Tuberculosis Control in Southern Malawi Annual Report: October 1, 2006 – September 30, 2007 Cooperative Agreement #: GHS-A-00-06-00012-00 Project Location: Malawi (Mulanje and Phalombe Districts) Project Duration: October 1, 2006 – September 29, 2011 Submitted to: Jill Boezwinkle Cognizant Technical Officer USAID, Office of HIV/AIDS Submitted by: Project HOPE, The People-to-People Health Foundation, Inc. Millwood, Virginia 22646 Tel: (540) 837-2100 Fax: (540) 837-1813 Report Authors: Sandra Dalebout Timothy Kachule Thandiwe Kamanga Elizabeth Kapyepye Caroline Teter Renslow Sherer Marija Joncesvska Table of Contents Table of Contents ............................................................................................................................ 2 Executive Summary ......................................................................................................................... 4 Introduction ............................................................................................................ 4 Overview of Activities and Approaches ....................................................................... 4 Summary of Accomplishments .................................................................................. 4 Major Challenges ..................................................................................................... 4 Activities Planned for Next Year ................................................................................. 5 Program Strategy ............................................................................................................................ 6 Strategic Objective 1: Improve treatment outcomes of TB cases and TB cases with HIV co-infection in Mulanje and Phalombe ........................................................................ 6 Strategic Objective 2: Increase case detection of TB, including among people with HIV co-infection in Mulanje and Phalombe. ....................................................................... 6 Main Accomplishments ............................................................................................. 6 Strategic Objective 1: Improve treatment outcomes of TB cases and TB cases with HIV co-infection in Mulanje and Phalombe ...................................................................... 7 Strategic Objective 2: Increase case detection of TB, including among people with HIV co-infection in Mulanje and Phalombe. ..................................................................... 9 Accomplishments (continued) ....................................................................................................... 11 Partnerships ......................................................................................................... 11 Mulanje District Health Management Team ............................................................ 11 District Assemblies.............................................................................................. 12 TB Control Partners Strategic Meeting ................................................................... 12 Zonal Quarterly TB Meeting.................................................................................. 12 Zonal Quarterly Private Practitioners Meeting ......................................................... 12 Multi Drug Resistance (MDR) TB Meeting ............................................................... 13 District Executive Committee (DEC) Meeting .......................................................... 13 National TB Events ................................................................................................ 13 Staff Capacity Building ........................................................................................... 14 Visit to a model village - Mtsiriza .......................................................................... 14 Lessons learned .................................................................................................. 14 Way forward ...................................................................................................... 15 TB Management Training ........................................................................................ 16 Group Discussions ................................................................................................. 17 Community Leaders Orientation ........................................................................... 17 Microscopists Refresher Training.............................................................................. 18 Successes .......................................................................................................... 21 Challenges ......................................................................................................... 21 Recommendations for Future Trainings/Lessons Learned ......................................... 21 Way Forward ...................................................................................................... 22 Health Worker Training .......................................................................................... 22 Monthly Supportive Supervision Visits by Project HOPE Team and MOH Partners ........... 24 Major findings for the health facilities visited .......................................................... 25 Possible Reasons for the Problems: ....................................................................... 26 Actions and Recommendations: ............................................................................ 26 Challenges: ........................................................................................................ 26 Lessons Learned:................................................................................................ 27 Quarterly Supportive Supervision by Zone Supervisor ................................................ 27 Semi-Annual Review Meetings ................................................................................. 36 Curricula Development ........................................................................................... 37 Microscope Donations ............................................................................................ 37 TB Control in Southern Malawi Annual Report (Oct. 1, 2006 – Sept. 30, 2007) Challenges..................................................................................................................................... 37 Technical Assistance ..................................................................................................................... 38 Changes from DIP ........................................................................................................................ 39 Monitoring .................................................................................................................................... 39 Absolute and Percent of Case Detection in Mulanje and Phalombe Districts ................... 39 DOTS OPTION IN 1ST AND 2ND QUARTER 2007 .......................................................... 40 Absolute Values for TB patients offered DCT and on Cotrimoxazole treatment in Mulanje and Phalombe Districts ........................................................................................ 41 Supervisory Checklist Design ............................................................................... 41 Sustainability Plan ........................................................................................................................ 41 Baseline Data ........................................................................................................ 42 Community Baseline Summary ................................................................................ 43 Health Facility Survey ............................................................................................ 43 Laboratory Assessment .......................................................................................... 50 Smear preparation and staining ............................................................................ 53 Specific Information Requested During the DIP .......................................................................... 55 Social and Behavior Change Strategy for TB Control ................................................................. 55 Summary of strategy: ............................................................................................ 55 Channels of Communication: .................................................................................. 56 BEHAVE Framework ............................................................................................... 56 Monitoring table .................................................................................................... 57 Management System...................................................................................................................... 57 Mission Collaboration .................................................................................................................. 59 Timeline for Year 2 ....................................................................................................................... 59 Results Highlight ........................................................................................................................... 60 Publications .................................................................................................................................. 60 Success