Tuberculosis
One of 372 patients that was screened using ultraportable chest X-rays that deliver results in two minutes. The screening was part of the Philippines Department of Health’s Pista ng Kalusugan health fair in Quezon City. Photo credit: Cressida Reyes
Tuberculosis
Since 1990, URC has worked with 24 of the 30 countries which collectively represent 80% of the global TB burden to combat TB – including 11 World Health Organization high-TB burden countries.
URC TB programs work with ministries of health, private health providers, and communities to reduce the burden of TB and save lives. URC TB programs help improve:
- Case detection, testing, and tracking;
- Treatment success rates for TB and drug-resistant TB; and
- Community participation in TB prevention, care, and support.
One key tactic is the Finding TB Actively, Separating safely, and Treating effectively (FAST) approach, which includes actively seeking and identifying hospital visitors, patients, and health care workers with TB symptoms, testing them, and educating them about TB. FAST promotes early diagnosis and effective treatment of TB patients as the best two ways to reduce the spread of the disease, especially among health care workers. URC is implementing FAST via projects in Uganda, the Philippines, and elsewhere.
URC is helping address TB challenges in a variety of ways to include:
Maintaining Essential TB Serviced During Crises –The COVID-19 pandemic disrupted health care around the world, including efforts by URC projects to reduce the spread and impact of TB and its drug-resistant strains. However, URC TB-focused projects in Uganda, the Philippines, South Africa, and elsewhere quickly adjusted to these new realities. Working with government counterparts, these projects devised innovative ways to identify TB cases, connect patients to effective treatment, train health care providers, and carry out communication and behavior change activities.
TB Treatment Success Rates – For several years the treatment success rate for drug-susceptible TB patients in Uganda had stagnated below 75%. The USAID Defeat TB Activity supported the Uganda National Tuberculosis and Leprosy Control Program in developing a package for improving treatment success rates (TSR) using an improvement collaborative approach. The package focuses on improving TB patient retention, reducing mortality, and improving data quality. Early implementation of the national TSR package resulted into an increase of TSR from 78% to 85% in three USAID Defeat TB-supported districts: Kampala, Wakiso, and Mukono. The initiatives contributed to an improvement of the quarterly national drug-susceptible TB TSR from 72% for the January-March 2018 cohort to 85.7% for the January-March 2020 cohort. The intervention has yielded similar TSR gains for multidrug-resistant TB cohorts.
Improving TB Case Notification Rates – The USAID Regional Health Integration to Enhance Services in East Central Uganda (RHITES-EC) Activity supported the Uganda Ministry of Health to improve regional health outcomes by increasing the use of high-quality health care services. RHITES-EC, which has operated in 12 districts in East Central Uganda since 2016, supported districts and facilities to implement national TB program strategies, resulting in: an improvement in the TB case notification rate from 92/100,000 at project start to 100/100,000 every quarter beginning in 2018; increased TB treatment success rates from 74% at project start to an average of 80% per quarter; and TB cure rates that increased from 50% to 61% in early 2020.
Community Involvement – The USAID TB Platforms for Sustainable TB Detection, Care and Treatment designed and pretested a social behavior change strategy, called Tibay ng Dibdib – literally, “chest strong,” which aims to improve knowledge and risk perception of TB among Filipinos. Part of the strategy included the creation of a story and coloring book. The books tell the story of two young TB survivors who overcame the disease with support of family and the community. In Marawi, this concept was tested and later scaled up with buy-in from the regional centers for health development.
Global Support for TB and MDR-TB – Over the past decade, the global TB CARE II Project has been a USAID lead implementing partner, addressing MDR-TB while working closely with the World Health Organization. The project has implemented more than 36 multi-year activities to control and prevent the spread of TB and MDR-TB. These activities improved treatment outcomes and the quality and breadth of services provided through national TB control programs in more than 15 countries. Activities include efforts to encourage innovation and standardization around implementation approaches to control TB, such as developing tools, guidelines, operating procedures, training manuals, and frameworks.
Digital Health – The USAID TB South Africa Project (TBSAP) created a mobile health application to support TB testing and treatment. The ConnecTB app was used for recording and reporting patient data during directly observed treatment support visits to TB and MDR-TB patients. The app was launched in the Nelson Mandela Bay Metropolitan Health District in June 2015. Within nine months of initiation, loss to follow-up rates in supported areas were much lower than rates in the greater Mandela Bay District area.
Our People in Tuberculosis
Ersin Topcuoglu
Dr. Ersin Topcuoglu is a TB expert, physician, and public health leader known for being solutions-oriented and pragmatic. Ersin has dedicated more than half of his 32-year career in public health experience to managing global projects on drug-sensitive (DS) and drug-resistant (DR) TB. His main focus areas in TB have been program design, technical leadership, monitoring and evaluation, data use for decision-making, performance management, and operations. Ersin has designed and implemented numerous international strategic information and performance management courses.
Ersin is URC’s senior portfolio director for Asia, the Middle East, and Northern Africa, providing oversight and technical assistance to TB projects in the Philippines and the Kyrgyz Republic. Ersin is known for thinking outside the box and always keeping up with the latest research in TB implementation, as he demonstrates in his leading role in the strategic planning and design of URC’s TB efforts. He provides oversight of URC’s malaria project in Myanmar, ensuring activities align with the best scientific evidence. Ersin also develops strategies, budgets, work plans, reports, and other project deliverables.
When Ersin served as deputy program director of two global USAID TB projects – TB CARE I and Challenge TB – he developed a robust system to rapidly and frequently reprogram and re-budget DS-TB and DR-TB country projects with his teams. This system dramatically reduced the budget pipelines and increased the level of implementation.
Ersin received his Master of Public Health from Harvard University, and his Doctor of Medicine from Cumhuriyet University in Turkey.
Marianne Calnan
Dr. Marianne Calnan is senior technical advisor for URC’s TB activities in Asia, the Middle East, and Northern Africa. She has nearly two decades of experience implementing TB and HIV control programs.
Most recently, Marianne was the chief of party of the USAID TB Platforms Project in the Philippines. In that role, she successfully led a team of experts in designing, implementing, and evaluating innovative and evidence-based solutions for health challenges in the Philippines. The project received four Gold Awards for Public Health Programs from the Philippine Ministry of Health just last year. After six years of implementation, the treatment coverage rate in the Philippines increased from 60% to 101% of the set target. The treatment success rate for DR-TB increased from 56% to 84% in the same period.
Marianne is known for her impressive management skills, which she couples with her strong technical and clinical background in epidemiology, public health, health policy, health systems, and quality improvement when she leads URC’s projects. She has authored and contributed to several publications and reports on HIV, TB, and systems support issues.
Marianne received her Master of Public Health from the University of Manchester, and her Doctorate in Public Health from Walden University. She has since received two postgraduate certifications: a Certificate in Implementation Science from the University of Melbourne, and a Postgraduate Diploma from Yale University’s Business School on Advancing Health Management Practice.
She received her clinical degrees in Uganda – a Master of Medicine in Internal Medicine from Makerere University, and Bachelor of Medicine and Surgery (MBChB) from Mbarara University of Science & Technology.
Abel Nkolo
Dr. Abel Nkolo is URC’s senior technical advisor for TB initiatives in Africa, Latin America, and the Caribbean regions. A known TB expert, Abel also serves as the URC global TB focal point for the Stop TB Partnership, where he has contributed significantly to global TB strategy development efforts.
Abel served as chief of party of both the URC-led USAID Defeat TB Activity and the USAID Regional Health Integration to Enhance Services – North, Acholi (RHITES-N, Acholi) Project, which aimed to enhance the use of TB/HIV health services through improved service delivery and quality of care.
His leadership of Defeat TB, which applied quality improvement and health system approaches to improve Uganda’s TB response, resulted in sustained improvements including: a national-level increase in the TB case detection rate from 69% to 102%, a reduction in missing TB cases from 38% to 0%, and an increase in uptake of IPT among PLHIVs from 14% to 88%.
Prior to joining URC, Abel led Management Sciences for Health’s TB activities in Africa using health system strengthening approaches. He has also led many efforts to improve TB control efforts both for USAID and the United Nations, including introducing the End TB Strategy in Uganda.
Abel is particularly interested in ending the TB epidemic through the implementation of quality improvement approaches, predictive modeling using TB data analytics, health systems strengthening, system redesign, and understanding multimorbidity and mortality among TB patients.
Abel holds a PhD in Public Health from Walden University, a Master of Public Health from Makerere University, and a Bachelor of Medicine and Surgery (MBChB) from Mbarara University of Science & Technology.
