ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

The proposed COP for 2009 includes the following modifications to the activities based on the PEPFAR

South Africa Interagency Partner Evaluation's recommendation of separating TASC II TB activities from

PEPFAR activities, and dropping some of the activities.

The following activities have been removed from PEPFAR's COP 2009 but will still be implemented using

other United States government resources:

- ACTIVITY 3: Strengthen Laboratory Services

- ACTIVITY 6: Strengthen Surveillance of MDR/XDR-TB

- ACTIVITY 8: Strengthen Services for Pediatric Patients

Changes have been made to the following activities:

ACTIVITY 1: Guidelines/Policy Development and Systems Strengthening in Public and Private Sectors

URC will not use PEPFAR funds to ensure correct implementation of multi-drug resistant (MDR-TB)

recording and reporting tools in all MDR-TB units in the country. Nor will funds be used to train health-care

workers and information officers on tools, and printing and dissemination of these tools. All other activities

remain the same.

ACTIVITY 2: Reduce Stigma and Discrimination

URC will not use PEPFAR funds to provide small grants to local faith-based and community-based

organizations to integrate TB and HIV activities and to provide nutritional support to individuals to

encourage treatment adherence. Further, URC will not fund organizations to undertake advocacy and public

education to create awareness of TB/HIV dual infections and need for early screening, nor will funding be

allocated to home-based care groups to provide adherence support to co-infected patients on TB and

antiretroviral (ARV) drugs. All other activities remain the same.

ACTIVITY 5: Strengthen Implementation of TB/HIV Infection Control Policies and Guidelines

This activity title has been changed to: "Strengthen Efforts to decrease the Burden of TB in People Living

with HIV and AIDS by Accelerating the Implementation of the '3 Is' "

URC will assist districts and facilities to provide intensified case finding in all HIV-infected patients by

ensuring that all clients receiving HIV services (voluntary counseling and testing, antenatal care, sexually

transmitted infections, ARV) are routinely screened for TB disease and all those with an initial positive TB

screen are referred for TB diagnostic services and those that are diagnosed with TB, receive treatment

according to the national TB control guidelines. URC will continue to provide training to community-based

health workers to promote early identification and referral of TB suspects, patient treatment support, default

tracing and linkages with primary health-care facilities. URC will support the scale-up of isoniazid preventive

therapy (IPT) by ensuring that supported facilities provide IPT to all HIV-infected people in whom TB

disease has been ruled out, according to the national guidelines, ensuring that health-care workers are

appropriately trained in the delivery of IPT. Through grassroots advocacy and social mobilization, RC will

ensure that clear messages are conveyed to the patient, family and caregivers about the importance of

adhering to and completing prophylactic therapy as well as reporting any potential side effects. Family

members and close contacts of active TB patients, are screened for TB and if active disease is ruled out,

IPT is provided.

URC will work with the National TB Programme to ensure implementation of infection control activities.

Other activities will include development of information and education materials for TB infection control in

work settings and in the community; and assistance to facilities to develop, implement and monitor infection

control policies and plans (administrative, environmental, and personal protection) like safe sputum

collection, promoting cough etiquette and cough hygiene, assessing patient flow and separation of TB

suspects from other patients and open windows to improve room air ventilation.

----------------------

SUMMARY:

TASC II TB Project (TASC II TB), managed by University Research Co., LLC, works with all levels of

Department of Health (DOH) to increase screening, referral, treatment, and follow-up of TB and TB/HIV co-

infected patients. Activities are designed to improve TB/HIV coordinated activities at program management

and service delivery levels. TASC II TB provides support in development of operational policies and

capacity development in laboratory, clinical skills, and community outreach. At service delivery level,

emphasis is on integrating TB screening at HIV testing sites and vice versa as well as ensuring that TB/HIV

co-infected patients are put on appropriate treatment regimens as well as referred for ARV treatment and

follow-up services. Limited support is provided to community and home-based care groups to increase

awareness of TB/HIV coinfections and need for early screening and follow-up. Emphasis is on human

capacity development.

BACKGROUND:

This is an ongoing activity and is part of a larger USAID-funded TB project started in September 2004, with

TB/HIV activities funded by PEPFAR. TASC II TB is currently working at all levels of 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; strengthen laboratory services to support comprehensive TB and HIV diagnosis and

care; develop new approaches to improve collaboration between TB and HIV programs; and improve

Activity Narrative: coordination between public and private sector to respond to the dual epidemic. TB/HIV strategy is

implemented using a collaborative approach to rapidly scale-up integrated TB/HIV services in targeted

provinces. Focus is on increasing access to counseling and testing (CT) for TB patients and early referral

for ARV therapy, and improve TB detection in HIV-infected people. TASC II TB will work closely with

PEPFAR partners involved in palliative care including basic health services for people living with HIV and

AIDS (PLHIV). The project will assist partners in integrating TB case management in basic health packages

for PLHIV. TASC II TB will also work with USAID partners providing services to children to integrate TB and

TB/HIV care algorithms in pediatric and well-baby care for HIV-infected infants and children. This will

include working with Medical Care Development International (MCDI), Integrated Primary Health Care

(IPHC), and other partners providing care and support for orphans and vulnerable children (OVC).

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Guidelines/Policy Development and Systems Strengthening in Public and Private Sectors

TASC II TB will continue working with National TB Program (NTP) and HIV and AIDS Unit at national and

provincial levels in developing and refining operational policies on TB/HIV coordinated activities. This

includes policies on treatment of co-infected patients. By providing on-going training and mentoring support,

TASC II TB will assist health facilities and health care workers to improve compliance with national

guidelines and protocols for screening, treatment and follow-up of TB/HIV co-infected patients. A cadre of

Master Trainers will be developed in each province to improve knowledge and skills of healthcare workers.

Managers and service providers will be trained to improve knowledge and skills in TB/HIV management and

service delivery issues; strengthen capacity of private providers and medical schemes to better manage co-

infected patients by ensuring that TB services are included as part of a comprehensive package of services;

improve HIV services in TB facilities by promoting provider-initiated CT, and appropriate staging and referral

of HIV-infected individuals. This will also ensure expansion of CT uptake among TB patients Referral

systems will be strengthened at district level between health and social services. Private practitioners will be

trained on MDR-TB and TB/HIV management. Systems will be put in place to ensure prompt diagnosis and

appropriate treatment. Links will also be developed between private practitioners and district TB

coordinators to ensure proper monitoring and reporting of TB/HIV co-infected patients. Funds will also be

used to ensure correct implementation of MDR/TB recording and reporting tools in all MDR-TB units in the

country. This will include training of healthcare workers and information officers on tools, and printing and

dissemination of these tools. TASC II TB will assist facilities and districts in reviewing performance data to

ensure all TB and HIV patients are screened for coinfections and co-infected patients are provided with

appropriate treatment and referrals.

ACTIVITY 2: Reduce Stigma and Discrimination

TASC II TB will support grassroots advocacy through CBOs/FBOs to counter stigma and promote a

supportive environment for people with TB and HIV by implementing community-based awareness

campaigns. The project will promote early diagnosis of TB among PLHIV by promoting routine TB screening

of HIV-infected patients and CT among TB patients. Small grants will be provided to local FBOs and CBOs

to integrate TB and HIV activities and provide nutritional support to individuals to encourage treatment

adherence, and also allow organizations to undertake advocacy and public education to create awareness

of TB/HIV dual infections and need for early screening. Home-based care groups will be funded to provide

adherence support to co-infected patients on TB and ARV drugs. Advocacy materials will be developed.

The project will fund local CBOs/NGOs for placing HIV counselors in all MDR-TB units to promote HIV

testing of all hospitalized TB patients. In addition, the project will also work with sessional doctors to stage

and manage co-infected patients and fast track access to ART for TB patients.

ACTIVITY 3: Strengthen Laboratory Services

The project will work with NTP and National Health Laboratory Services (NHLS) at service delivery level to

improve availability and quality of laboratory services critical for identifying TB among HIV-infected

individuals. Specific activities will include: 1) enhancing skills of laboratory staff in preparing and reading

smears; 2) placement of a laboratory quality assurance system to improve sensitivity and specificity of

sputum checking; and 3) development of a simple laboratory information system, linked with the electronic

TB Register (ETR) to track turn-around-time of specimens sent to laboratory. Working with NTP, NHLS,

World Health Organization (WHO) and Medical Research Council (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 to train districts and facilities on MDR-TB surveillance data collection and

reporting.

ACTIVITY 4: Monitoring and Surveillance

The project will work with NDOH to strengthen recording and reporting systems for TB and HIV by training

healthcare workers in implementation of revised TB and HIV registers, data collection and analysis, and on-

going problem solving functions. TB TASC will strengthen capacity of provincial, district and local service

area (LSA) health offices to establish functional HIV and AIDS, STI and TB (HAST) committees in order to

strengthen monitoring, supervision, and surveillance of TB and HIV by using an approach of continuous

feedback and mentoring of service providers. The project will also work with National DOH to strengthen

and improve TB and HIV monitoring through use of ETR. TASC II TB will work with DOH to monitor TB and

HIV programs as well as cross-referrals for TB/HIV and ARV treatment. Technical support will be provided

to health facilities and CBOs and FBOs in integrating TB and HIV with other health services to reduce

missed opportunities and improve continuum of care by promoting routine CT to TB patients and routine TB

screening for HIV people including pregnant women

ACTIVITY 5: Strengthen Implementation of TB/HIV Infection Control Policies and Guidelines

TASC II TB will work with WHO and NTP to finalize the development of infection control guidelines for TB

Activity Narrative: program. This will be followed by training of primary health care managers and service personnel including

doctors, nurses and allied health workers on the implementation of the national policy and guidelines.

Information and education materials for TB infection control in work settings will be developed for health

care workers.

ACTIVITY 6: Strengthen Surveillance of MDR/XDR-TB

TASC II TB will work with NTP as well as local universities to improve and expand surveillance of

MDR/XDR-TB in the country. Assistance will be provided to design a simple framework to collect and

analyze data on MDR/XDR patients in each province. In addition, mechanisms will be developed and

implemented for contact tracing of MDR patients to minimize risk of nosocomial transmission. Close

contacts of MDR/XDR-TB patients will be put under close surveillance and appropriate prophylactic

treatment if needed.

ACTIVITY 7: Promote Linkages with Palliative Care

TASC II TB will work with PEPFAR partners responsible for delivery of basic health care for PLHIV to

integrate TB screening, diagnosis, treatment and follow-up as part of their routine care and management of

HIV clients. PEPFAR partners will be helped to ensure all HIV infected clients are regularly screened for TB

and those with bacilli are put on TB treatment, and also in management of TB/HIV patients. TASC II TB will

provide training and follow-up support to these partners.

ACTIVITY 8: Strengthen Services for Pediatric Patients

TASC II TB will work with USG partners working on child health issues to improve quality of services.

Partners will be trained in management of pediatric TB including suspecting and referring for TB diagnosis.

Key partners may include groups receiving USAID funds as well as other PEPFAR partners tasked with

OVC care and support.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13870

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13870 3112.08 U.S. Agency for University 6638 1212.08 TB - TASC $5,407,750

International Research

Development Corporation, LLC

7626 3112.07 U.S. Agency for University 4492 1212.07 TB - TASC $5,575,000

International Research

Development Corporation, LLC

3112 3112.06 U.S. Agency for University 2714 1212.06 TB - TASC $1,700,000

International Research

Development Corporation, LLC

Emphasis Areas

Health-related Wraparound Programs

* TB

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $2,620,055

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12: