Since 2009 ICAP has been implementing a nationwide TB/HIV program in close collaboration with the MOHSW. In the upcoming year special efforts will be paid to consolidate the achievements made as well as to address new challenges. Ojectives for FY 2012 are: 1: Strengthened National Capacity: support the MOHSW to strategically plan, implement and evaluate TB/HIV related activities through the development, dissemination and implementation of TB/HIV related strategic plans, policy, guidelines, models for delivering optimal TB/HIV services, training programs, performance tools and new M&E tools. ICAP will provide TA and institutional capacity building to the NTP by seconding a TB/HIV technical advisor and M&E manager. 2: Comprehensive and Quality District-Wide TB/HIV Service: strengthen DHMT capacity and role in TB/HIV service delivery with emphasis on joint clinical mentorship and supervisions. ICAP will strengthen and expand its supportive system of providing clinical mentorship by hiring additional multi-disciplinary teams to cover each district, all public health facilities and to target key affected populations (factory and migrant workers). 3: Effective TB Laboratory Network: support the MOHSW with the implementation of the decentralization plan for sputum microscopy to 13 additional health centers as well as roll-out plan for GeneXpert, in close collaboration with other implementing partners (FIND, PIH). Objective #4: Community Mobilization: support further integration of adherence and psychosocial support within TB services and strengthen the Village Heath Worker (VHW) support system to improve TB treatment outcomes, increase uptake of ART among co-infected patients, and to increase community mobilization and awareness.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? No

ICAP will support the development of advanced guidelines on issues such as the 3 Is, latent TB infection, and TB APS and community follow-up, as well as more general lab and ACSM plans and policies, which currently do not exist.

ICAP will play a key role in developing Lesotho-specific TB-related training programs, resources, and performance tools to provide immediate and long-term support at all levels. ICAP will also help to update existing tools (registers, job aids, patient forms).

ICAP will provide TA and institutional capacity building to the NTP by seconding a TB/HIV technical advisor and an M&E manager.

In line with the newly developed national referral guidelines for TB/HIV-co-management and the national guidelines for the 3 Is, ICAP will continue to provide TA and training to DHMTs to improve TB/HIV service integration and to strengthen the referral system between facilities, between services, and between facilities and the community via sensitization meetings. On-the-spot refresher trainings will be organized for 500 HCW in all districts on the guidelines for TB, TB/HIV and the 3Is. ICAP will strengthen and expand its supportive system of providing clinical mentorship by hiring additional multi-disciplinary teams. This will allow ICAP to cover each district with an individual team, to cover all public health facilities, and to increase the intensity of support for all supported sites.

VHW will be trained and supported regularly by ICAP and MOHSW to trace those who missed appointments and defaulters (using a newly developed tracing tool) and to follow up with high-risk patients in support of HIV and TB treatment, adherence, and care in the household. ICAP, in collaboration with FIND (Foundation for Innovative New Diagnostics) and PIH (Partners in Health), will support the MOHSW with the actual implementation of the TB Rapid Testing using the newly developed Xpert MTB/RIF test.

ICAP will support 8 microscpy centres to support TB diagnosis at health facility level. This will include equipment and personnel. ICAP will also support the Ministry of health to establish reliable cross border refferal system to address TB burden among migrant Basotho miners working in colloboration with recruitment agancies, South African mining companies and the South Africa department of Health.

ICAP will continue to provide support needed to improve diagnosis of TB, MDR-TB, and XDR_TB. ICAP willl support the Ministry of Health with the implementation of the TB rapid testing (Gene Xpert) for all HIV infected TB suspects in Line with the WHO guidelines and the National Gene Xpert roll-out plan. This is will include Integration of the gene xpert into the existing diagnositic protocols, Supporting FIND in the developemnt of Gene X pert TB Diagnostic Aligorithm and the training of clinicians nationally as well as supporting its impelementation nationally . Development EQA system for Gene Xpert, evaluation of impact on time to diagnosis and TB treatment outcomes. ICAP support MOHSW to improve sample collection networks, reducing turn around times for testing and support implementation of quality assurance activities for TB and HIV services in the laboratories. Specifically in this area, ICAP is being requested to strengthen quality of sputum collection for laboratory analysis through training of health care workers, development and distribution of standards of procedure(SOPs) for sputum microscopy for TB, sputum processing for culture and sensitivity, sputum transportation and reduction of turn around time for results. ICAP also will further support the ongoing job training for microscopists. Based on the results of FIND EXPAND-TB pilot project results of timely results through short messaging printers, ICAP will support the Ministry of Health to roll out the approach nationally. Within this budget $100,000 is reserved to support the strengthening of cross-border referal for Basotho migrant mine workers affected by TB and HIV using a Private Public Partership model. The focus will be implementation of electronic data systems for TB/HIV patients from the mines linked with short message service (SMS) to track mine workers diagnosed with TB between Lesotho and South Africa. This is partnership with The Employment Bureau Agency (TEBA). This will leverage on resources from private sector (South African Mine companies) already invested in TEBA.

The OHSS budget is planned to support 8 laboratory assistants that will support the provision of TB microscopy services and supporting laboratory activities for the initiation of ART within the TB clinics. This support will also include support for equipment including LED microscopes. They also include the decentralization of microscopy centers beyond hospitals to health centers with high TB burden. Additionally ICAP is supporting 24 positions as lay counselors whose major role is to conduct HIV counseling and testing within the TB clinics. The lay counselors also support linkages to HIV treatment and care as well as supporting adherence to both TB and HIV treatment. ICAP will work closely with the National TB program to support Monitoring and evaluation systems for TB and HIV data and ensuring that it is incorporated into the MOHSW HMIS system. This includes the support of the functioning of the Electronic TB Register (ETR) and integration of the ETR data into the national HMIS. In collaboration with WHO and NTP, ICAP will support strengthening of surveillance systems for TB through the national monitoring and evaluation system based on the new WHO guidelines. ICAP will also provide ongoing mentoring for the national TB program management of the management of other donor resources including Global fund. Mentoring will also focus on the use of program results to improve services and roll out of best practices in TB/HIV care nationally. PEPFAR will work with ICAP and MOHSW to develop to support systems of ensuring that human resources supported for service provisions are absorbed by government and ensure continuity of services.Finally, PEPFAR will provide computers/hardware at MCC renovated health clinic sites. These computers will be part of the PPP HMIS system that will move TB data from the clinics to the district and national level.