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URC Health & Population Focus Areas

Tuberculosis

Countries around the world continue to face a massive challenge in defeating the TB epidemic at the global, regional, national, and community levels. A curable disease, TB kills some 2 million people each year due to health system failures to reach those infected, especially those with weakened immune systems. 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.

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 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) and the Centers for Disease Control and Prevention, are helping National TB Programs to expand and strengthen the delivery of Directly Observed Treatment, Short Course (DOTS) strategy; 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

South Africa: The URC team is providing assistance to improve TB care initiatives at the district and community level, as well as to strengthen the health system to manage the challenges presented by the HIV/AIDS epidemic. The program's principle focus is at the provincial, district, and community levels. At the national level assistance is provided to strengthen critical health systems such as information management, supervision, and policies and guidelines for TB and MDR/XDR prevention and control guidelines, as well as infectino control. The project is placing emphasis on the key themes of USAID's TB program which includes capacity building, sustainability, quality of care, and integration and coordination.

Swaziland: HCI works with the Ministry of Health and Social Welfare’s National Tuberculosis Control Program (NTCP) and the National AIDS Programme  in Swaziland to improve systems for promoting cross referrals for TB and HIV screening, treatment, and follow-up, strengthen TB DOTS implementation and implementation of guidelines for Multi-Drug Resistance TB case management. The project's focus is on capacity development, policy and guideline development; increasing compliance with evidence-based guidelines; behavior change communication; and monitoring and evaluation. HCI provides technical assistance and training to all 19 TB diagnostic sites and 71 out of the 162 clinics in all four regions of the country and to the NTCP. We are assisting with development of a reporting and recording system for TB control; and MDR and XDR TB management guidelines, infection control guidelines and TB-HIV policy guidelines. In addition, the project team participates in strengthening lab capacity through training of laboratory personnel and  establishment of quality assurance for sputum microscopy. 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 and suspects who get tested for HIV and vice versa and are referred for onward care and support services.

In the Russian Federation, the USAID-funded Health Care Improvement Project (HCI) led by URC has been improving the early detection of TB among HIV-positive patients by enhancing TB screening in outpatient facilities. HCI project support has led to the institutionalization of new practices for increased TB testing among HIV patients in polyclinics. In May 2007, an order by the Ministry of Health of Orenburg oblast introduced TB testing procedures, implementation of isoniazid preventive therapy among HIV-positive patients and completion of uniform registration and report forms on screened patients. From 2007 to 2009, the number of HIV patients screened for TB with chest x-ray in the Eastern Zone of Orenburg oblast increased from 2092 to 4964. By decentralizing screenings to local polyclinics, patients are more able to access these services. As of September 2009, 8199 people living with HIV/AIDS (PLWH) were screened in city polyclinics, representing 71% of HIV-infected patients, screened in all medical facilities of St. Petersburg, a marked increase from 42% at the end of 2008 and 7% at the end of 2007. Over the same period, the coverage indicator for TB screening of the patients examined in city polyclinics reached 60%.

Cambodia: Under a USAID-funded project to strengthen health systems in Cambodia, URC is working to reduce airborne illness infections in hospital settings. Hospitals in Cambodia are currently unable to prevent M. Tuberculosis transmission to other patients, staff and visitors.  URC provides technical assistance to selected hospitals to develop and enforce administrative control measures and policies, create environmental controls, and develop and implement respiratory protection measures.

Bolivia: HCI, in partnership with the Ministry of Health and the Gestión y Calidad en Salud Project, completed in December 2008 the demonstration phase of a TB Collaborative. The initiative engaged 114 health care facilities from 16 municipal networks in three departments in an intensified effort to improve TB case finding, sputum sample collection, diagnosis, directly observed treatment (DOTS), and patient follow-up. Laboratory personnel, the municipal networks' managerial teams, and the provincial offices of the MOH also participated in the collaborative. The demonstration sites in the collaborative improved cure rates, particularly in the La Paz region, which had the lowest performance prior to the collaborative. HCI and Gestión y Calidad en Salud, are spreading the improvement interventions developed in the demonstration phase to 12 additional municipalities (including 33 QI teams covering 82 facilities). The projects are currently working in the city of El Alto with nearly one million inhabitants, most disadvantaged, who migrated from the rural areas of the highlands of Bolivia. The spread phase of the collaborative in El Alto aims to improve TB activities in 36 facilities in the city, training near 450 health workers, improving DOTS, cure rates, abandonment rates and other impact indicators. Production of a revised Spanish version of the Tuberculosis Case Management CD-ROM, developed by the Bolivian Ministry of Health with support from the Quality Assurance Project, is underway.

Vietnam: HCI, in partnership with the National Tuberculosis Program, the Vietnam Administration of HIV/AIDS Control, Ministry of Health (MOH), and other stakeholders, 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 develop a model of care that can be extended to other provinces. Plans are underway to expand this model to Hai Duong province. 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. Additionally, the cross-referral mechanism of suspected cases from private clinics to TB hospitals has been fostered. As a result, the proportion of TB patients receiving HIV testing increased from 10–15% in 2006 to 80–90% by the end of 2008, 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: HCI is using a collaborative improvement approach to enhance TB and TB-HIV program outcomes in a pilot district in Andhra Pradesh. The program focuses on increasing case detection through scale-up of TB related information to public and private providers and through the strengthening of referral systems between TB and non-TB providers. Community involvement and building awareness have also contributed to increased case detection.

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

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