SUMMARY: The University Research Corporation's TB Project (TB TASC) works with all levels of the Department of Health (DOH) to increase screening, referrals, treatment, and follow-up of TB and TB/HIV co-infected patients. The program activities are designed to improve TB/HIV coordinated activities at program management and service delivery levels. TB TASC will provide support in the development of operational policies as well as capacity development in laboratory, clinical skills, and community outreach. At service delivery level, emphasis is on cross referrals of TB and HIV patients for screening, treatment and follow-up of co-infected patients. Limited support is provided to community and home-based care groups to increase awareness of TB/HIV co-infections and the need for early screening and follow-up. In addition to TB and HIV patients, other target populations include public and private health care providers, TB and HIV program managers, community-based and home-care service delivery organizations and men and women. The major focus is the development of networks and referral systems, with training, community mobilization/participation, local organization capacity building and policy and guidelines as minor areas.

BACKGROUND: This is an ongoing activity and is part of a larger TB project started in September 2004 funded by USAID, with TB/HIV activities funded by PEPFAR. TB TASC is currently working at all levels of the DOH in 5 provinces to improve coordination of TB and HIV strategic and operational planning to integrate TB and HIV services into primary health care; to strengthen laboratory services to support comprehensive TB and HIV diagnosis and care; to develop new approaches to improve collaboration between TB and HIV programs; and to improve the coordination between public and private sector to respond to the dual epidemic. The TB/HIV strategy is being implemented using a collaborative approach to rapidly scale-up integrated TB/HIV services in the target provinces. The focus has been on increasing access to counseling and testing (CT) for TB patients and early referral for ARV therapy, as well as improved TB detection in HIV-infected patients.

ACTIVITIES AND EXPECTED RESULTS: ACTIVITY 1: Funds will be used to expand DOTS in the private sector. Private practitioners will be trained on MDR TB and TB/HIV management. Systems will be put in place to ensure prompt diagnosis (through links with NHLS laboratories), and appropriate treatment according to national guidelines through links with district pharmacies for the supply of TB drugs. Links will also be developed between private practitioners and district TB coordinators to ensure proper monitoring and reporting of TB/HIV co-infected patients. ACTIVITY 2: Funds will be used to ensure correct implementation of MDR/TB recording and reporting tools (developed by the project at the request of NTP) in all MDR/TB units in the country. This will include training of healthcare workers and information officers on the tools, and printing and dissemination of these tools. By funding local CBOs/NGOs, HIV counselors will be placed in all MDR TB units to promote HIV testing of all hospitalized TB patients and sessional doctors employed to stage and manage coinfected patients and fast track access to ART for TB patients. ACTIVITY 3: The project will work with other partners to improve VCT uptake and referral for HIV care including ARVs and expanding TB/HIV integrated care to children infected with HIV. ACTIVITY 4: Working with the WHO and the NTP, funds will be utilized to finalize the development of infection control guidelines for TB and to assist with training of primary health care managers including doctors, nurses and allied health workers on the implementation of the national policy and guidelines. Information and education materials for TB infection control will be developed for health care workers. ACTIVITY 5: Working with NTP, NHLS, WHO and MRC, laboratory TB policies and guidelines will be updated to be in line with international standards and the STOP TB strategy. The project will work with other partners e.g. FIND to train districts and facilities on MDR TB surveillance data collection and reporting. ACTIVITY 6: The project will work with local Universities to identify major topics that would assist NTP to revise national policy on possible high risk groups for XDR-TB.

This project will contribute substantially towards meeting the vision outlined in the USG Five-Year Strategy for South Africa by working with NTP to build the capacity of health workers to provide CT for all TB patients; screen all HIV-infected persons for active TB and ensure cross-referral of clients between TB and HIV and AIDS programs. These activities

will also contribute to the 2-7-10 goals for South Africa by providing HIV care to a large number of TB/HIV co-infected clients.