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ENGAGE-TB Operational Guidance | November 1, 2013

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ENGAGE-TB

Operational Guidance

Paris, 1 November 2013

ENGAGE-TB Operational Guidance | November 1, 2013

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Outline

 Background  Purpose  Target audience  Integrating TB activities  The ENGAGE-TB approach

ENGAGE-TB Operational Guidance | November 1, 2013

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ENGAGE-TB Operational Guidance | November 1, 2013

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Background

 TB second largest killer after HIV; but is curable  A third of those with TB are either not diagnosed or not reported  MDR-TB growing; requires longer treatment and adherence  A wider range of stakeholders needs to be involved  NGOs and other CSOs are able to reach remote and marginalized populations  Community-based TB activities can help to reach many more

67% 33%

Persons with TB

Reached/reported Unreached/not reported

ENGAGE-TB Operational Guidance | November 1, 2013

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Who carries the burden of TB?

TB linked to HIV infection, malnutrition, alcohol, drug and tobacco use, diabetes

10 million “TB”

• rphans in 2010

Migrants, prisoners, minorities, refugees face risks, discrimination & barriers to care People living in crowded & poorly ventilated settings

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Risks from TB in pregnancy for mothers and neonates

Risk Normal TB

Neonatal effects (per 1000 pregnancies) Low birth weight (< 2.5Kg) 165 342 Prematurity (< 37wk) 111 228 Small for dates 79 202 Perinatal death 16 101 Fetal death (16-28wk) 2.3 20.1 Maternal effects Pre-eclampsia 47 74 Vaginal bleeding 22 44

Bj er erked edal 1975 1975;Jan ana a 1994 1994;Bot ha ham ley y 2001 2001;Kha han n 2001 2001; Figueroa-Dam am ian an R,1998 1998

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Purpose

 Provide guidance on the implementation of community-based TB prevention, diagnosis, treatment and care activities  Provide guidance on collaboration between NTPs and NGOs and

• ther CSOs working on

community-based TB activities

ENGAGE-TB approach

ENGAGE-TB Operational Guidance | November 1, 2013

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Target audience

 NGOs and other CSOs  NTPs and their equivalents  Patients and communities affected by TB  Funding agencies  Researchers

ENGAGE-TB Operational Guidance | November 1, 2013

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Integrating TB

 Assisting early detection  Assisting treatment support  Preventing TB transmission  Addressing the social determinants

ENGAGE-TB Operational Guidance | November 1, 2013

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Integrating TB into projects

 HIV – screen for TB; help them receive IPT  MCH – pregnant women test for HIV; screen for TB. Watch children under 5  Education –TB messages in curricula; children recognize TB symptoms  Agriculture/income generation/water and sanitation

– Raise awareness – Encourage those with symptoms to get their sputum examined – Provide support eg nutritional, psychosocial, treatment adherence, transport

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Principles

Mutual understanding and respect Consideration for local contexts and values A single national system for monitoring with standardized indicators

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§

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Situation analysis

 Collect basic data  Review the main actors and factors  Gather qualitative information  Analyse SWOTs

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Enabling Environment

• Supportive policies; simple procedures

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Enabling Environment

• NGO coordinating body and regular meetings with NTP

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Guidelines and tools

 National operational guidance  Standardized tools

• forms for referrals, diagnosis, treatment; registers

 Training curriculum  Locally tailored “how-to” manual

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Task identification

 NTPs should include engagement of NGOs in their plans  NGOs should consult with NTPs and link with facilities  Full range of options for community-based TB services and advocacy – e.g. prevention, screening, referral, treatment support, advocacy

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Capacity building

 Human resources  Financial resources  Physical assets  Management and leadership  Systems and processes

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Monitoring and evaluation

 Two indicators monitored:

– Referrals and new notifications: how many referred by CHWs and CHVs – Treatment success rates among those receiving support from CHWs and CHVs

 Periodic evaluation – qualitative information as well

– Presence of an NCB, trends in membership, etc – Quality of NTP interaction with NCB

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Country Notified patients from referrals Patients who received treatment support (2011 cohort)

%age

Source of data

%age

Source of data Burkina Faso

9%

All districts

33%

All districts Côte d'Ivoire

16%

59/82 districts N/A Democratic Republic

• f Congo

10%

45/515 districts

3%

8/515 districts Ethiopia

33%

98/821 districts

40%*

98/821 districts India

3%

374/662 districts

50%

All districts Kenya

5%

All districts

88%

All districts Malawi

20%

2/28 districts

91%

2/28 districts Myanmar

2%

92/330 districts

2%

92/330 districts Nigeria N/A

5%

36 districts Rwanda

28%

All districts

46%

All districts Senegal

6%

All districts N/A Tanzania

14%

63/162 districts

86%

All districts Uganda

N/A 35%

All districts Community contributions to TB case notifications and treatment adherence support, 2012

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Indicator 1: Referrals and new notifications

Definition Number of new TB patients (all forms) diagnosed and notified with TB who were referred by community health workers and community volunteers expressed as a percentage of all new TB patients notified in the basic management unit (BMU) during a specified period Numerator Number of new TB patients (all forms) referred by community health workers or community volunteers to a health facility for diagnosis and notified in the BMU(s) in a specified period Denominator Number of new TB patients (all forms) notified in the BMU(s) in the same period Purpose To measure the level of engagement of community health workers and community volunteers in increasing new notifications of TB. It can also indicate the effectiveness of the referral system in ensuring the flow of persons with presumptive TB from community-based structures to the BMU. Method Entries on tuberculosis treatment cards, the presumptive TB register (also known as ‘TB suspects’ register) kept at facilities, the BMU TB register and the laboratory register should be modified to include ‘Referral by community health workers and community volunteers’, to allow standardized recording of the community contribution to referral. The quarterly report on TB registration in the BMU should also be adjusted to record this contribution.

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Indicator 2: Treatment success

Definition New TB patients (all forms) successfully treated (cured plus completed treatment) who received support for treatment adherence from community health workers or community volunteers among all new TB patients (all forms) provided with treatment adherence support by community health workers or community volunteers (number and percentage) Numerator Number of new TB patients (all forms) successfully treated and provided with treatment adherence support by community health workers or community volunteers in the BMU(s) in a specified period Denominator Total number of new TB patients (all forms) given treatment adherence support by community health workers or community volunteers in the same period Purpose To measure the scope and quality of implementation of community-based TB activities particularly relating to treatment outcome of patients. It can also indicate the acceptability of community health workers or community volunteers to patients with TB as treatment adherence support providers. Method Treatment adherence includes all efforts and services provided by community health workers and volunteers to TB patients receiving treatment to help them complete their treatment

• successfully. These can include treatment observation, adherence counselling, pill counting and
• ther activities to monitor both the quantity and timing of the medication taken by a patient.

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Purpose Periodic evaluation provides a qualitative view of the progress of community-based TB activities. In particular, it helps to assess the contributions of NGOs and other CSOs to new case notifications and to treatment outcomes. It also indicates whether NGO contributions are increasing or decreasing and reflects the quality of the relations between NTPs and NGOs on the basis of variables such as the frequency of meetings, the quality of such meetings, the cooperation of people involved, the factors in success and the overall interest and drive of the NTP in involving NGOs and other CSOs in TB activities. Indicators

• Existence of an NCB

*trends in membership *frequency of meeting *spread to subnational levels *coordination between levels *mechanisms for transferring knowledge, skills and resources

• Quality of interaction with the NTP at various levels

*frequency of meetings *quality of follow-up on agreed actions *availability of TB diagnostic services and drugs

• The relative contributions of NGOs and other CSOs and of the government to new case

notifications and treatment success, with trends in these variables over time

• Challenges and hurdles faced by different actors in government and civil society as well as

successes and new opportunities

Annex 2. Periodic evaluation

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Thank you