core quarterly report january march 2019 submitted by

USAID TB CARE II Project

Core Quarterly Report

January – March 2019

Submitted by:

University Research Co., LLC

Chevy Chase, Maryland

May 15, 2019

USAID TB CARE II Project, FY2019 Q2 Core Quarterly Report, January-March 2019 ii

TABLE OF CONTENTS

OVERVIEW ............................................................................................................... 1

PROJECT PERFORMANCE AND RESULTS .......................................................... 1

1. Multi-Drug Resistant Tuberculosis (MDR-TB) .................................................................. 1

1.1. Community-based MDR-TB Consultation and Roll-Out .................................................. 1

1.2. Support Countries to Introduce Short Course DR-TB Therapy and New Anti-TB Medications

(STR&ND) ................................................................................................................................... 1

2. Infection Prevention and Control ........................................................................................ 1

2.1. Global Consultation and Support for IPC Implementation .............................................. 1

2.2. Design and Implementation of Country-Level IPC Strategies ......................................... 2

2.3. Building Design and Engineering Approaches to Airborne Infection Control Course (AIC)

2

3. Support Countries with the Uptake of the DR-TB Care Package .................................... 4

4. Support the Dissemination of the DR-TB Care Package through a Union Conference

Workshop ...................................................................................................................................... 4

5. Support 10 NAP Countries with the Uptake of Digital Technology for TB and DR-TB 5

6. Support the Organization of Two Pharmacovigilance Workshops .................................. 5

7. Advanced TB Diagnostics Course ........................................................................................ 6

USAID TB CARE II Project, FY2019 Q2 Core Quarterly Report, January-March 2019 iii

ACRONYMS

aDSM active Safety Management and Monitoring

AIC Airborne Infection Control

AIDS Acquired Immunodeficiency Syndrome

DOTS Directly Observed Treatment Short-course

DRA Drug Regulatory Agencies

FAST Finding TB cases Actively, Separating safely, and Treating effectively

GoS Government of Swaziland

GUV Germicidal Ultra-Violet

HCW Healthcare Worker

HIV Human Immunodeficiency Virus

HVAC Heating, Ventilation, and Air-Condition

IC Infection Control

ICU Intensive Care Unit

IPC Infection Prevention and Control

IPT Isoniazid Preventive Therapy

KOL Key Opinion Leaders

MDR-TB Multidrug-Resistant Tuberculosis

M&E Monitoring and Evaluation

MoH Ministry of Health

NGO Non-Governmental Organization

NTCP National Tuberculosis Control Program

NTP National Tuberculosis Program

OPD Outpatient Department

PCA Patient Covered Accompaniment

PHTB&LD Provincial Hospital of TB and Lung Disease

PIH Partners in Health

PLWH People Living with HIV

PMDT Programmatic Management of Drug-resistant TB

SADC Southern African Development Community

SNAP Swaziland National AIDS Program

SOP Standard Operating Procedure

TB Tuberculosis

URC University Research Co., LLC

USAID United States Agency for International Development

WHO World Health Organization

USAID TB CARE II Project, FY2019 Q2 Core Quarterly Report, January-March 2019 1

OVERVIEW

The USAID TB CARE II Project started in 2010 with the goal of providing global leadership and

support to the national TB programs (NTP) and other in-country partners and stakeholder to

support NTPs to achieve their national targets to decrease the rates of TB and MDR TB in the

respective countries. Over the past seven years the project has provided technical assistance to

national TB programs worked in 19 countries worldwide using core funds (Bangladesh, India,

Kenya, Lesotho, Malawi, Peru, Philippians, Russia, South Africa, Swaziland, Tajikistan, Thailand,

Vietnam, Zambia, and Zimbabwe) to develop and implement evidence- based and innovative ideas

that are put into action in a sustainable and effective manner for prevention and control of TB. The

project has worked to support the following technical areas: 1) DOTS expansion and strengthening

(Infection Control); 2) Programmatic management of drug-resistant TB (PMDT), 3) TB/HIV care

and treatment, and 4) health systems strengthening.

Since 2010, TB CARE II has contributed to the successful design and implementation of several

strategies in the fight against TB, but the need for TB reduction and prevention programs is still

high. It is essential that the impactful and sustainable work of TB CARE II be continued to have

an effective and lasting impact that advances the reduction and prevention of TB.

In FY18 (Year 8), TB CARE II focused on the following:

• Supporting USAID efforts to advance the National Action Plan (NAP) for combating

multidrug-resistant TB in the 10 targeted countries,

• Fostering dialogues to mobilize domestic resources to support TB and DR TB activities

and ensure smooth transition of key TB CARE II funded core activities to government or

alternative donor funding,

• Documenting and disseminating lessons learned and best practices by packaging successful

solutions, tools and interventions initiated by the project for sustainability,

• Harnessing the use of technology to maximize impact,

• Scaling up proven approaches and high-impact interventions to other settings, and

• Measuring impact.

In Project Year 8, TB CARE II worked with partners and NTP teams to support policy and

programmatic level interventions and advance and scale up operational strategies that are in line

with the US NAP for Combatting MDR TB and USAID goals to end TB. The Year 9 workplan

was approved by USAID on April 25, 2019.

The TB CARE II team looks forward to continuing this work in Year 9. A summary of activities

completed in Q1 of FY2019 is presented below.


1. Multi-Drug Resistant Tuberculosis (MDR-TB)

1.1. Community-based MDR-TB Consultation and Roll-Out

No updates for FY2019 Q2.

1.2. Support Countries to Introduce Short Course DR-TB Therapy and New Anti-TB

Medications (STR&ND)


2. Infection Prevention and Control

2.1. Global Consultation and Support for IPC Implementation


2.2. Design and Implementation of Country-Level IPC Strategies


2.3. Building Design and Engineering Approaches to Airborne Infection Control

Course (AIC)

The team held an additional meeting to review existing chapters, to consolidate overlapping

material and to continue developing content

3. Support Countries with the Uptake of the DR-TB Care Package


4. Support the Dissemination of the DR-TB Care Package through a Union Conference

Workshop


5. Support 10 NAP Countries with the Uptake of Digital Technology for TB and DR-TB


6. Support the Organization of Two Pharmacovigilance Workshops


7. Advanced TB Diagnostics Course



PROJECT YEAR 8 AT-A-GLANCE

Since October 2017, the USAID TB CARE II project has hosted

multiple meetings to advance the field of TB and to achieve

NAP milestones.

In Project Year Eight, the

TB CARE II project hosted

647

participants in meetings, webinars and workshops, including

326 men

and

347 women

PROJECT PERFORMANCE AND RESULTS

1. MULTI-DRUG RESISTANT TUBERCULOSIS (MDR-TB)

1.1. Community-based MDR-TB Consultation and Roll-Out

Overview and Planned Deliverables

For the implementation of the “National Action Plan for Combating MDR-TB”, which has been

in effect since January 2016, USAID should support countries in establishing and expanding

community-based DR TB care.

In particular, Objective 2.1.2 – Expand and strengthen national MDR-TB care and treatment

capacity to optimize the use of current and novel regimens – states the following milestone: Within

3 years, USAID will work with up to 10 countries to develop quality facility and community-based

MDR-TB care and treatment services. The following countries have been selected as a NAP

priority: India, China, Pakistan, Indonesia, Ukraine, Nigeria, Burma, The Philippines, South

Africa, and Kazakhstan.

Summary of Key Achievements

Under the TB CARE II Project, URC updated the planning tool for the Community Management

of DR TB. In 2017, TB CARE II held “The Best Practices in DR-TB Community Care:

Development of National Community-Based DR-TB Care Plans” workshop from September 11-

13 in Pretoria, South Africa. Over 72 participants attended, including multiple National

Tuberculosis Program (NTP) directors and other high-level advisors from all 10 NAP countries.

Country-level guidance on community-based DR-TB care programs was produced, national action

plans for roll-out or scale-up of programs were drafted, and valuable comments on the next version

(version 3) of the “Community-Based Care for Drug-Resistant Tuberculosis' Implementers Guide”

were collected. Version two of the guide has already been submitted to USAID in Year 7 and a

revised version of the guidelines were also finalized in October 2017 integrating recent WHO

recommendations on treatment and care for DR TB patients.

Key Activities in Q2 • No additional activities in FY 2019, Q2. Pending workplan approval.

Activities for Next Quarter

The TB CARE II team plans to continue work on community-based DR-TB care pending the

approval of the FY2019 work plan.

1.2. Support Countries to Introduce Short Course DR-TB Therapy and New Anti-TB Medications (STR&ND)

No additional activities in FY 2019, Q2. Pending workplan approval.

2. INFECTION PREVENTION AND CONTROL

2.1. Global Consultation and Support for IPC Implementation


In coordination with the NAP Milestones (specifically Milestone 2.2.3: Prevent the transmission

of TB and MDR-TB within healthcare facilities), the TB CARE II project has leveraged past

USAID TB CARE II Project, FY2019 Q2 Core Quarterly Report, January – March 2019 2

success in infection prevention and control (IPC) to continue global guidance and synthesis of best

practices in IPC. Using past success in implementing FAST, GUV, and other IPC interventions,

the TB CARE II project has assessed the landscape of in high burden countries as well as the 10

NAP countries summarizing the current tools, checklists, SOPs, and other resources available for

IPC. Along with this landscape analysis, a desk review and literature review have been completed

in FY 2018. A global consultation on infection prevention and control was held in Manila,

Philippines from August 6-7, 2018 to advance the implementation of IPC, especially toward the

achievement of the US Government’s National Action Plan (NAP) for Combatting Multidrug-

Resistant TB (MDR-TB) in ten priority countries. The workshop was attended by 62 participants

(38 women and 24 men) from seven of the 10 NAP countries, USAID, CDC, WHO, the End TB

Transmission Initiative (ETTi) working group, academic institutions and civil society.

Additionally, an expert committee meeting was held on October 29, 2018 to operationalize the

best practices in IPC for the 10 NAP countries and to provide a specific structure for developing

comparative IPC indicators for use among NAP countries.

Key Activities in Q2


Activities for Next Quarter:

The TB CARE II team plans to continue work on IPC pending approval of the FY2019 workplan.

2.2. Design and Implementation of Country-Level IPC Strategies


Aside from the expert committee meeting on a global IPC guidance document, the TB CARE II

project will also provide limited in-country technical support for the design and implementation

of IPC strategies to address the 3rd and 4th NAP milestones. This support includes the development

of a scorecard and gap analysis to understand current gaps in IPC strategic plan implementation at

the country level and will facilitate the synchronization of country-level guidance with global best

practices. A “how to operationalize” guide will be developed to facilitate the implementation of

these country—level guidelines and will be an essential component for the adoption of improved

IPC guidelines.

Activity 2.2 is meant to capacitate countries to develop plans for adapting and adopting best IPC

practices based on specific country situations. As well, a “how-to-operationalize” document will

be created, including additional IC tools to address existing gaps and needs, an IC M&E

framework, and other details.

Summary of Key Achievements and Key Activities in Q2:




2.3. Building Design and Engineering Approaches to Airborne Infection Control Course (AIC)


The USAID-funded Airborne Infection Control Course (AIC) is a unique two-week

multidisciplinary course dedicated to educating professionals about the prevention of transmitting

airborne disease in high-risk spaces including clinics, hospitals, laboratories, and congregate living


settings. These strategies are devised to create solutions that are feasible and effective for both

resource-rich and resource-limited settings. The AIC summer course was created to build global

capacity in the technical aspects of building design and engineering in airborne infection control.

However, the course does not focus exclusively on building design and engineering. It teaches

respirator use, fit-testing, and emphasizes administrative controls that impact active case finding,

early diagnosis, effective treatment, and transmission.

In FY 2018, in place of the full two-week, in-person course, BWH continued work to produce an

electronic book and related video (and distance learning) materials based on the AIC course. The

book is under contract to be published by Taylor and Francis/CRC Press. It will be an electronic

version of the two-week course dedicated to educating a global body of engineering, architecture

and health care professionals on the prevention of airborne disease transmission in high-risk spaces

such as hospitals, clinics, laboratories, prisons, and congregate living settings. The information

and strategies presented will be relevant and feasible for both resource-rich and resource-limited

settings, including the 10 NAP countries.


Specific progress and next steps are as follows:

• General Principles of Airborne Infection Control-- 50% of sections written

• Designing Healthcare Settings for Airborne Infection Control--23% of sections written

• General Principles of Ventilation—50% of sections written

• Mechanical Ventilation—33% written

• Natural Ventilation—0% written

• General Principles of Ultraviolet Germicidal Irradiation (UVGI) 42% written

• Air Cleaning Devices—90% written

• Commissioning, Maintaining and Operating Healthcare Facilities—90% written

• Laboratory Design—85% written

Case studies will be included in support of individual topics. A sample case is currently in

development and will be used as an example for others. One case study for Chapter 1 is complete:

Reconstruction of prison MDR TB Ward in Vladimir Region, Russia

Additionally, a series of videos has been shot at the Northeastern University labs and is being

edited/refined. Additional videos at the TB facility in Vladimir, Russia, are currently in production

and are expected to be done in early October. Videos from South Africa and elsewhere will also

be included. These are either ready for editing or still under development.

In early August 2018, with TB CARE II support, [names redacted] met in Boston for a week of

intense work on the Airborne Infection Control (AIC) book and related videos. Once a full draft

of the book has been finalized the version will be sent to the publisher (Taylor and Francis) for

review. Case studies will serve as real-life examples to supplement the course material, and a series

of videos will supplement the electronic content. These materials will be disseminated as widely

as possible (pending copyright restrictions) with NTP teams in the 10 NAP high-priority countries.

In December 2018, [names redacted] worked with [names redacted] in Spruce Creek, Florida.

[name redacted] has agreed to review each chapter for content as they are completed. They

discussed overlapping presentation material given during the course could be consolidated.

[names redacted] will work to eliminate redundant material. Present plans are to continue all co-

authors writing through the end of August. [name redacted] will organize a meeting with [names


redacted] in Boston in this Fall to go through a final draft. [name redacted] will then turn the draft

into a finalized document (references, copy write, pictures and videos links).

Activities for Next Quarter


3. SUPPORT COUNTRIES WITH THE UPTAKE OF THE DR-TB CARE PACKAGE


USAID has piloted the DR-TB care package in China, Pakistan, South Africa and Ukraine in 2017.

The data collection and analysis phases of the pilot will conclude by June 2018 and will be ready

for dissemination to the remaining 6 NAP countries. The DR-TB Care package, which includes 14

potential components for assuring community-based DR-TB care, considers all aspects of

programmatic implementation, including prevention, treatment, and care components.

As the results of the pilot implementation phase of the care package in China, Pakistan, South

Africa and Ukraine become available, these results have been summarized and packaged in an

actionable format to serve as lessons for further scale up and implementation, and for additional

implementation sites in Burma, India, Indonesia, Nigeria, Philippines, and Kazakhstan.

Summary of Key Achievements and Key Activities in Q2



The TB CARE II team plans to continue work on the DR-TB care package upon approval of the

FY2019 workplan.

4. SUPPORT THE DISSEMINATION OF THE DR-TB CARE PACKAGE THROUGH A UNION CONFERENCE

WORKSHOP


The Union World Conference on Lung Health is the largest gathering of lung health professionals

and includes clinicians, program implementers, policymakers, and donors. This platform serves as

an ideal platform for wider dissemination of the DR-TB care package results and implementation

guides, as described in Activity 3 above, to other USAID-supported non-NAP countries. To further

expand the reach and awareness of the DR-TB care package, the TB CARE II project hosted a

full-day workshop at The Union conference at The Hague in 2018 to include USAID-supported

countries interesting in piloting or implementing the care package.

URC supported a workshop at the Union World Lung Health Conference on the DR-TB care

package dissemination. The workshop targeted other USAID-supported countries with the goal of

increasing uptake of the package of care beyond the NAP countries. URC hosted a full-day (6

hour) workshop for 157 participants.




The TB CARE II team plans to continue work on this activity pending approval of the FY2019

workplan.


5. SUPPORT 10 NAP COUNTRIES WITH THE UPTAKE OF DIGITAL TECHNOLOGY FOR TB AND DR-TB


The United States Government (USG) is committed to supporting the development of an inclusive,

responsible, and sustainable global digital ecosystem. The United State Agency for International

Development (USAID) promotes the application of the digital development principles, a set of

best practices in active projects as well as activities under the Center for Digital Development.

Digital technologies strengthen health systems at multiple levels by improving data services and

information flow for system managers and offering health providers and patients better access to

innovative tools in prevention, diagnosis and treatment for TB and DR-TB. The recent WHO

Global Ministerial Conference in Moscow highlighted digital technologies for TB as key

opportunities to advance global efforts to eliminate TB, particularly for high burden countries and

vulnerable populations, including the National Action Plan (NAP) countries (China, India,

Indonesia, Kazakhstan, Myanmar, Nigeria, Pakistan, Philippines, South Africa, and Ukraine).

These technologies have vast potential to contribute to the EndTB Goals as well as national TB

strategies and goals.

To synchronize with this guidance and to systematically introduce digital solutions for TB

treatment adherence, URC organized a global consultation for the 10 NAP countries for knowledge

exchange and for the creation of a roadmap and agenda for digital health. Three specific

interventions of interest are SMS, medication event monitoring systems (MEMS), and video

observed therapy (VOT), which are described in detail in the WHO handbook.

Through this workshop, the TB CARE II team has supported NAP countries in capitalizing on

these tools for improved patient and program management outcomes. This workshop: 1)

demonstrated and showcased innovative digital health solutions for TB; 2) promoted digital health

solutions as cost effective and high impact platforms to advance TB efforts in the 10 NAP

countries; 3) advanced public private partnership and resource mobilization efforts among in-

country stakeholders from government sectors, technology companies and interested industry

groups, and NGOs/implementing organizations to collaborate and further support current

technologies or new opportunities for TB; and 4) helped countries to initiate or scale up high

quality digital technologies for TB which integrate evidence of impact thinking for effective and

sustainable impact.




The TB CARE II team plans to continue work on this activity pending approval of the FY2019

workplan.

6. SUPPORT THE ORGANIZATION OF TWO PHARMACOVIGILANCE WORKSHOPS


Following a successful aDSM workshop conducted by USAID in 2017 for 10 countries in the

Asian region, similar 3-day workshops for selected 21-countries in the African and Eastern Europe

& Central Asia Republics (EE/CARs [DRC, Ethiopia, Kenya, Liberia, Mozambique, Nigeria,

South Africa, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe, Armenia, Azerbaijan, Belarus,

Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Ukraine, Uzbekistan]) were held.




7. ADVANCED TB DIAGNOSTICS COURSE


Every summer, the McGill International TB Centre hosts the Summer Institute in Infectious

Diseases and Global Health (www.mcgillidgh.ca) at McGill University. This event features

internationally known faculty, a focus on highly applicable new knowledge, and an opportunity to

network with fellow global health professionals from around the world. Every year, it attracts a

diverse group of participants, from industry leaders to NGO’s, academics and researchers, and

advocacy group members. As of 2016, the Summer Institute hosted about 400 participants from

46 countries. In 2017, TB CARE II sponsored 21 participants from 13 countries to participate in

advanced TB diagnostic courses, including key policy makers, NTP staff, and national research

institute staff from low-income countries. Project-funded participants hailed from 13 high burden

countries, including Benin, Ethiopia, Ghana, India, Kenya, Mozambique, Nigeria, Paraguay, South

Africa, Swaziland, Uganda, and Zimbabwe.



core quarterly report january march 2019 submitted by

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