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World TB Day, March 24, 2008

Poster available at World TB Day web site

World TB Day on March 24, 2008 celebrates the actions of people and institutions around the world to fight the global TB epidemic. Although TB is a curable disease, the epidemic remains a massive public health challenge, with nine million new cases and more than 1.5 million deaths each year. The day is also intended to serve as a reminder of the collective responsibility that touches everyone as long as the disease continues to exist anywhere in the world. Because TB is the single leading killer of people with AIDS, accounting for at least 13% of all AIDS deaths worldwide, special attention must be paid to detecting and treating TB among persons infected with HIV, particularly in Africa, where the majority of TB-HIV co-infected individuals live.

Download brochure produced by URC's TASC2 TB project

The World TB Day 2008 theme “I am stopping TB” recognizes that everyone can do something to stop TB, and every person’s action counts. As a STOP TB coalition partner, URC is proud to work in partnership with local and national governments, public and private providers, and community health workers in 10 countries to improve the quality of TB programs, increase case detection, and expand access to quality treatment. URC projects, funded by the United States Agency for International Development (USAID), are helping National TB Programs to expand and strengthen the delivery of DOTS; improve the quality of microscopy; increase the impact of Advocacy, Communication, and Social Mobilization activities; strengthen and integrate TB and HIV/AIDS control activities; strengthen supervision, referral, and monitoring systems at the district level; and scale up best practices through collaboratives and knowledge sharing.

Current URC country activities

TASC2 TB teardrops

South Africa: Under a USAID-funded TASC2 Tuberculosis task order, URC assists the National TB Control Program (NTCP) to strengthen information systems, supervision, and program management at the national level and is working with the provincial, district, municipal, and community levels to build local capacity to detect, treat, and prevent TB in five provinces. Particular emphasis is placed on developing community-based strategies to identify undetected cases, ensure early referrals for screening and treatment, and support treatment adherence. In collaboration with the National Health Laboratory Service, URC’s TASC2 TB team is developing a national laboratory information system to strengthen quality monitoring and reduce turnaround time for sputum smear test results. These efforts are coordinated with those of the USAID Health Care Improvement Project (HCI), formerly the Quality Assurance Project (QAP), which supports quality improvement activities focused on increasing TB screening for patients with HIV in some 150 health facilities. Read more about achievements in South Africa in 2007.

Banner produced by TASC2 TB

Lesotho: Through HCI, formerly QAP, URC, in partnership with the Ministry of Health and Social Welfare (MOHSW) and other stakeholders is designing and implementing interventions to strengthen TB programs as well as to improve and better integrate TB and TB-HIV services. HCI is working to strengthen Lesotho’s TB program in seven districts: Leribe, Berea, Maseru, Butha-Buthe, Mohale’s Hoek, Mokhotlong, and Qacha’s Nek. In partnership with the NTP and other stakeholders, the URC team is developing policies and guidelines, including a National TB Policy, TB/HIV Strategy, and National TB Training Guidelines. URC supports the National TB Control Program (NTP) to improve case management, reduce HIV among TB patients, and strengthen recording and reporting systems. The project team works to prevent the spread of MDR/XDR TB by training health facility staff in TB case management and follow-up procedures, including conducting sputum examinations and strengthening infection control, and dissemination of IEC materials. Read more about achievements in Lesotho in 2007.

Swaziland: URC works, through HCI, with the Ministry of Health and Social Welfare’s National Tuberculosis Control Program (NTCP) and the National AIDS Council in Swaziland to improve systems for promoting cross referrals for TB and HIV screening, treatment, and follow-up. With a focus on capacity development, HCI provides technical assistance and training to 7 (of 15) diagnostic sites and 52 clinics in the country. URC services include building the NTP’s capacity for coordination, supervision, monitoring, and evaluation activities. We are assisting with development of a reporting and recording system for TB control and MDR and XDR TB infection control guidelines. The URC project team trains laboratory personnel and strengthens lab capacity.  We are also helping to develop advocacy and social mobilization activities. With funding from the Centers for Disease Control, URC is also seeking to increase the proportion of TB patients who get tested for HIV and vice versa and are referred for onward care and support services. Read more about achievements in Swaziland in 2007.

Russia: Through HCI and in partnership with local health authorities, HCI is implementing improvement collaboratives to scale up TB-HIV co-infection screening and treatment in all 18 districts of St. Petersburg, three districts in Leningrad Oblast, and four cities in Orenburg Oblast (Orenburg Cty, Gai, Novotroitsk, and Orsk). URC also continues to work with inter-disciplinary teams in Saratov Oblast to strengthen the continuum of care for TB-HIV co-infected patients. The project collaborates with the Federal TB-HIV Center to disseminate innovations developed in the collaboratives with health authorities from other oblasts. Read more about achievements in Russia in 2007.

Albania: URC works with the National TB Program (NTP) to improve community-based information and education programs in TB endemic areas. The USAID-funded Improving Primary Health Care in Albania II (Pro Shëndetit II) project, in partnership with the NTP developed a training manual and IEC materials for community-based educators and health promoters. Within the endemic regions where NTP and URC collaborate, the Pro Shëndetit team, in partnership with the Faculty of Medicine, is upgrading clinic-based doctors’ skills in TB case detection and case management.

Cambodia: Under the USAID-funded Health Systems Strengthening Project, URC works to increase the quality of TB case management and lab services in public health centers and hospitals. In Cambodia, the project team is strengthening public sector TB services as well as facilitating a Public-Private Mix approach to improve TB service delivery by reinforcing private provider skills in case detection, diagnosis, and follow-up, as well as referrals, recording cases and reporting to the National TB Program. URC supports activities to increase TB case detection among HIV-positive patients and to refer TB patients for HIV counseling and testing.

Bolivia: In partnership with the Gestión y Calidad en Salud Project implemented by John Snow International and the Ministry of Health, QAP launched a Tuberculosis DOTS Improvement Collaborative in three of Bolivia’s nine departments: Santa Cruz, Cochabamba, and La Paz. The collaborative is engaging eight to ten municipal health care networks (made up of a municipal hospital plus several satellite health centers) in each department in a process of team-based continuous quality improvement and capacity development in TB DOTS. Laboratory personnel, the networks' managerial teams, and the departmental offices of the MOH also participate in the collaborative, which held a fourth departmental learning session in March 2008.  A newly completed Spanish version of the Tuberculosis Case Management CD-ROM, developed by the Bolivian Ministry of Health with support from QAP, includes the new 2008 National TB Norms.  The Bolivian MOH is launching the CD-ROM at an official event in La Paz on World TB Day 2008.

Vietnam: Through HCI and in partnership with the National Tuberculosis Program, the Vietnam Administration of HIV/AIDS Control, Ministry of Health (MOH), and other stakeholders, URC is developing and implementing specific operational strategies to integrate TB-HIV prevention, treatment/care, and follow-up services in Thai Binh Province. Collaborative improvement activities are being implemented in TB clinics and selected hospitals in Thai Binh to operationalize guidelines and develop a model of care that can be extended to other provinces. Since the launch of the collaborative in April 2007, a cross-referral system has been established between TB and HIV/AIDS programs and referral forms implemented in all TB-HIV facilities.  The proportion of TB patients receiving HIV testing increased from 10–15% at the end of last year to 40–50% in the second quarter of 2007, and the percentage of TB-HIV patients receiving cotrimoxazole also increased. 

Philippines: Tuberculosis is the sixth most common cause of death in the Philippines. Under the HealthPro Project, the URC team is working to increase the impact of behavioral change communication interventions and develop local institutional capacity to carry out health promotion efforts in the areas of tuberculosis and DOTS.

India: In activities launched in 2007, HCI is using a collaborative improvement approach to enhance TB and TB-HIV program outcomes in a pilot district in Andhra Pradesh.  The project will be implemented in two phases:  The first includes a rapid baseline assessment, results of which will be used to design program interventions.  The second includes expansion as well as community-based service integration. 

For more information on URC’s work to fight TB, contact Dr. Neeraj Kak at nkak@urc-chs.com.

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