COP 2008 builds on COP 2007 PEPFAR funds and leverages $1.2 Million in USAID Child Survival and

Health TB funds. PEPFAR funding is used to support collaborative TB/HIV activities, while USAID CSH

funding continues to focus on strengthening the foundation of TB prevention and control, in particular - the

continued roll out of community based DOTS to Oshana, Oshikoto, and Erongo. Achievements in COP 08

are planned in close coordination with other USG partners, Government of Namibia and Global Fund in

TB/HIV collaborative activities. USG partners relevant to TB CAP are: CDC (strengthening NIP in quality

assured sputum-smear, culture and drug sensitivity testing, drug resistance surveillance; counseling &

testing), I-TECH (training health workers on TB/HIV and developing a TB/HIV training for community field

promoters and supervisors), MSH/SPS (rational drugs management, regulation of new additional second-

line drugs, monitoring of side-effects, prescription audits, public health evaluation), Capacity (training, VCT,

Community-based DOTS), DAPP (home based care), PACT (home based care) and Global Fund (training

health workers on TB/HIV IEC, C&T for HIV in TB patients, training home-based-care workers on TB/HIV)

At the moment coordination of these activities at all levels is still a major challenge for MOHSS National

AIDS Control Program and National TB Control Program (NTCP), enhanced by persisting shortage of

human resources, lack of competency - and monitoring and evaluation. Priority for TB CAP is thus

strengthening leadership and management of NTCP, in all aspects of TB control (in particular CB-DOTS,

MDR-TB, TB-Infection control, TB/HIV). Much of the activities will not require additional funding; COP 2008

seeks to enhance and expand communication and deliberations among program officers and staff through

the TB CAP supported review meetings and TBHIV committees at all levels, and annual TB/HIV meetings

using the MSH MOST model (MOST is a management tool developed by MSH, which was applied in July

2007 for TB/HIV in Namibia). Funding is sought for the anticipated expansion in coordination, management,

technical assistance, and development of technical policies.

Funding through TB CAP will concentrate on the following areas:

-Hiring two Senior Health Program Administrators. This is a continuation from COP 2007. They will work in

vacant MOHSS positions in two regions to coordinate and strengthen TB/HIV and basic TB control activities

with all partners in these regions. This activity will be sustained when MOHSS employs these staff from its

recurrent budget;

-Coordination at all levels. This new activity will strengthen coordination through the establishment and

facilitation of TB/HIV Coordinating Committee meetings at all levels on a quarterly basis, which should

enable all stakeholders in TB/HIV - both from a clinical and community perspective - to review progress

and challenges and develop remedial actions. Once yearly a TB/HIV MOST workshop will be organized at

national level and in each region to ensure that planning and evaluation go hand-in-hand, and activities

supported from all different funding streams are coordinated, and well targeted. Clinical management of

patients dually treated for TB and AIDS (ART, CPT) will be reviewed at health facility level in clinical

meetings through USG partners supporting TB treatment, HAART and HIV/AIDS care. This will be linked to

clinical supervision supported by TB CAP, on TB management in general, and MDR-TB in particular. This

activity is sustained when MOHSS will adopt the coordination steering committees as a useful management

modality;

-TB/HIV IEC materials. This is a continuation from COP2007, but will now focus on re-printing and

translation of IEC materials into additional tribal languages for TB patients, PLWHA, and the community

(with co-funding from GFATM). A new activity is the development of short videos, leaflets etc. towards

awareness rising on TB/HIV and appropriate actions. MOHSS will sustain these activities after the recurrent

budget for TB control is increased;

-TB Infection control is a continuation activity but will be expanded to all hospitals and busy health centers

through training of already existing Infection Control Officers on prevention of TB nosocomial infection using

the new Namibian infection control guidelines, support site visits for making infection control assessments

and plans, and for supervising and monitoring their implementation. Some funding will be set aside for

purchasing N95 respirators.. TB-IC will thus become fully integrated in the national IC policy and technical

guidelines. TB CAP will support external technical assistance for TB-IC to assist with on-site training,

supervision, and M&E of TB-IC. Once already existing infection control officers are trained in TB-IC and

health facility infection control plans are developed and implemented MOHSS will sustain their enforcement.

A new activity is supporting the adjustment of an existing electronic MDR-TB Register (developed by Stop-

TB Partnership) for Namibia, in order to improve M&E of MDR-TB management. Linkage to NIP data on

drugs resistant strains diagnosed in NIP will be pursued. Once introduced MOHSS will sustain the activity

provided financial resources are committed;

-One medical doctor and nurse will continue to be supported (as under COP2007) in the TB ward in

Katatura hospital, for supporting on-the-job and formal training of medical doctors and nurses on MDR-TB

management, conducting supervision to any of the other 5 MDR-TB admission centers and doing clinical

audits, supporting M&E for MDR-TB. MOHSS will sustain the staff once it is funding these positions;

-CB-DOTS coverage will be expanded further within regions already supported by TB CAP. TBCAP will also

provide technical assistance to Home based care NGOs such as and DAPP so they include TB/HIV

collaborative issues into their activities.

-TB CAP increases its management capacity. COP 2008 funds continue supporting a KNCV Tuberculosis

Foundation office in Windhoek. The office will comprise three resident medical officers providing hands-on

technical assistance towards implementation of both USG and Global Fund work plans, one of which will be

the project coordinator. They will be assisted by a financial controller and bookkeeper and driver.

In COP2008, TB CAP will continue working with the Namibian government and other partners to improve

access to quality of tuberculosis (TB) care to those infected with HIV & TB. All partners will continue

supporting one common goal as stipulated in TB Medium Term Plan I: to reduce tuberculosis morbidity and

mortality until TB is no longer a public health problem; and more specifically through MTPI Strategic Result

7: All PLWHA and PLWTB have access to a continuum of care and support services for TB and HIV/AIDS,

in all health care facilities and home-based care services in public and private sector by 2009.

Considerable progress has been made in the past two years showing that funding and technical assistance

from TB CAP is working, also allowing parallel efforts supported by Global Fund and WHO (Global Drug

Facility) to bear fruit. Timeliness and completeness of quarterly reporting has improved tremendously

showing good progress improvement of treatment success (up from 75% in 2005 cohort, to 78% in patients

registered in the first half of 2006 cohort), and uptake of HIV testing and counseling for TB patients (up from

16% reported as HIV tested in 2005 to 48% in the first half 2007, with 58% of patients HIV+).