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STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 1
STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL
By
NAME
SCHOOL
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STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 2
INTRODUCTION
Bulabazi District is a coastal district in sub-Saharan Africa covering an area of 8987
square kilometres. The district population is estimated at 441,744 individuals who are spread in
both urban and rural parts of the district. The life expectancy is 42 years, the education system is
well established, however, girls are disadvantaged in access to education. The health sector is
well established, however, disease burden from TB, HIV, diarrhoea and Malaria is high.
Traditional forms of health care remain persistent in the district. Stigma towards TB in the
district is high. Maternal health in the district is also poor with high maternal deaths.
TB Situation Analysis
Tuberculosis (TB) is a communicable disease caused by Mycobacterium tuberculae an
acid fast mycobacteria. It commonly attacks the lungs but can attack other body systems; the
bacteria is spread through air droplets. A decline in immunity increases a risk for development of
TB hence increased risks for TB in HIV-infected patients, who account for largest number of TB
in sub-Saharan Africa.
Over 8.8 million TB cases most of which are from low and middle-income countries are
diagnosed across the globe. TB is responsible for over 1.7 million deaths globally. The burden of
TB in Africa has tremendously been amplified by the HIV pandemic that has ravaged the
continent, more so in Sub-Saharan Africa which accounts for the highest prevalence of HIV.
Ineffective TB management in the regions has led to the development of multi and extra drug
(MDR and XDR) resistant TB which are much more difficult to treat. The global focus on the
management of TB has improved diagnosis and treatment. However, major challenges persist.
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STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 3
The National TB Control Program (NTCP) has reported increased prevalence of TB in
the country from 51 to 205 per 100,000 people between1990-2001. The prevalence is high
among HIV-infected populations. Bulabazi TB is a huge problem with prevalence rates equalling
national prevalence rates; drug default rate stands at 30% and a cure rate below 60%. Case
identification in the district is passive despite the increasing prevalence of TB in the district. The
existence of traditional doctors who inefficiently manage respiratory diseases is a red flag on the
weak TB prevention and control structures and effort in the district. The NTCP is poorly staffed
and with only the coordinator covering the whole district. The health care system in the district is
weakened by lack of proper infrastructure such as diagnostic equipment and infrastructure to
ensure adequate diagnosis of TB and prevention of cross-transmission in medical wards.
Global strategies towards ending the TB epidemic, as per sustainable development goal 3
of 2030 aim at ensuring effective diagnosis, enrolment to treatment and adequate management of
HIV. WHO strategy towards ending TB aims to reduce TB deaths by 95% and reduce incidence
by 90%. This strategy calls for greater collaboration and financing for TB programs. Improved
diagnosis such as employment of gene-x-part machines, adequate treatment follow up and
initiation of isoniazid prophylaxis for HIV-positive patients.
Purpose of the Proposal
The goal of the proposal is to strengthen identification and treatment of TB and reduce
morbidity and mortality from TB by increasing TB detection rate to 85%% and ensuring at least
95% treatment rate by the year 2020 for all smear positives.
The proposal goals will be achieved through expansion and support for Directly
Observed Therapy (DOTS) in the district hospital. Establishment community-based TB
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STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 4
prevention and control activities in all the 16 wards in the District. Ensuring a constant and
adequate uninterrupted supply of anti-TB drugs. Strengthening TB diagnostics services and
access to such services. Expanding the collaboration of TB and HIV services in the district.
Capacity building for all health care workers on TB diagnoses, identification, prevention and
notification. Improve the data management for TB and TB disease surveillance in the district.
Program Plan
The program will utilise funds from Global Fund to carry out the following activities which are
aimed at achieving the objectives identified.
Establish with the assistance of the local administration two sections in each ward which
will be demarcated as TB regions for community involvement in TB control. From the sections
selected, two volunteer community workers (per section) who are from the areas demarcated,
will be trained on TB and will then be empowered through the provision of visibility materials
each with 20 branded posters and 100 pamphlets to conduct door to door and targeted
community sensitization sessions to communities. The volunteers will also be used by the care
team for case follow-ups and tracing patients lost to care. The programme will facilitate the
movement of these community volunteers by providing one bicycle each for their movements.
The volunteers will be paid a small allowance each month calculated based on the number of
complete referrals made to treatment from the community.
The purchase of TB drugs, laboratory reagents and maintenance of 4 microscopes to be
used to strengthen diagnosis of TB in the health centres. Each health centre will have a well-
equipped laboratory with a functioning microscope and uninterrupted supply of reagents. The
money will also purchase and install one geneXpart machine to be located at the district hospital
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STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 5
for DNA sputum tests and in identification of rifampicin-resistant TB. Training for laboratory
staff on the use of these machine will be conducted through the NTCP.
Intensifying TB case identification in all HIV clinics and establishing a task force for
HIV/TB to establish and ensure the collaborative functioning of HIV and TB programs in the
district. Sensitisation for all TB patients to receive HIV testing services and HIV patients without
active TB to receive isoniazid prophylaxis. Community sensitization to alleviate fear and
stigmatisation of HIV and TB to improve service access. Identify possible centralization of TB
and HIV departments to provide easily coordinated care and treatment.
Establish and train 107 health care providers from all cadres and departments in the
district hospital and all qualified health providers in the health posts on TB notification and
referral, case identification and management using the most current guidelines for TB
management and care. Establishing focal point persons in each ward who will Champion proper
prevention of TB protocols in their wards. Refresher training will be scheduled every six months
for the first two years and once in the final year to cover for staff turnover and review best
practices.
Introducing separate registers to be ticked by health providers in TB clinics on the
utilisation of TB services such as numbers of new positive sputum, enrolment to care, follow-
ups, drug utilisation and laboratory data. Data will be shared through the district TB coordinator
each month. Disease surveillance data will be reported to the coordinator continuously with
reports shared at each end month.
Educating and sensitising the community on the use of DOTS and capacity building
health care providers on the DOTS. Due to the high defaulter and stigma rate, the program will
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STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 6
establish ward based DOTS to take advantage of the trained health providers, isolation and other
infection prevention methods will be applied. Establishing and supporting TB two support
groups within the district hospital and one in each health centres. Establish management and
evaluation system for DOTS.
Justifications of objectives
Implementation of these activities will strengthen the access to TB diagnostics, enrolment
to care and management of patient under care and hence reverse the spread of TB in the district.
Carefully constructed community involvement in TB according to World Health organisation,
(2008) is critical in increasing access to care, reducing costs and health worker strain. WHO also
point out that community involvement should be done through education and promotion of self-
reliance. Improving community education and awareness of B will improve health seeking
behaviours and lead to increased diagnosis and enrolment to care. Zhang et al., (2016), in a
systematic review of the effectiveness of community-based DOTS, established that the
implementation of community-based DOTS improved treatment outcomes in the management of
TB patients. The use of community-based DOTS will decrease the defaulter rate in TB
management and the treatment of TB in the district. Getahun et al., (2017), in a study of health
Centre based DOTS established success in the management of TB, drug adherence and patient
outcomes. Ridderhof, (2007), supports the critical role of proper laboratory services in ensuring
efficient TB diagnosis which consequently impacts the patient enrolment to care and affects
patient outcomes. Various other studies have identified health care workers attitudes and
knowledge level impact the preventive and treatment of TB in high prevalence areas. Data
management in TB management will improve the monitoring and evaluation of care and enhance
surveillance.
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STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 7
The implementation of the TB interventions will be conducted in collaboration with local
government administrators, NGO collaborations such as with Genderaction (assumed the NGO
will expand its focus to HIV/TB sensitization) and other health related NGOs in the district, The
AIDS Control Program and private health practitioners (assumed to be existing in the district).
Implementation timeline
Implementation plan 2018
Activities
JAN
FEB
MAR
APR
MAY
JUN
AUG
SEP
OCT
NOV
DEC
KAP survey
Recruitment
of 128 CVWs
Purchase of
Bicycles
Purchase of
drugs
Reagent
purchase
Microscope
maintenance
CVWs
Training
HCWs
Training
Task force
committee
M&E
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STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 8
Implementation plan 2019
Activities
JAN
FEB
MAR
APR
MAY
JUN
AUG
SEP
OCT
NOV
DEC
KAP survey
Recruitment
of 128 CVWs
Purchase of
drugs
Reagent
purchase
Microscope
maintenance
CVWs
Training
Task force
committee
M&E
HCWs
Training
Implementation plan 2020
Activities
JAN
FEB
MAR
APR
MAY
JUN
AUG
SEP
OCT
NOV
DEC
KAP survey
Recruitment
of 128 CVWs
Drugs
purchase
Reagent
purchase
Microscope
maintenance
CVWs
Training
Task force
committee
M&E
HCWs
training
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STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 9
Monitoring and Evaluation
The existing health information systems on TB in the district involves passive diagnosis
of TB data is recorded in TB registers which are shared with the TB coordinator each month. The
systems. The TB program intends to institute more comprehensive data management systems
which will involve daily patient data that will be collected and analysed. Every health centre will
be required to share their data with the TB coordinator each month. Data forms will be
introduced to segregate patient data and management interventions including failures and
defaulter data. The data from the district will then be analysed and sent to a central data centre in
the Ministry of Health. Continued monthly visits by the TB coordinators will be maintained to
inspect registers and supervise and ensure standardised data recording and reconciliations of data
where needed. The data collection and analysis will inform the program infection rates and
provide monitoring for successful treatments, defaulter rates, rates of infection and the case
identifications.
An initial knowledge gaps and attitudes (KAP) survey will be conducted to establish
community and health care workers knowledge and a second on the community perceptions in
the second year. The KAP surveys will be done at the beginning of the program, after two years
and at the end of three-year-period. KAP survey will inform among others, health seeking
beliefs, perceptions, knowledge and attitudes towards TB and any improvements over time.
A committee will be formed to monitor the NTCP as the recipient of the funding. The
committee will establish quarterly a year meetings to review the program reports and activities
against the plan. The committee will also monitor the management of funds by the NTCP.
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STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL
10
References
Getahun, B., Ameni, G., Medhin, G. and Biadgilign, S. (2017). Treatment outcome of
tuberculosis patients under directly observed treatment in Addis Ababa, Ethiopia.
Implementing the WHO Stop TB Strategy. (2008). 1st ed. Geneva: World Health Organization.
Ridderhof, J. (2007). Roles of laboratories and laboratory systems in effective tuberculosis
control. Bulletin of the World Health Organization, 85(5), pp.354-359.
WHO (2006). The Stop Tb Strategy: Building on and enhancing DOTS to meet the TB-related
Millennium Development Goals http://www.who.int/tb/strategy/en/
Zhang, H., Ehiri, J., Yang, H., Tang, S. and Li, Y. (201)6. Impact of Community-Based DOT on
Tuberculosis Treatment Outcomes: A Systematic Review and Meta-Analysis.

Unformatted Attachment Preview

STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL By NAME SCHOOL 1 STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 2 INTRODUCTION Bulabazi District is a coastal district in sub-Saharan Africa covering an area of 8987 square kilometres. The district population is estimated at 441,744 individuals who are spread in both urban and rural parts of the district. The life expectancy is 42 years, the education system is well established, however, girls are disadvantaged in access to education. The health sector is well established, however, disease burden from TB, HIV, diarrhoea and Malaria is high. Traditional forms of health care remain persistent in the district. Stigma towards TB in the district is high. Maternal health in the district is also poor with high maternal deaths. TB Situation Analysis Tuberculosis (TB) is a communicable disease caused by Mycobacterium tuberculae an acid fast mycobacteria. It commonly attacks the lungs but can attack other body systems; the bacteria is spread through air droplets. A decline in immunity increases a risk for development of TB hence increased risks for TB in HIV-infected patients, who account for largest number of TB in sub-Saharan Africa. Over 8.8 million TB cases most of which are from low and middle-income countries are diagnosed across the globe. TB is responsible for over 1.7 million deaths globally. The burden of TB in Africa has tremendously been amplified by the HIV pandemic that has ravaged the continent, more so in Sub-Saharan Africa which accounts for the highest prevalence of HIV. Ineffective TB management in the regions has led to the development of multi and extra drug (MDR and XDR) resistant TB which are much more difficult to treat. The global focus on the management of TB has improved diagnosis and treatment. However, major challenges persist. STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 3 The National TB Control Program (NTCP) has reported increased prevalence of TB in the country from 51 to 205 per 100,000 people between1990-2001. The prevalence is high among HIV-infected populations. Bulabazi TB is a huge problem with prevalence rates equalling national prevalence rates; drug default rate stands at 30% and a cure rate below 60%. Case identification in the district is passive despite the increasing prevalence of TB in the district. The existence of traditional doctors who inefficiently manage respiratory diseases is a red flag on the weak TB prevention and control structures and effort in the district. The NTCP is poorly staffed and with only the coordinator covering the whole district. The health care system in the district is weakened by lack of proper infrastructure such as diagnostic equipment and infrastructure to ensure adequate diagnosis of TB and prevention of cross-transmission in medical wards. Global strategies towards ending the TB epidemic, as per sustainable development goal 3 of 2030 aim at ensuring effective diagnosis, enrolment to treatment and adequate management of HIV. WHO strategy towards ending TB aims to reduce TB deaths by 95% and reduce incidence by 90%. This strategy calls for greater collaboration and financing for TB programs. Improved diagnosis such as employment of gene-x-part machines, adequate treatment follow up and initiation of isoniazid prophylaxis for HIV-positive patients. Purpose of the Proposal The goal of the proposal is to strengthen identification and treatment of TB and reduce morbidity and mortality from TB by increasing TB detection rate to 85%% and ensuring at least 95% treatment rate by the year 2020 for all smear positives. The proposal goals will be achieved through expansion and support for Directly Observed Therapy (DOTS) in the district hospital. Establishment community-based TB STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 4 prevention and control activities in all the 16 wards in the District. Ensuring a constant and adequate uninterrupted supply of anti-TB drugs. Strengthening TB diagnostics services and access to such services. Expanding the collaboration of TB and HIV services in the district. Capacity building for all health care workers on TB diagnoses, identification, prevention and notification. Improve the data management for TB and TB disease surveillance in the district. Program Plan The program will utilise funds from Global Fund to carry out the following activities which are aimed at achieving the objectives identified. Establish with the assistance of the local administration two sections in each ward which will be demarcated as TB regions for community involvement in TB control. From the sections selected, two volunteer community workers (per section) who are from the areas demarcated, will be trained on TB and will then be empowered through the provision of visibility materials each with 20 branded posters and 100 pamphlets to conduct door to door and targeted community sensitization sessions to communities. The volunteers will also be used by the care team for case follow-ups and tracing patients lost to care. The programme will facilitate the movement of these community volunteers by providing one bicycle each for their movements. The volunteers will be paid a small allowance each month calculated based on the number of complete referrals made to treatment from the community. The purchase of TB drugs, laboratory reagents and maintenance of 4 microscopes to be used to strengthen diagnosis of TB in the health centres. Each health centre will have a wellequipped laboratory with a functioning microscope and uninterrupted supply of reagents. The money will also purchase and install one geneXpart machine to be located at the district hospital STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 5 for DNA sputum tests and in identification of rifampicin-resistant TB. Training for laboratory staff on the use of these machine will be conducted through the NTCP. Intensifying TB case identification in all HIV clinics and establishing a task force for HIV/TB to establish and ensure the collaborative functioning of HIV and TB programs in the district. Sensitisation for all TB patients to receive HIV testing services and HIV patients without active TB to receive isoniazid prophylaxis. Community sensitization to alleviate fear and stigmatisation of HIV and TB to improve service access. Identify possible centralization of TB and HIV departments to provide easily coordinated care and treatment. Establish and train 107 health care providers from all cadres and departments in the district hospital and all qualified health providers in the health posts on TB notification and referral, case identification and management using the most current guidelines for TB management and care. Establishing focal point persons in each ward who will Champion proper prevention of TB protocols in their wards. Refresher training will be scheduled every six months for the first two years and once in the final year to cover for staff turnover and review best practices. Introducing separate registers to be ticked by health providers in TB clinics on the utilisation of TB services such as numbers of new positive sputum, enrolment to care, followups, drug utilisation and laboratory data. Data will be shared through the district TB coordinator each month. Disease surveillance data will be reported to the coordinator continuously with reports shared at each end month. Educating and sensitising the community on the use of DOTS and capacity building health care providers on the DOTS. Due to the high defaulter and stigma rate, the program will STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 6 establish ward based DOTS to take advantage of the trained health providers, isolation and other infection prevention methods will be applied. Establishing and supporting TB two support groups within the district hospital and one in each health centres. Establish management and evaluation system for DOTS. Justifications of objectives Implementation of these activities will strengthen the access to TB diagnostics, enrolment to care and management of patient under care and hence reverse the spread of TB in the district. Carefully constructed community involvement in TB according to World Health organisation, (2008) is critical in increasing access to care, reducing costs and health worker strain. WHO also point out that community involvement should be done through education and promotion of selfreliance. Improving community education and awareness of B will improve health seeking behaviours and lead to increased diagnosis and enrolment to care. Zhang et al., (2016), in a systematic review of the effectiveness of community-based DOTS, established that the implementation of community-based DOTS improved treatment outcomes in the management of TB patients. The use of community-based DOTS will decrease the defaulter rate in TB management and the treatment of TB in the district. Getahun et al., (2017), in a study of health Centre based DOTS established success in the management of TB, drug adherence and patient outcomes. Ridderhof, (2007), supports the critical role of proper laboratory services in ensuring efficient TB diagnosis which consequently impacts the patient enrolment to care and affects patient outcomes. Various other studies have identified health care workers attitudes and knowledge level impact the preventive and treatment of TB in high prevalence areas. Data management in TB management will improve the monitoring and evaluation of care and enhance surveillance. 7 STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL The implementation of the TB interventions will be conducted in collaboration with local government administrators, NGO collaborations such as with Genderaction (assumed the NGO will expand its focus to HIV/TB sensitization) and other health related NGOs in the district, The AIDS Control Program and private health practitioners (assumed to be existing in the district). Implementation timeline Implementation plan 2018 Activities KAP survey Recruitment of 128 CVWs Purchase of Bicycles Purchase of drugs Reagent purchase Microscope maintenance CVWs Training HCWs Training Task force committee M&E JAN FEB MAR APR MAY JUN JULY AUG SEP OCT NOV DEC 8 STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL Implementation plan 2019 Activities JAN FEB MAR APR MAY JUN JULY AUG SEP OCT NOV DEC APR MAY JUN JULY AUG SEP OCT NOV DEC KAP survey Recruitment of 128 CVWs Purchase of drugs Reagent purchase Microscope maintenance CVWs Training Task force committee M&E HCWs Training Implementation plan 2020 Activities KAP survey Recruitment of 128 CVWs Drugs purchase Reagent purchase Microscope maintenance CVWs Training Task force committee M&E HCWs training JAN FEB MAR STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 9 Monitoring and Evaluation The existing health information systems on TB in the district involves passive diagnosis of TB data is recorded in TB registers which are shared with the TB coordinator each month. The systems. The TB program intends to institute more comprehensive data management systems which will involve daily patient data that will be collected and analysed. Every health centre will be required to share their data with the TB coordinator each month. Data forms will be introduced to segregate patient data and management interventions including failures and defaulter data. The data from the district will then be analysed and sent to a central data centre in the Ministry of Health. Continued monthly visits by the TB coordinators will be maintained to inspect registers and supervise and ensure standardised data recording and reconciliations of data where needed. The data collection and analysis will inform the program infection rates and provide monitoring for successful treatments, defaulter rates, rates of infection and the case identifications. An initial knowledge gaps and attitudes (KAP) survey will be conducted to establish community and health care workers knowledge and a second on the community perceptions in the second year. The KAP surveys will be done at the beginning of the program, after two years and at the end of three-year-period. KAP survey will inform among others, health seeking beliefs, perceptions, knowledge and attitudes towards TB and any improvements over time. A committee will be formed to monitor the NTCP as the recipient of the funding. The committee will establish quarterly a year meetings to review the program reports and activities against the plan. The committee will also monitor the management of funds by the NTCP. STRENGTHENING TB TREATMENT IN BULABAZI PROPOSAL 10 References Getahun, B., Ameni, G., Medhin, G. and Biadgilign, S. (2017). Treatment outcome of tuberculosis patients under directly observed treatment in Addis Ababa, Ethiopia. Implementing the WHO Stop TB Strategy. (2008). 1st ed. Geneva: World Health Organization. Ridderhof, J. (2007). Roles of laboratories and laboratory systems in effective tuberculosis control. Bulletin of the World Health Organization, 85(5), pp.354-359. WHO (2006). The Stop Tb Strategy: Building on and enhancing DOTS to meet the TB-related Millennium Development Goals http://www.who.int/tb/strategy/en/ Zhang, H., Ehiri, J., Yang, H., Tang, S. and Li, Y. (201)6. Impact of Community-Based DOT on Tuberculosis Treatment Outcomes: A Systematic Review and Meta-Analysis. Name: Description: ...
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