Overview of strategy and goals for FY14 CAP-TB PROJECT China

1. Overview of strategy and goals for FY14CAP-TB PROJECTChina August 2013

2. CAP-TB: Strategic Model

3. Patient’s Perspective on Barriers to Seeking TB care

4. CAP-TB China FY14 Goal: To increase early case detection and to improve treatment success and reduce MDR-TB-related incidence and mortality in Yunnan Province Objectives: • To strengthen the involvement of Women’s Federation and community volunteers in TB/MDR-TB prevention and education in Xi Shan District; • To increase early case detection through interventions with high risk groups for TB/MDR-TB (migrants, PLHIV, DM and elderly) and strengthen referrals from the private sector; • To improve patient adherencethrough adequate treatment education, counseling and psychosocial support with greater involvement of community and patients aligned with appropriate medical care; • To strengthen capacity building in TB and MDR-TB diagnosis, treatment and care for Yunnan TCC, Kunming No.3 Hospital and others.

5. Prevention and Education • Targeting Migrants • Conducted rapid assessment on Migrants / TB Care in Xi Shan district • In Fu Hai community, 90,000 migrants and about 6,000 local residents. (93% migrants) • Conducted outreach in construction sites • FY14 • Increase community educational activities in Fu Hai community • Educational activities for construction workers at the workplace / job market • School children as bridge population for migrant workers Communities with Migrants Construction Workers School Children

6. Fu Hai community

7. Prevention and Education • Targeting Diabetes Patients • There are 12,000 diabetes in Xi Shan district • Bi-directional screening started from June, FY13 • Conducted the first site visits in July • 330 patients screened during the last 2 weeks of June after initiation of the screening • FY14 • Continue bi-directional screening of diabetes/TB in routine community health service (10 CHC and TCC ) • Continue collecting and analyze the screening data by using monthly reports and daily patients records • Document the process for the local government in order to expand the screening model

8. Prevention and Education Treatment • Targeting PLHIV • Conducted rapid assessment on HIV/TB • Yunnan province has highest HIV prevalence in China • Yunnan HIV Inpatient Care Center 30% of PLHIV patients are co-infected with TB • HIV Outpatient Care Center and “Blue Sky” HIV CBO • Provided a 4-days TB/HIV training for clinicians on diagnosis, treatment and management of TB/HIV co-infection • FY14 • Supporting clinicians: continue to provide trainings and case review workshops to enhance clinicians capacity for TB diagnosis and treatment of TB/HIV • Supporting “Blue Sky” HIV CBO • Screen and refer HIV patients for TB care; • Provide TB prevention education among PLHIV • Conduct regular group activities in Care Center (in-patient)

9. Prevention and Education • Targeting Elderly • “Essential public health service program”: Since 2011, government has provided an annual physical check-up for elders. But, this check-up does not include TB screening • FY14: • Integrate TB Symptom screening and X-ray into annual physical check-up; • Pay home visits to disadvantaged elderly people for TB education by Women’s Federation in Chinese festivals; • Organize small group activities and events for elderly people in the project communities with the support of the community elderly union.

10. Prevention and Education • Working with private sector • Worked with private clinics and pharmacy on TB referral • Conducted Consultation with Private Sector Pharmacy and Clinics in May FY13 • Poor knowledge of TB symptoms ( clinicians listed more symptoms than pharmacy staff ) • Most of them were not concerned about becoming infected by a client. Minimal IC practices, particularly among pharmacy staff • FY 14 • Improve the training quality targeting private clinics • Providposters on key message of TB to pharmacies • Provide regular facilitation to increase referrals from private clinics and pharmacies in the communities • To develop of IEC material to facilitate the dissemination of key messages

11. Diagnosis Improve TB diagnosis • There is only one Gene Xpert in Yunnan provided by CAP-TB program • Conducted training on rapid test • Coordinated with No. 3 Hospital on MDR-TB referral to TCC FY14 • Continue lab training on Gene Xpert and LED microscopy for technicians • Conduct EQA for No. 3 Hospital lab by Yunnan CDC /Kunming CDC • Support provincial lab on ISO15189 credit • Continue provide MDR-TB diagnosis training for No. 3 Hospital and TCC

12. Treatment Initiation MDR-TB management • With the support from Union, conducted TB/MDR-TB management training and case review for clinicians at TCC • Conducted regular distance consultations for MDR-TB cases by Skype FY14 • Engagement of No. 3 Hospital • Provide training and case review for clinicians (especially for No 3 hospital) in proper management of TB/MDR-TB • Continue conducting regular distance consultations for MDR-TB cases by Skype • 9-month “ short regimen” for MDR-TB in Kunming, Honghe and Yuxi

13. Treatment Success User friendly health care services Health providers • Provide quality and user friendly treatment and care to patients at Yunnan TCC and Kunming No.3 Hospital; • Conduct client satisfaction surveys for quality improvement ; Peer support group • Provide online education to TB/MDR-TB patients on treatment, via QQ Group through peer counselors; • Conduct treatment adherence education for TB/MDR-TB patients, face to face, either one-on-one or small group through (peer) counselors.

14. Cross-cutting Strategies Infection Control • Conducted IC rapid assessment in different health services sites • Improved IC in health services according to assessment • Developed household IC checklist • Conducted group activity on IC education for MDR-TB patients and family members FY14 • Continue providing IC training for clinicians, community health workers and TB patients • Provide IC within household.

15. Thanks! XieXie