TB Program South Africa

Overview and Objectives

URC and partners provide technical assistance in strengthening TB control and prevention initiatives. URC focuses on providing assistance in strengthening TB care initiatives at the provincial, district, and community level, as well as strengthening the health system to manage the pressures exerted by the HIV and AIDS epidemic. While the program’s principal focus is at the provincial, district, and community levels, USAID continues to provide assistance at the national level to strengthen critical health systems (e.g., information, supervision, and policies and guidelines for TB and multi-drug and extreme drug resistance prevention and control as well as infection control). The project emphasizes key USAID TB themes: capacity building, sustainability, quality of care, and integration and coordination.

The project builds on lessons learned from the previous USAID-funded TASC II TB Project, also managed by URC, and from health programs of other partners. The services and tasks support efforts in all nine provinces. However, the South African National Department of Health and several provincial health departments (Eastern Cape, Mpumalanga, Northwest, KwaZulu-Natal, and Limpopo) receive special emphasis. The project includes a small grants program that awards one-year grants to small NGOs that help increase the demand and availability of TB and TB/HIV services.

Project objectives included:

• Developing community-based strategies to identify potential TB cases and ensure early referrals for screening and treatment
• Assisting provincial health departments to integrate TB treatment with HIV and other health care services
• Introducing public education and social mobilization strategies, using mass and local media as well as the participation of patients and people with HIV/AIDS to reduce stigma, encourage early treatment-seeking, and promote a supportive environment for people affected by TB
• Providing assistance to integrate TB and HIV services by expanding the World Health Organization-funded ProTest model countrywide to ensure that TB suspects and cases are tested for HIV and that HIV-positive clients are screened for TB and other opportunistic infections
• Training providers to manage multi-drug and extensively drug resistant TB and to support patients’ drug adherence

Achievements

Training

• Trained 20,308 health care workers (7546 with USAID funds and 12,762 with funds from the President’s Emergency Fund for AIDS Relief [PEPFAR])
• Conducted national training to finalize the new package of training materials on the NTCP guidelines; followed up with roll-out trainings on the revised and new sections of the guidelines, including the GeneXpert algorithms, with 389 participants

TB/HIV

• Increased TB screening among HIV-positive clients in the project’s TB/HIV facilities from 74.5% in Q1 2010 to 96.3% in Q4 2011
• Increased HIV counseling and testing uptake in TB patients from 75.9% in Q1 2010 to 92% in Q4 2011
• Improved (1) IPT uptake among HIV-infected patients through improved recording calling for follow-up with patients on intermittent preventive therapy (from 5535 in Q1 2010 to 10,634 in Q4 2011) and (2) CPT uptake among TB/HIV co-infected patients from 70% in Q1 2010 to 92% in Q4 2011
  These improvements are attributed to consistent supportive supervision and in-service training and mentoring offered to facility staff by provincial coordinators.

Public-Private Mix (PPM)

• Expanding private sector participation in TB service delivery by leading a National Public Private Mix Summit; developing an implementation strategy for PPM; and starting PPM activities in several provinces with employers, private practitioners, and traditional healers

ACSM

• Reached 72% of South Africans residents ages 16–64 and 62% of children ages 5–14 through Stop TB TV commercials
• Reached over 40,000 school-aged children through the “Kick TB” campaign, which– fuses soccer and social mobilization to create a platform through which TB-appropriate messages are conveyed to youth
• Designed, developed, and produced 48,000 posters in seven languages; the posters address TB/HIV, infection control,treatment adherence, and ventilation.
• Trained over 200 people from TB directorates in three provinces
• Conducted six community dialogues in rural and informal settlements across four provinces in South Africa, engaging more than 500 community members and sparking their interest in addressing TB and TB/HIV challenges

Community MDR TB Management

• Conducted workshops in four provinces on the implementation of community management of drug-resistant TB

Small Grants

• Since 2009, the program has awarded 83 sub-grants to local organizations. These organizations are working to integrate TB and HIV activities, provide nutritional support to individuals to encourage treatment adherence, encourage advocacy and public education to create awareness of TB-HIV, provide support to co-infected patients on TB and ARV drugs, and implement community-based Directly Observed Treatment – Short Course (DOTS) programs.