challenge tb - ethiopia year 3 quarterly monitoring report...

Challenge TB - Ethiopia

Year 3

Quarterly Monitoring Report

October-December 2016

Submission date: January 30, 2017

2

Table of Contents

1. QUARTERLY OVERVIEW 3

2. YEAR 3 ACTIVITY PROGRESS 7

3. CHALLENGE TB’S SUPPORT TO GLOBAL FUND IMPLEMENTATION IN YEAR 3 28

4. SUCCESS STORIES – PLANNING AND DEVELOPMENT 29

5. QUARTERLY REPORTING ON KEY MANDATORY INDICATORS 31

6. CHALLENGE TB-SUPPORTED INTERNATIONAL VISITS (TECHNICAL AND MANAGEMENT-RELATED TRIPS) 33

7. QUARTERLY INDICATOR REPORTING 34

Cover photo: Tigray regional health office in collaboration with CTB conducted regional sensitization and awareness raising campaign on basic TB information including on infection

control. Photo: Tigray CTB team. This report was made possible through the support for Challenge TB provided by the United States Agency for International Development (USAID), under the terms of cooperative agreement number AID-OAA-A-14-00029.

Disclaimer

The authors’ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

3

1. Quarterly Overview

Country Ethiopia

Lead Partner KNCV

Other partners MSH, WHO

Work plan timeframe October 2016 – September 2017

Reporting period October-December 2016

Most significant achievements: (Max 5 achievements)

Sub-objective 1: Enabling Environment

In the reporting quarter, mapping of key populations1 has been finalized in all Challenge TB (CTB) regions. For example, in Oromia region, CTB supported mapping of key populations with the aim of screening for TB in 20 Mega projects, 14 universities, 28 prisons, 4 holy water (religious healing places), 1 nursing home (Missionary Charity), 1 refugee camp, 15 pastoralist communities and 4 mining areas (with an estimated total population size of 1,409,396).2 Mapping of key population, other activities have started this quarter such as engaging prison administrators

through sensitization workshops, training of health workers from prisons and mega projects and provision of materials in Oromia, Amhara, SNNPR, and Addis Ababa. Outputs of the implementation of these activities will be reported in the coming quarters.

Sub-objective 2: Comprehensive high quality diagnostics

Improving the quality of microscopy service is key intervention to improve the TB case finding, therefore, CTB continued to promote and support decentralized EQA services in all CTB supported regions. In the CTB supported regions, EQA coverage reached more than 1,845 (65%) of all

diagnostic health facilities and from these EQA participated facilities those with >95% concordance result are 94% of the facilities. [Table 1 EQA performance for CTB regions].

Ethiopia has limited infrastructure to provide full lab capacity for culture and Drug Sensitivity Testing (DST). These services are usually located in urban areas but not easily accessed for most of the health facilities in the regions. To address this challenge, a temperature-controlled vehicle specimen transportation system was procured by USAID/HEAL-TB project, which became operational under the USAID/Challenge TB Project. The impact of those vehicles in sample transportation in Amhara, Oromia, and Addis Ababa is being monitored. To date, the introduction of cold chain sputum transportation has brought significant improvement in the average sputum

transportation and delivery time from the previous 5-7 days before August 2016 to 1-2 days this quarter. It has also shown improvement in specimen integrity, timely specimen processing by

culture labs and decrease of the culture contamination rate caused by poor specimen storage and delay of specimen delivery time.3 A full and complete impact analysis will be completed and results reported in Q2. Moreover, the use of these vehicles has also a potential to eliminate the issue of transport safety risk, which is a concern when using public transport for sample movement. More than 2,100 samples were transported using this new system since Aug 2016.

In SNNPR, one of the big regions with 49 hospitals and 712 health centers, which are expected to be TB diagnostic facilities, there were only 4 EQA centers to supervise labs and assure quality of

lab services in the region. These 4 centers are under-staffed and poorly supported financially and logistically. They could only reach 78(10%) of the diagnostic facilities in previous year 2. Following sensitization workshop, 14 more EQA centers were selected to serve as centers to assure delivery of quality of laboratory services in the region. The EQA centers are in turn supervised by the RRL. Lab heads and quality officers from these selected facilities are capacitated on EQA data management. In the meantime, as proper slide collection was a

1 Key populations include people living in congregate settings such as prisons, mega projects, universities,

nursing homes, refugee camps etc. 2 Detailed report on key populations will be shared for CTB supported regions in the next quarter

3 Detailed analysis will be conducted and results reported next quarter

4

challenge for blind slide rechecking, two-day workshop on proper slide collection was conducted for 162 TB focal persons from all Zones and Woredas in SNNPR.

As part of the national initiative to make GeneXpert the primary test in urban setting, massive sensitization workshop conducted for 805 (F=286, M=519) health care providers and 81 lab professionals (F=26, M=55) trained in Addis Ababa, DD and Harari regions. Technical assistance was provided for installation of 14 more GeneXpert machines in these urban areas during the reporting period.

Sub-objective 3: Patient-centered care and treatment

Low quality of care provided to MDR-TB patients has been a major area needing improvement. In Tigray, the CTB team in collaboration with the regional TB team has undertaken the following interventions in the reporting quarter: PMDT training for all MDR follow up centers of 121 (F=46,

M=75) staff, all the 7 TICs have assigned general physicians as panel team heads and internist to manage difficult cases, all the TICs have conducted panel team meeting, catchment area meeting,

and all TICs conducted one supportive supervision and mentorship visit to their catchment TFC. Sub-objective 4: Targeted screening for active TB Contact screening of families of pulmonary TB index cases is one of the targeted approaches of case finding and this has been the focus area for CTB support in the quarter. For instance, in

Amhara region, a total of 1,221 households contacts of 662 index cases were registered (children < 5yrs=83), of whom 7 TB cases were diagnosed. In Addis Ababa, of 166 pulmonary TB index cases, 42 children age < 5yrs contacts registered and 38 (90%) screened, 26 (78%) were put on IPT. [Please see Tables 2-4]. In SNNPR CTB team started monitoring the yield of contact screening in the 1st quarter of Year 3. In 36 HFs (out of total 133 HFs) have started monitoring

contact screening, of 573 index cases reported in Year 3 Q1, 555 contacts were registered and

200 (36%) contacts screened. Of those 200, 44 were children under 5 years. Presumptive cases were 25/200 (12.5%). Case found was 1(4%) among 25 presumptive cases. And, only 4/40 (10%) put on IPT. This low percentage is attributed to a lack of 100mg INH, documentation problems, HCWs low confidence, amongst others. The implementation of this activity is at its infancy stage in most of the regions. To improve the current situation, CTB regional teams, in collaboration with regional TB officers conducted mentorship, supportive supervision and distributed a regionally customized TB and MDR TB close contact screening logbooks.

Sub-objective 5: Infection control In addition to early case finding and treatment, interventions targeting community awareness of TB transmission and infection control (TB IC) is the basis for TB prevention and control. CTB partnered with the Tigray health office and Civil Society organization i.e. the Ethiopian Medial

Students Association (EMSA) to conduct a regional TB IC sensitization and awareness raising

campaign through community outreach activities. This was done through face to face education, flyer distribution (around 40,000 educational flyers distributed), banners, mobile band, educational script reading, and the media (Tigray radio and television stations). Target audience included students, prison community, bus/taxi drivers and passengers, youths at DSTV stations, religious leaders /believers in Axum Zion church and Mekelle Mosques and the general public. This campaign was estimated to reach more than 200, 000 people across the region.

Sub-objective 9: Drug and commodity management system Uninterrupted drug supply and management system is an essential activity of the TB program for patient adherence and proper management, and in line with this CTB in collaboration with Tigray health office and Pharmaceuticals Fund and Supplies Agency (PFSA) distributed standard excel-based second line drug request and requisition form. MDR-TB treatment initiating centers were

communicated to timely notify concerned bodies. Such interventions have avoided potential

critical shortages of second line drugs especially Cycloserine and Capreomycin in regional DR-TB Treatment Initiation Centers (TICs). Sub-objective 10: Quality data, surveillance and M & E

5

Data quality problem is a long standing challenge for the TB control program in all regions. Cognizant of this issue, all regional CTB teams have been actively engaged with the RHB to correct this problem. In SNNPR, training was conducted for 135 (M=123, F=12) woreda HMIS focal persons on TB, TB/HIV and MDR-TB M & E. In Amhara region, training was conducted for a total of 950 (M=678, F=272) facility, woreda and zonal TB officers. In Addis Ababa, Dire Dawa

and Harari 204 (F=91, M=113) HMIS focal persons were trained on HMIS. In SNNPR CTB also supported joint supportive supervision with data verification in 37 woredas and 13 zones, leading to feedback and corrective measures. The extent of data quality problem varied by zone and woreda, over and under-reporting of treatment outcome has been a major problem. CTB was the lead partner in supporting the national research advisory committee (TRAC) in the development of the national TB research plan, Nov 21-23, 2016 (i.e. the country has revised its

TB research roadmap which was developed in 2012) with the participation of 42 key stakeholders including from WHO Geneva (Dr. Christian Leinhardt). Major reasons for revising the document were: i. the document now is 4 years old and covers only operational research; ii. We are now in

post 2015 where there is new global direction i.e. the End TB strategy and World Health Organization (WHO) developed new guidance document for countries developing TB research plan; iii. New technologies and approaches have been pursued by the NTP and this might require an

update of the national TB research priorities. After a national consultative workshop and endorsement by the Ministry, the national TB research plan will be launched in March 2017.

Pic 2: During the national consultative workshop to revise the national TB research priorities, USAID, CTB, WHO, Universities, research institutes, regional health office representatives, etc. participated.

Technical/administrative challenges and actions to overcome them:

Complaints regarding the new DSA rate to staff of government are increasing. Almost all trainings, sensitization workshops and supervisions are becoming eventful with regards to the low per diem rate. It has been observed that health staff in some places are refusing to participate in activities supported by the project. The Management team of the project is trying to mitigate the problem

by holding full board arrangements for selected trainings. Furthermore, discussion is underway to hold the trainings in ALERT and St. Peter training centers to conduct trainings similar to those of

GF. This is expected to reduce said complaint as it is managed by government facilities.

6

The registration of KNCV was obtained in mid-December 2016 due to delay in signing MOU with MoH and a series of discussion on compliance issue of 30/70 with audit desk of Charities and societies Agency. The civil unrest in most parts of the country has affected project implementation due to limited

movement and internet access. The country is in State of Emergency declared by the government.

7

2. Year 3 activity progress

Sub-objective 1. Enabling environment

Planned Key Activities for the Current Year

Act. #

Planned Milestones Milestone status Milestone met? (Met, partially, not met)

Remarks (reason for not meeting milestone, actions to address challenges)

Oct-Dec 2016

Jan-Mar 2017 Apr-Jun 2017 Jul-Sep 2017 Year end Oct-Dec 2016

Assist development of National Prison TB protocol/Guide

1.1.1 Development of training materials, job aids, SOPs

Dissemination workshop, TOT training

Prison guideline implemented

Supportive supervision and mentoring

?? Prison TB SOP & Job aids are sent for printing

Met

Assist implementation of Prison TB in CTB supported regions

1.1.2 Regional Biannual Review meeting on Prison TB conducted in all regions

Routine supportive. supervision conducted (quarterly) to all prison sites

Planned for next quarter: the printed prison TB SOP will be distributed and regions will be sensitized and supported for implementation

N/A

National consultative workshop

1.4.1

*Consultative workshop on CTBC * Consultative workshop on M&E/data quality

CTB, in collaboration with NTP, has conducted a consultative workshop to finalize the national ENGAGE TB implementation guide adopted from the WHO aiming to engage all CSOs working at community level in all sectors in to the TB prevention and care services.

Met

Printing of Guidelines, IEC/materials, registers, formats,

1.4.2

HEP Newsletter

HEP Newsletter

- This activity will be implemented in Q2

N/A

Costing study

1.4.3 Costing study on out of pocket catastrophic expenditure

Concept note submitted by Team of researchers from the Ministry staff and reviewed by reviewers of TB Research Advisory Committee (TRAC). It is now at the stage of submitting a full proposal by the research team to TRAC.

Partially met

8

Pic 1: Awareness raising campaign for schools and other segments of the community, Tigray

Sub-objective 2. Comprehensive, high quality diagnostics


Act. #



Oct-Dec 2016


Support finalization of

2.1.1 Sensitization workshop in

Sensitization workshop in

implementation of lab

evaluate implementati

Draft plan (currently needs major Not met The finalization of TB laboratory strategy plan

9

national TB lab strategic plan with complete rational mapping of diagnostic services

CTB regions on the revised TB lab strategic plan

CTB regions done on the revised strategic plan

strategic plan on of lab strategic plan

updates and revision) and dissemination workshop was not conducted because of NTP and EPHI focal persons are engaged in other competing priorities. Thus, this activity is postponed for next quarter.

Local Capacity Building on Smear Microscopy service/ ZN, FM and EQA in CTB regions

2.1.2 *Trainings cascaded in CTB regions (Gambella),

*All planned microscope procured

* S.S & mentoring held *Procured microscopes distributed

Regular quarterly supervision initiated I all regions with follow up action points, all procured microscopes distributed

* S.S & mentoring held

Procurement and distribution of 65 LED microscopes to all regions in the country.

Supported the printing & distribution of TB lab register logbook

Met .

Strengthen the TB Microscopy EQA activities

2.2.1 Review meeting on TB microscopy EQA conducted and POA defined;

review EQA implementation based on outcome of review meeting (POA), regular conduct of supervision and slide collection etc. * Panel Test preparation

supportive supervision, mentoring and Follow up of progress in decentralizing EQA service (proportion of labs included in EQA)

supportive supervision, mentoring and Follow up of progress in decentralizing EQA service (proportion of labs included in EQA) * Pannel Test preparation

NTP in collaboration with its partner / CTB established well-coordinated EQA program in the country. Currently RBRC for ZN AFB microscopy method is decentralized and implemented in all regions at all level

Met

Support the AFB Smear Microscopy network accreditation plan development and implementation (MSH Support

2.2.2 Implementation action plan developed

POA Implementation support in place

continue implementation support

review of implementation of action plan

Not met Budget was not allocated for this activity, however, additional financial support was acquired and the activity initiated but will be ongoing

10

Area)

National and regional level capacity building on TB culture for identification and DST

2.3.1 Support regular Site Supervision from NRL to RRLs

Support regular Supportive supervision from NRL to RRLs

Conducted in Harar, Hawassa, Bahir Dar, Mekelle and Gondar TB culture labs in the Q1

Met

Build national and regional capacity for maintenance of laboratory equipment

2.3.3 Capacity for maintenance of TB lab equipment created at St. Peter

CTB supported St Peter hospital and AHRI for equipment maintenance workshop through training of bio-medical engineers and equipping the workshop with standard maintenance tools. This support currently enabled bio-medical engineers to conduct regular preventive maintenance for medical equipment’s as per the manufacturer recommendation for microscope, autoclave, centrifuge, refrigerator, water distiller etc. in this quarter.

Met

Support the implementation of lab QMS at National & Regional TB culture labs including supporting SLIPTA *8 cultures labs are registered for SLIPTA process and received three rounds of improvement project including exit project. Assessment was also done by which Adama & EPHI

2.3.4 Currently 7 culture labs (Harar, Hawassa, Adama, Jimma, EPHI, Bahir Dar & Gondar) are implementing LQMS/SLIPTA while the two culture labs (Mekelle & St Peter) are not functional due to lack of biosafety certification & negative pressure. CTB is working with EPHI to address the challenges.

Met

11

have got three stars. Next step is to apply for accreditation. They need auditor/assessor training for internal cross checking.

Technical and material support for national and regional TB reference laboratories for national and international accreditation (focus on ALERT & St. Peter)

2.3.5 Partially met

Materials have been procured to support the regional lab facility development which is essential for the accreditation process. Technical support will be ongoing.

Local Capacity Building on GeneXpert MTB/RIF diagnostic technology

2.4.1 * Sensitization workshops for clinicians

A total of 92 (M=59, F=33) clinicians have participated in two rounds of sensitization workshop. Sensitization will be ongoing as part of the

national initiative to use Xpert as first line test.

Met

strengthening LIS and data management mainly on C/DST & GeneXpert sites

2.5.1 National profile micro data base for Xpert developed, for use at national & regional reference labs. It provides historical data of each Xpert machine (e.g. location, date of Installation, machine serial number, date of calibration and next schedule, remote connectivity status etc.)

Met

Strengthen the sample transport system for Culture/DST and GeneXpert services

2.6.1 *scale up plan prepared

A total of 59 GeneXpert testing referring HFs selected from Amhara region while a total of 112 GeneXpert sites were selected from Oromia region for establishing linkages with sample transportation system

Met

12

Pilot e-health solution for integrated sample transport system in SNNPR & Tigray

2.6.2 Scale up plan prepared

Implementation started in selected expansion sites

Implementation started in selected expansion sites

Met First round training was conducted for a total of 11 participants from EPHI, St. Peter Hospital and ALERT Hospital.

Activity delayed due to the current country internet problem, scale up will continue next quarter

Assist development/implementation of national biosafety standards

2.7.1 Negative Pressure Installation at St. Peter completed

Partially met

A signed an agreement with CRM South African Company for the installation of negative pressure for TB culture lab in both St Peter and AHRI/ALERT hospitals has been completed, the work is expected to be finalized in March 2017

Capacity building on biosafety standards (CDC have procured training tools and planned to train advanced training at national level-EPHI)

2.7.2 Customize CDC BSC (Biosafety Cabinet training) maintenance and calibration training

2 rounds of BSC trainings

support annual calibration and maintenance visit

Next quarter N/A

Table 1: CTB supported regions as of APA3 quarter 1, EQA performance July – Sept 2016 (HMIS data)

Region # diagnostic facilities

# HFs participating in EQA

# (%) HFs with >95% concordance

13

Addis Ababa 139 71 (51%) 64(90.1)

Amhara 769 526 (68%) 512(97.3)

Benishangul Gumuz 34 16 (47%) 15(93.8)

Dire Dawa 29 15 (52%) 13(86.7)

Gambella 32 5 (16%) 4(80)

Harar 16 12 (75%) 12(100)

Oromia 1120 828 (74%) 761(91.9)

SNNPR 530 265 (50%) 252(95.1)

Tigray 166 107 (64%) 98(91.6)

CTB total 2,835 1845 (65%) 1731 (94.0)

National 2,995 1869 (62.4%) 1756 (94.0)

Table 2: ZN BLR EQA results by region, July-Sept 2016

Indicators

Region

Total Amhara Dire Dawa Oromia Tigray

# of Health facilities evaluated 375 7 489 120 991

# of negative slides 15863 249 12768 3117 31997

# of positives slides 355 11 1347 126 1839

# (%) of False positives(FP) slides 14(3.9) 3(27.3) 50(3.7) 6(4.8) 73(4.0)

#(%)of High False Positives(HFP) 6(42.9) 3(100) 18(36) 4(66.7) 31(42.5)

#(%) of False Negatives(FN) slides 10(0.06) 3(1.20) 45(0.35) 6(0.19) 64(0.20)

#(%) of High False Negatives(HFN) 2(20) 3(100) 24(53.3) 5(83.3) 34(53.1)

#(%) of HFs with >95% concordance rate 2(99.5) 1(85.7) 22(95.5) 5(95.8) 30(97)

14

Sub-objective 3. Patient-centered care and treatment


Act. #



Oct-Dec 2016


Support implementation of Childhood TB roadmap

3.1.1 support regular joint monitoring and SS for pilot HFs

First results of AA pilot available

Cascade integration of Childhood TB training to regions

Cascade implementation to regions

Joint SS & mentorship to all pilot sites in Addis Ababa conducted (A.A RHB & NTP participated)

Met

Strengthen a national panel of experts on PMDT

3.1.2 Conduct national clinical symposium

review function of panel of experts

Conduct national clinical symposium

CTB supported NTP both technically and financially in conducting a two days’ clinical symposium and a one day clinical review committee workshop to strengthen case finding and quality of care.

Met

Strengthen TB/HIV collaborative activities at all levels

3.1.3 Support the TB/ HIV National level symposium *consultative workshops to develop blended TB/HIV training materials

* Assist consultative workshops to develop blended TB/HIV training materials including pilot trainings

review function of TWG at regional level

Not met Concept note was developed, however, due to competing priorities for NTP and currently in preparation of conducting a mid-term review of the TB program as a whole, therefore, important information could not be taken up for this activity

Provide TA at national level in development of protocol/tool CTBC in Pastoralist & rural settings and assist in implementation

3.1.4 CBTC implemented and monitored

CBTC implemented and monitored



CTB in collaboration with the NTP conducted baseline assessment in pastoral regions to observe the situation on the ground which may help how to design an effective case finding strategy for this group

Partially met

Though the assessment was made, Implementation of recommendations are yet to be monitored.

15

rural communities in two regions (GF Supported activity)

Support Implementation strategy/approaches to improve TB case detection in urban slums ( Map slum areas, areas of homeless people, Identify local charity shelters with vulnerable groups (elderly, orphanage …), Identify work places with potential TB transmission)

3.1.5 establish a routine monitoring and evaluation system and conduct supportive supervision and mentoring,

CSOs identified ( to work together to support TB patients/families).

Strengthen TB/HIV collaborative activities at HF level and assess the potential for coordination with other health services

review urban approach

Besides health facility based mentorship in the three urban settings, CTB mapped “key populations” in the three urban regions.

To improve the data quality problem in the three urban regions, a total of 134 (F=60, M=74) were trained on TB M & E

Met

Adopt Standard of Care for routine monitoring of access to quality care

3.2.1 Standard/quality of care monitoring tool routinely used in all regions

SOC tool has been introduced in consultation and sensitization workshops in all CTB regions

Met

Cohort review for MDR-TB cases

3.2.2 regular cohort review conducted

regular cohort review conducted

Evaluation of the cohort review conducted and improvement plan developed

Catchment area meetings and cohort review conducted.

Met

Assist implement routine hearing testing for MDR-TB patients; in development and

3.2.3 Monitoring continued * Procurement of reagents

Monitoring continued

Performance evaluated

CTB procured 10 audiometry for ALERT TICs and other TICs in the country; an audiometry training has been conducted for MDR-TB focal persons and CTB PMDT advisors. The

Met

16

implementation of drug toxicity monitoring system

for electrolyte and related supplies for ADR

training was provided in a class session by an expert from ALERT stream trial team and distance education from the company in Canada through video-conferencing system.

Patient support

3.2.4 Patient support

Patient support

Patient support

Patient support

Continued the patient support packages (as previous years of CTB support)

Met

Support ALERT & St Peter to be CoEs for TB, MDR TB & X-DR TB clinical care

3.2.5 Install the negative pressure at St.Peter , support in making St.Peter and ALERT culture lab functional * Support TIC-TFC linkage

* Support TIC-TFC linkage



Partially met

In the process of installing negative pressure (please see activity 2.7.1)

support implementation and scale up of new drug regimen and monitoring system

3.2.6 Drug arrived to the country and protocol approved, Training of the staff on the protocol and SOP, start patient enrolment

Continue patient enrolment ,monitoring and follow up,

Continue patient enrolment ,monitoring and follow up,

Cohort review and review meeting conducted.

Health care workers trained on clinical and programmatic management of patients with new anti-TB drugs, data clerk & social worker recruited, audiometry procured,

Payment made for the procurement of new and repurposed drugs to GDF except for Bedaquiline as it will be provided from the USAID free donation program

Met

Support PMDT in the CTB regions

3.2.7 Weekly PMDT meetings routinized, review implementat

Routine NAC conducted for MDR-TB patients and patients linked to nutritional

Refresher PMDT training conducted. Conduct Clinical Symposium/C

Not met Weekly meeting was not feasible. The meetings are more of ad hoc on needs basis

17

ion support ME

Sub-objective 4. Targeted screening for active TB


Act. #



Oct-Dec 2016


Improve Contact Investigations (CI) in the CTB regions and urban settings (PLHIV/children)

4.1.1 Regular monitoring and supervision have CI integrated

review conduct of Regular monitoring and supervision

All CTB supported regions sensitized and availed monitoring tools in the implementation of CI (please see figures below). SNNPR & Tigray will start reporting next quarter.

Met

Provide IPT for <5 household contacts of bacteriologically confirmed index patients in the two regions

4.1.2 Please ref to figures below Met

Assist development of ACF strategy & guide

4.2.1 N/A Under discussion with the NTP

Table 2: Contact screening performance in CTB supported regions from the baseline assessment (April - Aug 2016)

Variables Amhara Oromia Tigray SNNP Addis

Ababa

Dire

Dawa

Harar Total

Number of health facilities implementing contact

screening

134 1211 45 36 6 10 6 1448

Number of index smear positive TB cases 441 3064 85 573 37 43 20 4263

18

Household contacts registered 1221 8499 137 555 133 120 60 10725

Close contacts, children under 5 83 876 26 44 13 15 9 1066

Number of household contacts screened for TB 1157 8499 135 200 110 109 40 10250

Percent screened among household contacts (%) 94.80% 100.00% 98.50% 36% 83% 91% 67% 95.6

Number of children under 5 evaluated for TB 77 876 19 8 13 14 9 1016

Percent of children under 5 evaluated for TB out of the

contacts (%)

6.30% 10.30% 13.70% 1.40% 100.00% 93.33% 100.00% 95.3%

Number of presumptive TB identified 42 164 1 21 3 1 0 232

Proportion of presumptive TB identified (%) 3.60% 1.90% 0.70% 10.50% 2.73% 0.92% 0.00% 2.3%

Number of children under 5 presumptive identified 5 47 0 4 0 0 0 56

Proportion of presumptive TB identified among children

under 5 (%)

6.50% 5.40% 0 50% 0% 0% 0% 5.5%

Number of children under 5 eligible for IPT (screen

negatives)

72 797 19 4 13 0 9 914

Number of children under 5 started on IPT 38 379 7 3 13 0 6 446

IPT coverage for children under 5 (among those eligible)

(%)

52.80% 47.50% 36.80% 75% 100% NA 67% 48.8%

Number of TB cases identified among contacts 7 24 1 1 0 1 0 34

Percent yield among contacts screened for all ages 0.61% 0.28% 0.70% 0.50% 0.00% 0.92% 0.00% 0.33%

19

Sub-objective 5. Infection control


Act. #



Oct-Dec 2016


Assist in implementation & monitoring of TBIC at selected HFs & congregate setting

5.1.1 *Action plan developed, MDR TB contact screening introduced as routine practice * Training on TBIC to TICS & selected TFCs

Routine MDR-TB contact screening

Routine MDR-TB contact screening

review/evaluated routine MDR-TB contact screening

Modified contact screening logbook availed to all TICs and sensitization meeting were conducted in CTB supported regions

Met

Provide comprehensive TB-IC package support

5.1.2 Monitor implementation

conduct periodic UVC measurements and maintain the UV fixtures and lamps * FUP STTA

Monitor Evaluate Not met Activity differed mainly due to delay in procurement of UVGI from another source to the NTP. N-95 mask procurement delayed by CTB.

Engaging local CSOs/NGOs in TBIC through CBTC, integration of TBIC with other programs (e.g. NCDs), and TB in congregate settings

5.1.3 monitor implementation of sub awardees

monitor implementation of sub awardees

monitor implementation of sub awardees

evaluate performance of sun awardees

Not met Sub awardee identification delayed due to delay in obtaining renewal of KNCV registration by Charities and Societies Agency. Expected to award in Q2 of APA3.

Sensitize the two agrarian regions to monitor and accurately report

5.2.1 Strengthen the routine R & R of TB among

Strengthen the routine R & R of TB among HCWs



Partially met

Sensitization of HCWs conducted in CTB regions, results of efforts will be seen in

20

on TB disease among HCW

HCWs (e.g. SS, mentoring, etc.)

(e.g. SS, mentoring, etc.)



the next quarters

Demonstrate integration of TBIC in implementing IP chapter of Ethiopia's Hospital Reform in selected sites (OR context)

5.2.2 Continued protocol development (e.g. consensus building, etc.)

Implementation of the protocol in selected hospitals

Follow up of implementation of the protocol in selected hospitals

Implementation evaluated

Not met Protocol development protracted. The research team at St peter has begun working on it with technical support from CTB.

Note on TB IC: Reports from preliminary results of the baseline assessment and supportive supervision in SNNPR, Dire Dawa and Harrari regions indicates that IC practices vary among facilities by region and set-up. Functional IP committee exists in 59%,20 and 4% of facilities assessed in DD, Harrar, and SNNPR

respectively. Periodic screening of health care providers is reported from 65.7% and 20% of Health facilities from Dire Dawa and Harari. High level of TB cases were reported from Harrar and DD, 14 and 9 health workers were reported to be infected with TB during 1 year preceding assessment or supportive supervision. In collaboration with regional health office and CTB have intensified IP activities in HF in supported regions. Thus, better performance is expected in IP activities at facility level in subsequent quarters

Table: TB IC activities from baseline assessment (April-June 2016 Facility Reports)

SNNPR Harrar Dire Dawa

Total HFs visited=133

#of HF visited= 10

# HF visited =17

TB IC committee/ functional MDT

5(3.7%) 2(20%) 10(59%)

Facilities with TB IC plan 37(28%) 7(70%) 11(64.7%)

Facilities with Cough triage

12(9%) 7(70%) 13(76.4%)

Facilities conducting

Periodic Health Provider screening

No data 2(20%) 11(65.7%)

Health care providers reported to be infected

from 133HF

5 17 9(1MDR) from 5 HFs.

21

Sub-objective 6. Management of latent TB infection


Act. #



Oct-Dec 2016


support implementation of "accelerated IPT implementation plan" for PLHIV in high volume facilities

6.1.1 Proportion of PLHIV on IPT monitored in selected sites

Quarterly supervision conducted in

Review accelerated IPT implementation

Please see table below. (IPT is monitored in all ART sites, though there is a big data quality problem)

Met

scale up IPT for eligible U-5,

6.1.2

See under 3.1

N/A

Table 5: IPT coverage among newly enrolled PLHIV’s in CTB supported regions, July-Sept 2016 HMIS data

Region # HIV pts newly enrolled

# HIV patients put on IPT

% of HIV patients put on IPT

Addis Ababa 1592 218 13.69

Afar 94

41 43.62

Amhara 2258 900 39.86

Benishangul Gumu 50

24 48.00

Dire Dawa 129 74 57.36

Gambella 138 77 55.80

Harar 54

46 85.19

Oromia 1722 756 43.90

SNNPR 813 536 65.93

22

Tigray 794 249 31.36

CTB total 7550 2880 38.15

National 7644 2921 38.21

Sub-objective 7. Political commitment and leadership


Act. #



Oct-Dec 2016


Advocacy on universal access to diagnosis, treatment and care of TB, MDR TB, XDR TB

7.2.1 N/A

Integration of TB and RMNCH services

7.2.2 Partially met All preparations finalized in APA2 and pilot implementation ongoing ( A.A)

Integration of TB and NCD interventions

7.2.3 Partially met Concept note developed

Standardize revision of monitoring tools for TB control program implementations.

7.3.1 Standard/quality of care monitoring tool routinely used in all regions

Standard/quality of care monitoring tool routinely used in all regions

Met

Support conducting national level TB program supportive supervision

7.3.2 Evaluate conduct of supportive supervision

Supportive supervision conducted

Supportive supervision conducted

Evaluate conduct of supportive supervision

N/A No activity in 1st

quarter

Support NTP in organizing

7.3.3 Review meeting

Review meeting

N/A Next quarter

23

program specific review meetings at national level

conducted conducted

Coordinate ToT training on TB program management training for program managers and coordinators

7.3.4 Not met Timeline is not yet decided with RHBs.

Sub-objective 8. Comprehensive partnerships and informed community involvement


Act. #



Oct-Dec 2016


Conduct consultative workshop to finalize TORs for the coordinating bodies

8.1.1 Not met Competing priorities for NTP

Conduct consultative workshop to finalize TORs for the regional level coordinating bodies: Amhara, Benishangul and Gambella

8.1.2 Not met Benishangul & Gambella CTB team recruitment finalized / office established and baseline assessment completed at the end of Q1.

conduct quarterly technical working group meeting at national

8.1.3 TWG meeting conducted

Review functioning of TWG

TWG meeting conducted


Met

conduct quarterly technical working group meeting at the regional level

8.1.4 TWG meeting conducted

Review functioning of regional TWG



Met

24

national: Amhara, Benishangul and Gambell

GF grant monitoring supportive supervision to regions

8.2.1

Grant monitoring visit conducted

Grant monitoring visit conducted

Not met Postponed for next quarter- due to competing priorities of the grant monitoring team

Support implementation of activities under GF's Incentive funding

8.2.2

Support implementation of activities under GF's Incentive funding

Met Technical assistance provided to the NTP in compilation and analysis of quarter reports on community based TB care implementations from 15 project sites. (Global Fund Incentive Funding)

Sub-objective 9. Drug and commodity management systems


Act. #



Oct-Dec 2016


Support NTP in Forecasting & Quantification of anti-TB drugs & lab commodities

9.1.1 Forecasting and quantification workshop organized

N/A

TB Patient Kit implementation

9.1.2 Sensitization workshops in Tigray and BG

This has been done in the previous quarters (TB patient kit is implemented in all regions)

Met

Strengthen IPLS implementation

9.1.3 IPLS training in Tigray and Benishangul Gumuz

Partially met IPLS training conducted in Tigray region for 50 (F=32, M=18) participants; Benishangul G training planned for next

25

quarter

support pharmacy HR capacity building in the management of TB DSM esp. management of SLDs

9.1.4 Training on the use of Quan TB tool

Training on Quan TB tool has been done in the previous quarter.

CTB supported consultative meeting on distribution of small volume TB pharmaceutical which include SLDs, ancillary drugs, pediatric FLDs, GeneXpert cartridge, N95 mask and falcon tubes in the Q1. A total of 63 (M-50, F-13) participants from PFSA hubs, RHBs, TICs, EPHI and NTP participated in the consultative meeting to finalize the previously drafted distribution plan

Met

Support integration of TB commodities into auditable pharmaceutical transactions and services(APTS) system in selected regional Hospitals

9.1.5

TB drugs transaction report generated

APTS system which incorporates TB drugs in place in the selected HFs

Met A total of 130 (M=84, F=46) staffs from 14 hospitals in the Tigray region and from PFSA Shire hub and the RHB have been trained on APTS in two rounds. Therefore, these 14 hospitals are expected to implement APTS.

Sub-objective 10. Quality data, surveillance and M&E


Act. #



Oct-Dec 2016


Support development & implementation of eRR of TB, TB/HIV & MDR TB in phased manner including Piloting eRR at regional

10.1.1

Explained in the previous quarter reports

N/A

26

level

RDQA implemented & monitored

10.1.2 Partially met Is part of the integrated SS & SOC/Qual TB tools

Build capacity of M & E staff in selected woredas /PHCU

10.1.3 M & E staff in all CTB supported regions trained on TB M & E; total 907 staff trained (F=315, M=592)

Met

Support use of GIS technology for program improvement

10.1.4 GIS used as tool for TB control, examples available

Not met Competing priorities for NTP & RHBs.

Support Data management system of PMDT

10.1.5 action plan implementation started

review implementation of action plan

Action plan discussed and the implementation of DHIS 2 for PMDT agreed, and in the process of contracting out for company that can help in developing software

Met

Support TRAC and promote usage of OR results on high priority areas

10.2.1 TRAC meeting held

annual TRAC conference supported

TRAC meeting held

TRAC meeting held 42 (F=9, M=33) participants attended the workshop– national TB research priorities identified, action plan for national research plan outlined

Met

Support TB OR grant scheme

10.2.2 OR protocol 2nd round approved

OR studies 1st round completed

Four OR protocol approved for support and started data collection

Met

Support participation at the Union conference for 4 authors presenting their findings, 2 NTP staff & 2 CTB staff

10.2.3 Four presentations held on CHTB work at Union meeting

N/A

Support NTP to conduct Urban MDR-TB initiative as part of OR

10.2.4 implementation started

Implementation started in Adama, Addis Ababa , Dire Dawa and Harari town administrations

Met

27

activity (Gene Xpert testing of all presumptive TB cases in urban region)

Support preparation of DRS and second national TB Prevalence study

10.2.5 STTA Final draft protocol prepared, pre-survey assessment conducted

Met

Sub-objective 11. Human resource development


Act. #



Oct-Dec 2016


Support FMOH/RHBs HRD strategy through strengthening annual operational planning and supportive supervision

11.1.1 N/A

Assist IRT to HEWs on the TB module

11.1.2 Gap filing IRT training of HEW on TB/HIV module

Gap filing IRT training of HEW on TB/HIV module

N/A

Strengthen capacities of HITs

11.1.3 TOT training to regional and zonal TB program coordinators on revised HMIS

See 10.1.3 Met

28

Enhance Quality TB planning through Supporting Comprehensive TB, TB/HIV and PMDT plans at Woreda Based National planning (WBNP)

11.1.4 Support WBNP

N/A

Organize International Training for 30 participants including USAID/CTB, RHB and NTP staff (linked with Sondalo) in collaboration with WHO

11.1.5

Done in the previous quarter Met

’Current Global Fund TB Grants

Name of grant & principal

recipient (i.e., TB NFM - MoH)

Average

Rating* Latest Rating

Total

Approved/Signed

Amount**

Total Committed

Amount

Total Disbursed to

Date

ETH-T-FMOH Investing for impact against

Tuberculosis and HIV (July 2015 – Dec 2017) B1 N/A 58,177,462 25,260,319

15,262,632

* Since January 2011

** Current NFM grant not cumulative amount; this information can be found on GF website or ask in country if possible In-country Global Fund status - key updates, current conditions, challenges and bottlenecks

Preparation for the next GF application: The MoH / NTP finalized the preparation to conduct the epi-assessment and external program review from Jan 16 – 22,

2017 as part of the next GF application. Through the GF Hub, CTB supported the participant of three experts to join the program review team.

29

CTB project is also supporting the development of program review tools, participating in the program review and in concept note development.

Challenges: liquidation of funds at the lower level has remained to be a challenge. This may affect the allocation of the next GF grant. Challenge TB & Global Fund collaboration this quarter – Describe Challenge TB involvement in GF support/implementation CTB provided technical support for the implementation of GF incentive funding. These were the implementation of the GeneXpert test as primary test in three

urban areas and technical assistance provided for the NTP in compilation and analysis of the quarterly monitoring of the community TB care implementation in 15 project sites.

3. Success Stories – Planning and Development

Planned success story title: Periodic household contact screening- Key to DR TB case finding

Intervention area of story: 4.1. Contact investigation implemented and monitored

Brief description of story

idea:

A young man of 27, was advised by the multi-drug resistant tuberculosis (MDR-TB) focal person to bring his household

contacts for symptomatic TB screening to the hospital. The first screening did not pinpoint any positive TB screen among the

household contacts. However, in the 2nd quarter screening of his two sisters by Xpert test in two consecutive quarters revealed

that both of them were found to have RR-TB. As the story of Birhan and his sisters depict, quarterly, periodic household contact

screening should be an integral part of the drug resistant prevention and treatment program.

Status update (including estimated date of

completion):

Ongoing

Planned success story title: Innovation facilitate earlier TB detection in young children

Intervention area of story: 2.1. Access to quality TB diagnosis ensured


idea:

Two months old baby Elshaday developed a cough and fever and suffered from it for five days. Her parents took her to

Woldiya Health Center and she was referred to Woldiya hospital. The trained personnel at the hospital used Naso-gastric tube

to collect samples for gene Xpert testing. The result came out to be MTB with no rifampicin resistance detection. The nurse

Asemera Seyoum, has got training by USAID funded projects and serves as the TB focal person of the hospital. She

immediately referred the infant back to the health center to initiate TB treatment.

The father of the baby, Yohannes Mekonnen has been already sputum smear positive for AFB and was on treatment. Mr.

30

Yohannes has a wife and one infant, following his diagnosis, the health center has screened his wife and child for TB and were

screen negative. The TB focal person has taught the family to come to health center when anyone of them have TB

symptoms. Hence, when his little one developed coughs the family reported his case which encouraged the TB focal person of

the hospital to take samples. The father rightly suspected that the child might have contracted TB from him.

As this instance, demonstrated, using innovative diagnostic methods to increase early TB case detection particularly in

children.

Status update (including estimated date of completion):

Ongoing

Planned success story title: Contact screening rolling for RR-MDR – the case of West Hararghe

Intervention area of story: 1.4. Provider side: Patient centered approach integrated into routine TB services for all care providers for a supportive environment


idea:

The USAID TB program (HEAL-TB) supported the establishment of TIC and installation of Gene Xpert machine at Ciro Hospital.

And then since Apr 2016 CTB has continued the technical support to the hospital. Dr. Tekelany and Sr. Tirngo, who are

employees of Ciro Hospital- the government partner, are serving all patients with dedication. They are both trained on TB/HIV

and RR-MDR by this program. They put patients on second line treatment, follow laboratory investigations and observe

patients. They also do family screening and are busy with the daily follow up of the DOT program. The project also trained

health workers in the hospital and nearby health centers who are teaching the community about TB prevention, its

transmission and started screening of TB among household contacts of index TB cases

Status update (including estimated date of completion):

Ongoing

31

4. Quarterly reporting on key mandatory indicators

Table 5.1 RR-/MDR-TB cases notified and started on MDR-TB treatment or shorter treatment regimens (STR) in country (national data) Quarter Number of RR-TB or MDR-TB cases

notified (3.1.4) Number of RR-/MDR-TB patients stared on MDR-TB treatment (3.2.4)

Of which (3.2.4), number of RR-/MDR-TB patients started on STR (9.2.4)

Comments:

Total 2014 598 557 n/a Annual data cover period from July 1, 2015 – Jun 30, 2016 RR & MDR-TB case notified: July – Sept 2016 = 169, pts started on SLD = 168

Total 2015 648 597 n/a

Total 2016 Not available yet (733) Not available yet (733) n/a

Jan-Mar 2017

Apr-Jun 2017

Jul-Sept 2017

To date in 2017

Table 5.2 Number of patients (eligibility based on WHO/NTP criteria) started on bedaquiline (BDQ) or delamanid (DLM) in country (national data) Quarter Number of eligible patients started on BDQ

nationwide (9.2.2) Number of eligible patients started on DLM nationwide (9.2.3)

Number of BDQ or DLM treatment initiation sites

Comments:

Adults (15 yrs or>) Child (<15yrs) Adults (15 yrs or>) Child (<15yrs) ND treatment started in July 2016 July – Sept 2016; eligible enrolled = 10 (already reported) Oct – Dec 2016; total enrolled = 4 (DLM = 2; BDQ = 2), one patient taking both drugs

Total 2014 n/a n/a n/a n/a n/a

Total 2015 n/a n/a n/a n/a n/a

Total 2016 10 - 5 - 1

Jan-Mar 2017

Apr-Jun 2017

Jul-Sept 2017

To date in 2017

Table 5.3. Indicator for active tuberculosis drug-safety monitoring and management (aDSM) Quarter Total number of reported serious adverse event (SAEs)

Disaggregate by: treatment regimen (STR, BDQ-containing regimen, DLM-containing regimen)

Number of reported SAEs which led to a death Disaggregate by: treatment regimen (STR, BDQ-containing regimen, DLM-containing regimen)

Comments:

Adults (15 yrs or >) Child (<15yrs) Adults (15 yrs or>) Child (<15yrs) All SAEs are to be reported within 24hrs of the event awareness to FMHACCA. Two patients with SAE were reported (from July 2016 – Dec 2016), both on BDQ. One died due to hypokalemia.

Total 2016 2 0 1 0

Jan-Mar 2017

Apr-Jun 2017

Jul-Sept 2017

To date in 2017

32

Table 5.4 Number and percent of cases notified by setting (i.e. private sector, prisons, etc.) and/or population (i.e. gender, children, miners, urban slums, etc.) and/or case finding approach (CI/ACF/ICF) (3.1.1)

Reporting period

Comments Jul-Sept 2016 Oct-Dec 2016 Jan-Mar 2017 Apr-Jun 2017 Jul-Sept 2017

Cumulative Year 3

Overall CTB geographic areas

TB cases (all forms) notified per CTB geographic area (List each CTB area below - i.e. Province name)

Oromia 10,241 Oct-Dec 2016 data not available yet?

SNNPR 5,676

Amhara 5,131

Tigray 1,777

Addis Ababa 1,932

Harar 145

Dire Dawa 506

Benishangul-Gumuz 305

Gambella 155

TB cases (all forms) notified for all CTB areas 25,868

All TB cases (all forms) notified nationwide (denominator) 28,000

% of national cases notified in CTB geographic areas 92.4%

Intervention (setting/population/approach)

Community referral

CTB geographic focus for this intervention Oromia, Amhara, SNNP, Tigray, A.A, Harar, Dire Dawa

TB cases (all forms) notified from this intervention 7,749

All TB cases notified in this CTB area (denominator) 25,868

% of cases notified from this intervention 30% Children (0-14) CTB geographic focus for this intervention Oromia, Amhara, SNNP, Tigray, A.A, Harar, Dire Dawa

TB cases (all forms) notified from this intervention 2,689

All TB cases notified in this CTB area (denominator) 25,868

% of cases notified from this intervention 10.4% Choose an item. CTB geographic focus for this intervention

Data on CI will be reported next quarter

TB cases (all forms) notified from this intervention

All TB cases notified in this CTB area (denominator)

% of cases notified from this intervention

33

5. Challenge TB-supported international visits (technical and management-related trips)

# Partner Name of consultant

Planned quarter Specific mission objectives

Status (cancelled, pending, completed)

Dates completed Additional Remarks (Optional)

Q1

Q2

Q3

Q 4

1 KNCV Fraser Wares x PMDT, New Drug and Short Term Regimen

Cancelled Due to security reasons

2 KNCV Christine Whalen X Technical backstop Cancelled Due to security reasons

3 KNCV William Van Heerden

x Security and safety Complete 09 to 15 Oct 2016 KNCV own budget

4 KNCV Katja Brenninkmeijer

X HR Complete 24 Sept 2016 to 05 Oct 2016

5 KNCV Dianne van Oosterhout

X Operations Cancelled Unable to travel due to health reasons

6 Choose an item.

7 Choose an item.

8 Choose an item.

9 Choose an item.

10 Choose an item.

Total number of visits conducted (cumulative for fiscal year) 2

Total number of visits planned in approved work plan 5

Percent of planned international consultant visits conducted 40%

34

6. Quarterly Indicator Reporting

Sub-objective: 1. Enabling Environment

Performance indicator Disaggregated by

Frequency of collection

Baseline (timeframe) End of year target Results to date Comments

1.1.6. ETHIOPIA SPECIFIC: Status of National Policy for prisons

NA annually

0 3 National prison TB care SOP developed

1.4.2. #/% of health facilities where quality of services was measured

Region annually Amhara(90), Ormoia(90), SNNPR(0), Tigray(0), AA(0), DD(0), Harari(0), Gam(0), BGG(0)

Amhara(90%), Ormoia(90%), SNNPR(50%), Tigray(50%), AA(50%), DD(50%), Harari(50%), Gam(50%), BGG(50%)

n/a

Measured annually

Sub-objective: 2. Comprehensive, high quality diagnostics




2.1.1. # of laboratories performing microscopy (stratified by LED florescence, Ziehl-Neelsen)

by LED and ZN; by Region

quarterly

Amhara(182 LED/428ZN), Oromia(829 ZN and 181 FM), SNNPR(TBD),Tigray(42 LED/210 ZN),,AA(TBD),DD(TBD),Harari(8 LED/16ZN),Gam(10 LED/22ZN),BGG(20LED/34ZN)

additional 32 installed in SNNPR & Tigray, additional 100 in all other regions combined

Amhara = 191 LED/432 ZN Oromiya = 269 LED/818 ZN SNNPR = 21 LED/483 ZN Tigray = 43 LED/135 ZN Harari = 9 LED/0 ZN DD = 10 LED/7 ZN AA = 34 LED/61 ZN Gam = 0 LED/24 ZN BGG = 5 LED/31 ZN

National TB diagnostic HF = 2995 Total HFs with LED micr = 768

Data need verification (for both LED

& ZN)

2.1.2. A current TB lab strategic plan with complete rational mapping of diagnostic services at each level

NA annually

No Yes No Will be finalized in the next quarter

35





exists (Y/N)

2.2.1. #/% of laboratories enrolled in EQA for smear microscopy

by Region quarterly Amhara and Ormoia (90%), SNNPR(50%), Tigray(100%), AA(100%), DD(100%), Harari(63%), Gam(38%), BGG(91%)

Amhara and Ormoia (90%), SNNPR(75%), Tigray(100%),,AA(100),DD(100), Harari(90%), Gam(60%), BGG(95%)

National: Jul – Sept 2016 = 1869/2995 (62.4%) Amhara = 526/769 (68%) Oromiya = 828/1120 (74%) SNNPR = 265/530 (50%) Tigray = 107/166 (64%) A.A = 71/139 (51%) Harari = 12/16 (75%) DD = 15/29 (52%) BGG = 16/34 (47%) Gam = 5/32 (16%)

CTB regions: Jul – Sept 2016 = 1845/2835 (65%)

2.2.6. % of national reference laboratories implementing a quality management system according to international standards (GF)

National annually 2015 – Apr 2016 8/11 (73%)

Enrolled since 2015 culture labs and still implementing

2.2.7. AFB microscopy network is quality-assured according to international standards (i.e. the GLI "TB Microscopy Network Accreditation" tool)

by Region annually 9/11 (delete)

2.3.1. % of confirmed TB cases who undergo DST and receive their results, disaggregated by new and previously treated cases

Quarterly TBD 86% in Amhara and Oromia regions. 50% (for other regions) maintain 6% among new cases (nationally)

For July – Sept 2016 Amhara = 26; Orom = 36; Tigr=32; SNNP= 27; AA = 46; BGG=2; (DD, Gamb, Har = 0)

2.4.5. % unsuccessful Xpert tests

8% <3% ? July – Sept 2016 7.4%

2.5.1. Status of national LIMS

Annually N Y ? 31 sites modem installation completed

It is planned to be completed by Feb 2017

36





2.6.1. Average turnaround time from specimen collection/submission to delivery of result to the patient (stratified by microscopy, Xpert, culture, DST)

Quarterly No reliable data Xpert- 4 days; Solid culture- 8 weeks; 1st line DST- 4 weeks

Microscopy = 6 hrs Xpert (within same facility) = 1; for referring sites = 4 dys Culture & DST (TAT will be updated next quarter)

2.6.4. # of specimens transported for TB diagnostic services

Quarterly Sputum sample of presumptive MDR-TB cases tested for GeneXpert taken as a proxy: In Amhara and Oromia, we had 9124 cases tested for GeneXpert per year. Baseline will be determined in 1st quarter in the rest of the regions.

Increase by 20% in all regions.

1109

Sub-objective: 3. Patient-centered care and treatment




3.1.1. # of cases notified (all forms)

by Region quarterly Amhara(23956), Ormoia (49346), SNNPR(30817),Tigray(9893),,AA(9401),DD(1778),Harari(535),Gam(940),BGG(1669), National(135951); Baseline will be determined for selected prisons in quarter 1.

Amhara(26400), Ormoia (54404), SNNPR(33900),Tigray(10900),,AA(10300),DD(1950),Harari(590),Gam(1030),BGG(1840), National(149800)--END of APA3

CTB regions; July – Sept 2016 = 25,868 National Jul-Sep 2016? = 28,000

37





3.1.4. # of MDR-TB cases diagnosed

by Region quarterly TBD Amhara(190), Ormoia (230), SNNPR(50), Tigray(100), AA(130), DD(140), Harari(6), Gam(0), BGG(0), National(846))

CTB regions; July – Sept 2016 = 169 National Jul-Sep 2016? = 178

3.1.7. Childhood TB approach implemented

by Region annually No Yes Yes

3.1.8. % of TB cases (all forms) diagnosed among children (0-14)

by Region Quarterly and annually

Amhara(9.4%), Ormoia (13.6%), SNNPR(19%), Tigray(8.6%), AA(5.8%), DD(16%), Harari(8%), Gam(23%), BGG(16.9%), National(13.6%)

value should be between 10%-15%

CTB regions; July – Sept 2016 = 2,689 (10.4%) National Jul-Sep 2016? = n? 10.9%

3.1.10. #/% of prisons conducting regular screening for TB

by Region annually 0 50% NA Measured annually

3.2.1. Number and percent of TB cases successfully treated (all forms) by population (prisoners, children, miners, gender, etc.)

by Region, gender, children and in selected sites for prisoners

Annually 91.4% Amhara; 93.0% Oromia; 90.2% Tigrai and 83.4% Bgumuz; ,97%(SNNPR); 79.1%(AA),89.4%(DD),90%(Harar),66.8%(Gambella),; 92.2%( national), ,90.2%(Tigray),

at least 90% in all CTB region. TBD for key population (Prison, ped)

CTB regions; July – Sept 2015 cohort = 93% National = 92%

Measured annually

3.2.4. #/% of eligible patients with drug-resistant TB enrolled on second-line treatment (disaggregated by sex, age and urban/rural)

By region Quarterly TBD all regions to reach at least 90%, National =90% (n=760)

CTB regions; July – Sept 2016 = 168 National July – Sept 2016? = 174

3.2.7. Treatment success rate for MDR-TB patients on treatment

By region Annually National Report 2014/15- 69.1%

75% July – Sept 2014 = 74.8%

3.2.10. #/% of planned By region Annually NA Measured annually

38





cohort reviews conducted

3.2.13. % TB patients (new and re-treatment) with an HIV test result recorded in the TB register

By region Quarterly Amhara(96%), Ormoia (88%), SNNPR(57%),Tigray(68%),,AA(77%),DD(96%),Harari(82%),Gam(62%),BGG(71%), National(77%)

at least 90% CTB regions; July – Sept 2016 = 86.4% National July – Sept 2016? = 83%

Sub-objective: 4. Targeted screening for active TB




4.1.1. #/% of eligible index cases of TB for which contact investigations were undertaken

region Quarterly Amhara and Ormoia(95%), SNNPR(TBD), Tigray(TBD), AA(TBD), DD(TBD), Harari(TBD), Gam(TBD), BGG(TBD)

Amhara and Ormoia(100%), SNNPR(75%), Tigray(75%), AA(75%), DD(75%), Harari(75%), Gam(75%), BGG(75%)

# contacts screened = 9,894 Amhara = 1,157 Oromia = 8,499 SNNPR = 200 A.A (pilot sites) = 38

Sub-objective: 5. Infection control




5.2.3. #/% of HCWs diagnosed with TB annually

region Annually Amhara(TBD), Ormoia(TBD), SNNPR(1.3%), Tigray(0.5%), AA(TBD), DD(TBD), Harari(TBD), Gam(TBD), BGG(TBD)

TBD. Facility survey alongside Supervision.

NA Measured annually

Sub-objective: 6. Management of latent TB infection




39

Sub-objective: 6. Management of latent TB infection




6.1.7. Number/% eligible PLHIV with LTBI started on preventive treatment

region Annually Amhara (26.8%), Ormoia(38.6%), SNNPR(45%), Tigray(24.2%), AA(40%), DD(32%), Harari(45%), Gam(40.4%), BGG(79%)

Increase by 10% Measured annually

6.1.11. Number of children under the age of 5 years who initiate IPT

Annually Amhara and Ormoia (42.8%), SNNPR(TBD), Tigray(TBD), AA(TBD), DD(TBD), Harari(TBD), Gam(TBD), BGG(TBD)

Amhara and Ormoia(60%), other regions 50%

CTB region = 446 Amhara = 38; Oromiya = 379; Tigray = 7; SNNPR = 3; A.A = 13; DD = 0; Harari = 6

Measured annually

Sub-objective: 7. Political commitment and leadership




7.2.3. % of activity budget covered by private sector cost share, by specific activity

Annually TBD (obtain from USAID/ SHOPS project as baseline)

TBD NA Measured annually

Sub-objective: 8. Comprehensive partnerships and informed community involvement




8.1.2. National DR-TB coordinating body functioning

annually Yes

8.1.4. % of local partners' operating budget covered by diverse non-USG funding sources

Annually 0 TBD NA Measured annually

8.1.3. # of National Stop TB Partnerships in USAID

NA

40

Sub-objective: 8. Comprehensive partnerships and informed community involvement




supported countries that meet organizational standards

8.2.1. Global Fund grant rating

A2 B1

July – Sept 2016

Sub-objective: 9. Drug and commodity management systems




9.1.1. # of stock outs per [year] of anti-TB drugs, by type (first and second line) and level (ex, national, provincial, district)

region Quarterly Year 2015; SNNPR = 10.7% Amhara = 2%

SNNPR – 124 HFs; Stock out rate = 0.4%

Amhara -132 HFs; Stock out rate = 0.56%

The stock out rates of TB drugs was measured at different levels: Central, Regional (15 PFSA Hubs) and health facilities. At Central and hub level the stock out rate for the period of 6 months (July 7, 2016 – December 28, 2016) was measured and it’s was found out that there was no stock out for all FLDs at Central level. At all Hubs there was no stock out for TB Patient Kit, Streptomycin 1 gm. injection RHZ (60/30/150), RH (60/30) and Ethambutol 100mg tablets. But there was a stock out for E-400mg, INH 100mg and INH 300mg tablets at all hubs with their stock out rate of: 24.84%, 23.28% and 20.30% respectively.

41

Sub-objective: 10. Quality data, surveillance and M&E




10.1.4. Status of electronic R&R

Annually 1 2 Measured annually

10.2.1. Standards and benchmarks to certify surveillance systems and vital registration for direct measurement of TB burden have been implemented

Annually one in July 2013, next one planned for July 2016

NA No (2016)

Measured annually

10.2.6 % of operations research project funding provided to local partner (provide % for each OR project)

annually 100% 100% 26,614 / 80,000 (33%)

10.2.7. Operational research findings are used to change policy or practices (ex, change guidelines or implementation approach)

Annually yes yes All OR not yet completed for this quarter to report

Sub-objective: 11. Human resource development




42

Sub-objective: 11. Human resource development




11.1.3. # of healthcare workers trained, by gender and technical area

by sex and technical area

Quarterly and annually

974 (M=681; F=293) in APA1 (SNNPR & Tigray) 3129 (Amhra and Oromia)

Total of 6100 (APA2+APA3) Tigray=967; Benishangul =191; Oromia=330; Amhra=190; SNNPR=1430; AA=495; DD/Harari=459; Gambella=342 & central (TOT & pastoralist areas) =1220 and IRT =500

Oct – Dec 2016: - TB M & E = 907 (F=315, M=592) - PMDT = 303 (F=97, M=206) - Basic TBL/TBHIV = 423 (F=96, M=327) - Lab = 329 (F= 83, M= 246) - Childhood TB = 189 (F= 106, M= 83) - DSM = 236 (F=102, M=134)

11.1.5. % of USAID TB funding directed to local partners

annually 0 1% NA Measured annually

challenge tb - ethiopia year 3 quarterly monitoring report...

Documents