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UPHOLD Strategy for Tuberculosis Control 2006/2007

UPHOLD Strategy for Tuberculosis Control 2006/2007. Status Report May 2007 Presentation to Ministry of Health Officials. Overview of the Presentation. Introduction/background Strategy for TB control TB control Activities Results/Achievements Challenges Lessons learned Way forward.

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UPHOLD Strategy for Tuberculosis Control 2006/2007

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  1. UPHOLD Strategy for Tuberculosis Control 2006/2007 Status Report May 2007 Presentation to Ministry of Health Officials

  2. Overview of the Presentation • Introduction/background • Strategy for TB control • TB control Activities • Results/Achievements • Challenges • Lessons learned • Way forward

  3. Introduction and background (1) • UPHOLD -Uganda Program for Human and Holistic Development • UPHOLD is a USAID funded project • Overall project aim- increase access and utilization of sustainable and quality social services • Education, Health and HIV/AIDS in support of USAID’s Strategic Objective 8(aims to improve human capacity) • Assist Ugandans to achieve Improved health, longer and more productive lives • USAID resources for TB have increased each year and now total over $408 million making it the largest donor in this area

  4. Introduction and background (2) • Currently operates in 34 districts (up from 20), covering 42% • Uganda’s population ~ 11.8m people, Has six Regional Offices and one satellite office • geographical situated in all regions of the country

  5. Introduction and background (3) • UPHOLD implements activities with a focus on ‘4 Rs’: • Results at people level • Responsible speed in implementation • Regional leadership and accountability • Reaching out to and working principally with Ugandan institutions and systems

  6. Introduction and background (2) • UPHOLD’s core technical areas of implementation include: • HIV/AIDS • Primary School Education • Child Health • Integrated Reproductive Health • Adolescent Health • Communicable Disease Control- Malaria and Tuberculosis

  7. TB High Burden countries 2004/2005

  8. Tuberculosis Situation in Uganda • Est. ARI of 3%. Annual prevalence of 300-330/100,000 incidence of M + of 150-165/100,000 • HIV: it is estimated that 60% of TB patients are dually infected. (UPHOLD Records)

  9. Tuberculosis Situation in Uganda • Uganda has adopted the following WHO objective • Case detection rate of 70% • Treatment success Rate of 85% • Uganda aims at achieving the above objectives implementing the DOTS strategy with a community based TB Care Approach

  10. Community-based TB CareReferral System in rural settings

  11. Baseline Targets

  12. Start up • UPHOLD Received $690,000 for FY 2006/2007 to support the control of TB in all the 34 UPHOLD supported districts • Activity implementation was rolled out in October 2006 at district level

  13. Strategy • Collaboration with other stake holders Districts, NGOs and CBOs to; • scale up CB DOTS, • Improving diagnostics, • Support BCC (Prevention, treatment and control), • Support private sector involvement in TB, • Explore potential collaboration and involvement of schools in control of TB, • Support communities to embrace CB DOTS.

  14. Application of the strategic Approach • Previously AIM supported districts- Consolidate and Build on what AIM left in place • NUMAT-UPHOLD-Initiate Activities and eventually handover to NUMAT • UPHOLD only- Implement activities up to the end of the project • District TB profiles -CDR, TSR, DTUs, TUs etc

  15. Objectives • Achieve the WHO targets for TB case detection and cure rates.70 % CDR and 85% Treatment success rate • UPHOLD -5% Increase in CDR and 10% increase in TSR from the base line indicators • Strengthen the ability of the country to expand the use of proven and cost-effective interventions of the DOTS strategy

  16. Activities • Build capacity for • CB DOTS services in sub counties • TB/HIV case management at health facilities • TB drug logistics management at health facility level • Support Supervision activities at health facility-recording, drugs, case management • Support supervision and delivery of anti TB drugs and community levels. • Monitoring Implementation of activities

  17. Activity implementation was rolled out in October 2006 at district level

  18. Methodology • Districts planned, budgeted and scheduled for TB control activities • Involved Central and district facilitators in the trainings • Used National TB guidelines and training materials • UPHOLD Funded the activities • Technical assistance • On going monitoring and will do an Evaluation

  19. Outputs • Trained • 382 Health workers in TB drug logistics • 342 in CB DOTS/HIV • Supervisions • Supervision by DTLS in 91 HSDs • HFs supervised by HSD Focal persons • 422 sub counties supervised including town councils by SCHWS • 48% of patients on CB DOTS( ranging from 10% to 90%)

  20. Results/Achievements in 1st Quarter 2007 • Case Notification • 3,763 TB patients of all forms • 2163 Smear positive TB patients • Case Detection rate50% from 42% • Two fold increase in districts with CDR greater than 70%

  21. 2006 CDR 2007 CDR 1st Qtr Results -Case Detection rate Below target, CDR< 70% Above Target > 70%

  22. Comparison of TB case detection rate for 2006 and 1st Qtr 2007

  23. Results TB/HIV collaboration • TB/HIV Collaboration • All districts are implementing the TB/HIV collaboration in varying degrees according to TB/HIV policy • 1753 (47%) of TB patients are testing for HIV • 1051 (60%) of all the TB patients test positive

  24. Results –Treatment outcome • Case holding • CB DOTS coverage per patient is 48% (District Reports) • Treatment success rate78%( No change) • However more districts have TSR ≥85% (11 districts as compared to 4 last year)

  25. 2005 2006 1st Quarter Results-Treatment success rate Below target, TSR< 85% Above target, TSR≥ 85%

  26. Challenges • Poor implementation of the TB/HIV Collaboration • CPT numbers not known at the beginning of treatment • TB cases on ART not known • Inadequate Supervision at all levels • Small no. of patients on CB DOTS • Inadequate Coordination with other partners • Stock-out of essential supplies (e.g., HIV test kits, CPT) • Changes in district capacity to implement due to redistricting, • Restructuring- position of DTLS is threatened • Insecurity in the North and the Northeast parts of the country

  27. Lessons learned • MOH as a stake holder in implementation of TB control activities • District support is necessary in implementation of TB activities • ?Training and Supervision can lead to an increase is CDR

  28. Way forward • Extension for one year • Improve the quality, access and utilisation of key preventive and curative TB services, • Consolidating CB TB DOTS. • Strengthen the capacity of CVs and health workers thru CMEs, refresher training, and support supervision • Provision of job-aides, registers, implementation guidelines and policy/strategy documents to Volunteers and health workers • Strengthen TB/HIV collaboration

  29. Thank you

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