zomba (9)) to promote TB screening among people living with HIV and AIDS (PLHIV). The community-based TB service delivery systems also continued to be strengthened with the support provided to CSCPs. During this quarter, CSP volunteers conducted community awareness meetings and data verification in their respective catchment areas. Challenges with time of recording, sample transportation and turn-around time were identified and sorted-out at Kambale CSCP in Neno district. TB CARE II also supported community programs in Neno with enablers (Gum-boots, T-shirts, and cups) at Chawe, Kambale and Nsambe. The laboratory diagnostic network in target districts continued to be strengthened. In Zomba, ten microscopists were provided refresher training from four microscopy sites namely Matawale, St. Luke's, Cobe Barracks and Zomba Central Hospital. In Nsanje ten (7M & 3F) microscopists had refresher training at Nsanje District Hospital, Tengani, Sorgini, and Kalemba health centres. The project has been instrumental in supporting the rollout of GeneXpert technology for TB diagnosis especially among PLHIV and smear negative patients. In this quarter, TB CARE 11 conducted laboratory assessment at Nkhata Bay, Kasungu, Mchinji, Kamuzu Central Hospital, Kawale Health Centre, St. Gabriel and Limbe sites in collaboration with NTP in preparation for the installation of the seven Xpert® machines to be procured through PEPFAR funding. In addition, a GeneXpert refresher training was organized and supported by TB CARE II for 10 technicians (5 males each) from Ntcheu and Neno districts. The project further strengthened the access to diagnosis of MDR-TB by procuring 100 cooler boxes for sputum specimen transportation from the peripheral health facilities to the National TB October- December 2013 Quarterly Report, USAID/Malawi TB CARE II Project; University Research Co., LLC 5 Reference Lab in Lilongwe and district hospital laboratories with Xpert platforms. In addition, TB CARE II distributed 5,000 N95 masks to all 28 districts in the country while taking the lead in initiating an electronic MDR-TB recording and reporting system and the setting up of a steering committee that will start operating in Q2. In addition, TB CARE II also supported NTP in distributing 20 biosafety cabinets (BSC) to district hospitals selected by NTP that are awaiting installation. The project also played a key role in supporting NTP in meeting conditions to facilitate the release of Global Fund monies for Round 7 phase 2 TB grant, including collaborating with the NTP and Global Fund technical officers in the development of procurement and M&E plans for the revised implementation plan of the current grant. TB CARE II also provided technical support to the NTP M&E team during the revision of the recording and reporting tools some of which have been finalized, printed and distributed nation-wide through financial support from TB CARE II. Finally, TB CARE II supported NTP, both financially and technical, in developing the GeneXpert implementation plan for Malawi. 2 INTRODUCTION In FY14 Q1, TB CARE II intensified technical support to the National Tuberculosis program to improve TB and TB/HIV services in its 12 impact districts (Balaka, Chikwawa Machinga, Mangochi, Mulanje, Mzimba, Neno, Nkhotakota, Nsanje, Ntcheu, Phalombe and Zomba) through implementation of strategic activities. In this quarter, particular focus was put on improved TB case finding, early initiation of treatment, care & support. The project provided support to improve partner’s collaboration, cooperation and coordination by DHMTs, roll out of new diagnostics as part of continuing efforts to improve universal access to TB diagnosis and treatment, TB/HIV integration and health system strengthening. The main objectives of the project are: (1) DOTs expansion and strengthening; (2) Programmatic management of drug resistant TB (PMDT); (3) integrated TB/HIV care and treatment; and (4) Health systems strengthening. 3 MAJOR ACCOMPLISHMENTS The key achievements and challenges for the reporting period of October 1, 2013 – Dec 31, 2013 are summarized below: 3.1 Achievements • TB CARE II launched the Year 4 TB and TB/HIV implementation work plan that was developed jointly by the NTP, TB CARE II and district stakeholders. The work plan was developed at a joint meeting among the NTP, Zonal NTP, TB CARE II and 12 district TB officials. District specific implementation PY4 work-plans were also developed. • TB CARE II submitted the jointly revised annual work plan to USAID. The revised work- plan prioritizes improvements in TB/HIV implementation. October- December 2013 Quarterly Report, USAID/Malawi TB CARE II Project; University Research Co., LLC 6 • TB CARE II supported the participation of two NTP officers and one TB CARE II staff at the 2013 World Lung conference on TB organized by the International Union Against TB and Lung Diseases in France during the quarter. TB CARE II chaired one of the sessions at the conference in addition to a poster presentation. • TB CARE II supported the NTP
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