Annual report highlights from TB CARE I,

one of the main global mechanisms for

implementing USAID’s tuberculosis strategy

What contribution did

TB CARE I make to the global

fight against tuberculosis?

We implemented 34 new

core/global projects,

four regional projects

and 17 country projects

We Worked in Eight Technical Areas:

Universal and Early Access

Laboratories

Infection Control

Programmatic Management of Drug Resistant TB

TB/HIV

Health Systems Strengthening

Monitoring & Evaluation, Operations Research and Surveillance

Drug Supply and Management

We Worked Towards Three USAID 2014 Targets:

1. Sustain or exceed 84% case detection rate and 87% treatment success rate of those cases in countries with established USAID TB programs

2. Treat successfully 2,550,000 new smear-positive TB cases

3. Diagnose and initiate treatment for 57,200 new cases of Multi-Drug Resistant TB (MDR-TB)

One highlight from every TB CARE I Country
Red = Large Investment, Orange = Medium/Large Investment, Blue = Medium Investment, Grey = Small Investment

Dashboard

TB CARE I has made notable contributions to USAID’s targets and TB control efforts globally, below are a few of the Year 4 highlights and TB CARE I contributions to USAID targets:

SPOTLIGHT

International Standards for Tuberculosis Care 3rd Edition

The International Standards for Tuberculosis Care (ISTC) describes a widely accepted level of care that all practitioners, public and private, should seek to achieve in managing patients who have or are suspected of having TB. The Standards are intended to facilitate the effective engagement of all care providers in delivering high-quality care. TB CARE I played a critical technical and financial role in the development of the third edition of this essential document. New to the third edition is a free mobile phone application designed for use by TB practitioners,providing them with all the essential information for diagnosing and managing TB.

Strengthening Xpert use for increasing TB case detection among People Living with HIV in Nigeria and Zimbabwe

TB CARE I is piloting a practical model for increasing access of People Living with HIV (PLHIV) to Xpert testing as a part of routine health care services in Zimbabwe and Nigeria.
The model aims to:
1. Increase the number of PLHIV tested for TB with Xpert and put on TB treatment
2. Strengthen the accessibility and quality of Xpert testing service
3. Strengthen the collaboration between TB and HIV services
4. Inform policy and practices.

It was designed to be implemented within existing TB and HIV services, targeting priority geographic areas in each country.

Preliminary results reveal dramatic increases of 50-70% in the specimen referrals of PLHIV for Xpert testing at the different pilot sites which is mainly attributed to the optimal use of existing and newly established specimen transportation systems, which are minimizing the number of PLHIV with presumptive TB lost to follow-up. With this increasing rate of referral, more PLHIV are being tested for TB.

In Zimbabwe (two sites), 294 TB cases among PLHIV (including 18 Rifampicin-Resistant (RR) TB cases) have been detected since May 2014 as a result of the new approach (17% TB positivity rate). Across Nigeria’s three sites, 202 TB cases among PLHIV were detected (13% TB positivity rate) of which 31 were RR-TB. At present, the major impact observed is a more rapid system for case detection due to effective screening practices, consistent and sustainable specimen referral, strengthened integration of TB/HIV services and rapid Xpert testing. This alone is promising for patient care and the reduction of TB transmission within the community.

Center of Excellence on PMDT Training

The Center of Excellence (CoE) on PMDT Training, based in Kigali Rwanda, brings together the National TB and Leprosy Program of Rwanda, the National Reference Laboratory and the School of Public Health, National University of Rwanda. The CoE was established to build technical capacity on PMDT in the region using the Rwandan PMDT program as a case study. Partially funded by and receiving technical support from TB CARE I, this center has been a regional success, expanding to other technical areas important to the region (i.e. childhood TB, TB-IC). In Year 4, five international trainings were implemented with TB CARE I support: TB-IC, PMDT, TB/HIV, laboratory strengthening and childhood TB. In total 87 trainees participated from 17 African countries and one Asian country (India). Childhood TB was a new topic for the center this year and a new curriculum and course on the management of childhood TB was developed. At each of these trainings, there has been a combination of participants funded by the CoE and other sources (i.e. NTPs sending their staff from country funding). This demonstrates the CoE’s marketability and the trend towards greater self-sufficiency and sustainability.

Ethiopian Initiative to Build Capacity for Sustainable Operations Research

Ethiopia has a strong history of conducting operations research (OR), but translating research results into policy or practice has been limited. In 2012, to meet this challenge the USAID Mission in Ethiopia with the Federal Ministry of Health (FMOH)’s TRAC and key national and international partners including TB CARE I developed a project proposal to build sustainable OR capacity in Ethiopia. The initiative consists of three key pillars: building new capacity, enhancing existing capacity, and structuring and translating results into action for TB control. Since 2012, 52 people were trained in two cohorts on OR who in teams conducted 13 different OR projects.

Results from six studies have been published to date. In addition to building new capacity, existing capacity was enhanced by the implementation of a competitive grant scheme for funding operations research of current researchers through which an additional seven projects were supported. One additional OR project was funded as a result of an advanced training on the impact assessment framework conducted with the London School of Tropical Medicine; this brought the total number of OR projects conducted under the Ethiopia OR initiative to 21.

To disseminate results and share experiences, a TB CARE I-sponsored symposium was held at the Union conference in Barcelona, Spain, highlighting this OR initiative and providing new Ethiopian researchers the opportunity to present their results from the supported studies.

TB CARE I’s Contribution to USAID Targets

Case Detection Rate

Case detection rates have improved in 13 TB CARE I countries since the start of the program, eight of which showed improvement in the last year alone. Compared to the seven countries that surpassed the Stop TB target of 70% case detection rate in 2013, there are now nine countries that surpass this target. Most importantly, three countries have surpassed the USAID target of 84% case detection rate this year: Ghana (88%), Kyrgyzstan (91%) and Uzbekistan (89%).

Treatment Success Rate

Treatment success rates remain strong in most TB CARE I countries with five countries exceeding the 85% Stop TB target and five additional countries surpassing the 87% USAID target. Improvements between 2011 and 2012 were noted in seven countries (Cambodia, Ethiopia, Kazakhstan, Namibia, Nigeria, Tajikistan and Uzbekistan). The successful treatment of 861,406 Sputum-Smear Positive (SS+) patients from 2010-2011 and 805,266 new and relapse patients in 2012 translates to a 65% of the 2014 USAID target of 2.55 million SS+ patients successfully treated over five years.

Number of MDR-TB cases diagnosed and put on treatment

The diagnosis and treatment of MDR-TB cases is accelerating in most TB CARE I countries. In 2013, 13,533 confirmed MDR-TB patients were diagnosed across 19 TB CARE I countries – only a 2% increase compared to 2012, but 29% above the numbers in 2010. Treatment initiation for MDR-TB improved considerably in 2013; 13,041 confirmed MDR-TB patients started on second-line treatment, which represents a 19% increase compared to 2012 and an 81% jump from 2010.

In 2013, when totaling both confirmed MDR-TB cases and rifampicin-resistant TB (RR-TB) cases, 20,508 RR-/MDR-TB patients have been diagnosed, which is a 22% and 80% increase compared to 2012 and 2010 respectively. The number of confirmed and unconfirmed MDR-TB patients started on treatment in 2013 also grew considerably from 2010 (89%) and 2012 (21%).

Meet the Partners

Health Systems Strengthening

Aims:

1. TB control is embedded as a priority within the national health strategies and plans, with matching domestic financing and supported by the engagement of partners

2. TB control components (e.g. drug supply and management, laboratories, community care and M&E) form an integral part of national plans, strategies and service delivery.

Countries

16

Core Projects

13

etb

Supervision

TB CARE I supported the national TB programs in all TB CARE I countries with supervision activities. In total, 6,723 supervision visits were conducted with TB CARE I support – a 168% increase over the 2,509 visits conducted last year and 22% more visits conducted than planned. Supervisory visits in Nigeria made up 77% of all the completed visits this year.

Costing Tools

Countries need to develop sustainable financing strategies which replace dependency on donor funding with increased government budget allocations and revenue from insurance and corporate social responsibility financing. A key related strategy is to improve cost-effectiveness and efficiency so that results can be maximized with limited resources. To assist with this, TB CARE I has developed a suite of four costing tools that donors and governments can use to model costs and analyze cost-effectiveness.

costing
globalfund

Global Fund

TB CARE I plays a key role in collaborating with and supporting the Global Fund (GF) globally and at country level. Year 4 has been an especially critical time in supporting countries to prepare for and submit GF concept notes; all project countries, with the exception of Kyrgyzstan and Tajikistan, received some form of technical support from TB CARE I.

People Trained

15,772

Female

6,940

Male

8,832

Universal Access

Aims:

1. Increase the demand for, and use of, high quality TB services and improve satisfaction with the services provided

2. Increase the quality of TB services delivered by all care providers

3. Reduce patient and service delivery delays

Countries

17

Core Projects

7

Regional Projects

2

interview

Patient Centered Approach

TB CARE I implemented a core project to pilot the patient-centered approach (PCA) package and evaluate change towards improved patient-centeredness in five countries: Cambodia, Indonesia, Mozambique, Nigeria and Zambia. The results of the PCA pilot demonstrated that the tools provided practical approaches that enabled TB programs and health facilities to take steps to improving patient-centered care.

Childhood TB

In Year 4, TB CARE I has continued to invest in the quality diagnosis and treatment of TB in children in eleven countries (Afghanistan, Cambodia, Ethiopia, Indonesia, Kazakhstan, Kyrgyzstan, Mozambique, Nigeria, Tajikistan, Viet Nam and Zimbabwe). In 2013, 73,559 pediatric TB cases were notified to NTPs in TB CARE I countries. Although slightly lower than the 75,427 reported in 2012, pediatric cases made up 8% of all new and relapse cases with age information known, which is within the target range of 5-15% of all TB cases.

Laboratories

Aims:

1. Ensure capacity, availability and quality of laboratory testing to support the diagnosis and monitoring of TB patients

2. Ensure availability and quality of technical assistance and services

3. Ensure optimal use of new approaches for laboratory confirmation of TB and incorporation of these approaches in national strategic laboratory plans

Countries

15

Core Projects

9

Regional Projects

1

lsp

Laboratory Strategic Plans

Over the past year strong efforts have focused on completing National Strategic Plans (NSPs) that would inform GF concept note development. Many TB CARE I countries have developed NSPs with TB CARE I support, which include laboratory developments prioritized through previously written Laboratory Strategy Plans supported by TB CARE I technical assistance. A total of 15 out of 17 TB CARE I countries now have a NSP.

Supranational Reference Laboratories

In addition to strategic planning for laboratories, new linkages have been established between national reference laboratories NRLs in TB CARE I countries and supranational reference laboratories (SNRLs). Currently all countries have developed SNRL linkages, with at least one on-site visit in Year 4.

snrl
genexpert

GeneXpert Implementation

One of the greatest undertakings of TB CARE I has been the rollout, strategic implementation, and expansion of GeneXpert (Xpert) throughout all TB CARE I countries. Although the level of investment and TB CARE I project role varies from country to country, these efforts began with training and procurements, and then extended to providing extensive mentoring, supervision, and monitoring activities.

Xpert Fast Facts:

1. TB CARE I supported the procurement of nearly 25% of the operational instruments in TB CARE I countries by the end of Year 4 (101 out of 439).
2. Over 44,000 Xpert MTB/RIF cartridges were procured to support country activities.
3. Training, Technical Assistance and Mentoring were provided to 14 out of 17 countries.
4. Total number of successful tests completed in 4 years = 114,699.
5. Total number TB positive cases detected by Xpert = 39,398 (34% positivity rate).
6. Total TB positives with rifampicin resistance = 10,060 (26% RIF-resistance rate).
microscopy

Expansion of Quality Microscopy

Quality microscopy has been a major focus for TB CARE I. Expanding services to improve access, implementing LED microscopy, and working to build strong foundations for quality assurance are a continued focus as microscopy networks remain one of the essential tools used to screen for TB and follow-up patients on treatment in limited resource settings. At present all countries have implemented external quality assurance (EQA) programs for microscopy with 12 out of 17 countries having >75% EQA coverage. The performance level for EQA in all but one country is above 80%.

TB Infection Control

Aims:

1. Increase TB-IC political commitment.

2. Scale up the implementation of TB-IC strategies.

3. Strengthen TB-IC monitoring and measurement.

4. Improve TB-IC human resources.

Countries

16

Core Projects

1

Regional Projects

1

All TB CARE I countries have now developed national TB Infection Control (TB-IC) guidelines and TB-IC is also incorporated in the overall national infection prevention and control policy of all TB CARE I countries. In Ethiopia, TB CARE I provided assistance for the development of building design and engineering standards of healthcare facilities for the prevention of airborne infections. Ethiopia now has complementary regulations on the building design of healthcare facilities to prevent the transmission of airborne infectious diseases, including TB – only the second country in the Sub-Saharan African region to have these important regulations.

ic

TB CARE I continued to invest in facility level TB-IC implementation by offering training to facility level staff, technical assistance for facility risk assessments and the development of facility IC plans, provision of commodities such as surgical masks, respirators and fans, and the completion of minor refurbishments. TB CARE I Afghanistan invested the most in facility level TB-IC implementation supporting 120 healthcare facilities.

TB/HIV

Aims:

1. Strengthen the prevention of TB/HIV co-infection.

2. Improve the diagnosis and treatment of TB/HIV co-infection.

Countries

11

Core Projects

1

Regional Projects

6

art

Testing for HIV

With 57% of TB patients having HIV test results recorded in the TB register in 2013, slow improvements are being made (compared to 50%, 51% and 56% in 2010, 2011 and 2012 respectively). Globally in 2013, 48% of notified TB patients had a documented HIV test result (46% in 2012), which illustrates that TB CARE I countries are generally ahead of the curve.

Antiretroviral Therapy and Cotrimoxazole Preventive Therapy

TB CARE I has worked in ten countries in Year 4 to expand antiretroviral therapy (ART) and/or cotrimoxazole preventive therapy (CPT) coverage among patients co-infected with TB and HIV (Botswana, Ethiopia, Ghana, Indonesia, Mozambique, Namibia, Nigeria, South Sudan, Zambia and Zimbabwe). The average percentage of HIV positive TB patients on ART in 2013 rose to 71%, up from 39% in 2010, 49% in 2011 and 65% in 2012.

art2

PMDT

Aim:

Improve the treatment of Multi-Drug Resistant TB (MDR-TB).

Countries

16

Core Projects

2

Regional Projects

1

As the diagnosis and treatment initiation for MDR-TB are scaled up in most countries, it is essential to also ensure the quality and completion of appropriate treatment. As PMDT expands many countries have seen treatment success rates decrease or remain low as the complexities of managing more patients rise. More patients were successfully treated from the 2011 cohort (5,994) than the 2010 cohort (5,596), however the overall number of MDR-TB patients on treatment also grew, resulting in only 69% treatment success (compared to 68% in 2010). Although an improvement over 2009 levels (only 3,811 treated and 66% successfully treated), there is major work still to be done to improve treatment outcomes for MDR-TB patients. Cambodia (86% TSR), Zimbabwe (81%) and Uganda (77%) were the only countries to exceed the target of at least 75% treatment success, although Kazakhstan (74%), Ethiopia (72%) and Viet Nam (72%) are nearing the target.



TB CARE I continued to invest in facility level TB-IC implementation by offering training to facility level staff, technical assistance for facility risk assessments and the development of facility IC plans, provision of commodities such as surgical masks, respirators and fans, and the completion of minor refurbishments. TB CARE I Afghanistan invested the most in facility level TB-IC implementation supporting 120 healthcare facilities.

Universal Access

  • International Standards for Tuberculosis Care 3rd Edition (English)
  • The International Standards for Tuberculosis Care (ISTC) describes a widely accepted level of care that all practitioners, public and private, should seek to achieve in managing patients who have or are suspected of having TB. The Standards are intended to facilitate the effective engagement of all care providers in delivering high-quality care. This is the third edition published in March 2014.
  • ISTC Mobile Application
  • For the 3rd edition of the ISTC (see above) a mobile app has been developed that features clinical decision algorithms with step by step guidance for diagnosing and managing TB, along with the full text of the ISTC. The app is designed for TB practitioners, providing them with all the essential information for diagnosing and managing TB. The app is available for free.
  • Vietnam Childhood TB Materials - Vietnamese | English
  • Brochures/Posters on the prevention, early detection and treatment of TB in children.
  • Compendium of Tools & Strategies – To achieve universal access to TB care for at risk and vulnerable groups.
  • This publication is designed to introduce users to the range of tools and strategies available in TB control. The TB community is encouraged to browse the Compendium to select approaches that meet the needs of specific types of TB patients.
  • Zimbabwe Engaging Community Organizations in TB Control
  • These guidelines and the accompanying training manuals, aim to provide guidance on how to involve and collaborate with communities in TB control activities, contributing to increased early TB case detection, treatment adherence and access to quality patient centered TB services. (Zipped package of 4 files).
  • Childhood TB Activities
  • After decades of being side-lined, the childhood tuberculosis epidemic is now front of stage. TB CARE I has been active in fighting Childhood TB since the start. This six-page document contains an overview of what TB CARE I is doing to help put a stop to this scourge.
  • Patient Centered Approach
  • This 8-page document contains an overview of what constitutes a patient centered approach (PCA), what TB CARE I is doing to make care more patient centered, a summary of the TB CARE I PCA tools, and the results of several country experiences.
  • Childhood TB: A Toolkit
  • This is a training toolkit to combat childhood TB. The training focuses on building the capacity of HCWs at the primary and secondary level to address and manage TB in children.

Laboratory Strengthening

  • Intensified implementation of GeneXpert MTB/RIF in 3 Countries
  • The methodology and outcomes of providing intensified support on the implementation of Xpert in three countries: Nigeria, Indonesia and Kazakhstan.
  • Laboratory Diagnosis of TB by Sputum Microscopy – A Handbook (2nd Edition)
  • This microscopy handbook uses simple text and clear illustrations to assist laboratory staff in understanding the important issues involved in conducting sputum smear microscopy for the diagnosis of TB.
  • Microscopy Network Accreditation Tool
  • This tool is designed to assess laboratory networks to ensure that conditions, resources and quality assurance are adequate to guarantee good overall results.
  • Xpert Training Package
  • The training course is designed for HCWs (including laboratory officers, clinicians and TB program staff) involved in implementation of the Xpert MTB/RIF assay. The purpose is to provide knowledge and skills necessary to; (1) perform the Xpert assay in an accurate and reliable manner, (2) use the Xpert results for proper management of TB patients, and (3) plan and monitor implementation. The training packages consist of PowerPoint training modules with customization guidelines, participant and facilitator guides, materials to perform and facilitate an effective training program, exercises and instruction for lab practical trainings, and reference material to support each module.

TB Infection Control

  • Ndola District TB-IC Demonstration Project Final Report
  • The Ndola District TB IC demonstration project (2011-2014) was implemented to provide safe work practices reducing TB transmission in particular among PLHIV and HCWs in 15 health facilities, surrounding communities and households of TB patients. The report highlights key experiences, findings and recommendations to enhance TB Infection control in Zambia.

Programmatic Management of MDR-TB (PMDT)

  • PPM PMDT Linkage – A Toolkit
  • One of the obstacles in scale up of PMDT is the poor linkage of PMDT with hospitals and private practitioners. This toolkit is designed to help establish better links and is a collection of best practices and lessons learnt from the experiences in the participating countries, including inputs for improvement and use of PPM PMDT linkage assessment and planning.
  • Medical Management of Multidrug-Resistant Tuberculosis - 2nd Edition English | Russian
  • This pocket guide is designed to provide practitioners with useful information for the clinical management of MDR-TB patients. It draws from WHO international guidelines whenever possible. When WHO guidelines do not cover a specific topic, it provides recommendations based on interpretations of cohort studies, clinical trials, case reports, and personal experience.

TB/HIV

  • Counting on Us
  • This report focuses on the reported mortality among TB patients in five African countries and progress in ensuring the survival of vulnerable TB patients, particularly dual diagnosed TB/HIV patients.

Monitoring and Evaluation

  • Innovations in TB Data Quality - An Monitoring and Evaluation Workshop Facilitators Guide
  • In order to ensure that adequate capacity exists to meet the increasingly stringent monitoring and evaluation requirements, this course was designed to build the capacity of Monitoring and Evaluation Officers of NTPs and technical partners. This course has three over-arching themes. They are to avoid, detect, and fix data quality problems. These three themes seamlessly map onto the three tracks of our TB work, which is to prevent, diagnose, and treat TB.
  • Understanding and Using TB Data
  • The handbook shows how to use various data sources, presents existing tools to analyze the quality of data and describes methods to estimate the burden of TB and related trends. It is aimed at NTP managers, Monitoring and Evaluation officers, researchers including epidemiologists and statisticians, and staff working with technical, financial and development agencies.

Costing Tools

  • TB CARE I Costing Tools
  • The estimation and projection of costs are essential for the planning, budgeting, financing and evaluation of TB services. To meet this need TB CARE I has developed four costing tools which are presented in this 4 page document.
  • Modeling the Cost-Effectiveness of Multi-Drug Resistant Tuberculosis Diagnostic and Treatment Services in Indonesia
  • A guide to the creation of a simple, generic and user-friendly model accessible to NTP managers at national and local levels for conducting cost and cost-effective analyses of MDR-TB diagnostic and treatment services. Analyses were conducted in Indonesia, but are applicable a global context.
  • MDR-TB Cost-Effectiveness Analysis Tool (Zipped Package)
  • The Cost-Effectiveness Tool is a simple, user-friendly, generic tool that is available for countries to use to compare the cost-effectiveness of different diagnoses and treatment methods for MDR-TB. The tool builds on previous studies on cost-effectiveness of MDR-TB, and on WHO guidelines on cost and cost- effectiveness analysis of TB control. It can be used to compare the costs and effectiveness of different treatment strategies from the provider perspective. For outcome measures the tool uses case completion rate, the cure rate and the cost of deaths averted. The intended users are district, provincial and central level TB program managers and planners. This package contains an excel workbook and a ‘read me’ file.
  • TB Economic Burden Analysis Model (Zipped Package)
  • The TB Economic Burden Analysis Tool is designed to help national and sub-national Program Managers and others calculate the economic burden. Based on treatment numbers and assumptions on drop out rates etc., the tool adds treatment costs, patients costs, and productivity losses to calculate the total economic burden. The tool is in Microsoft Excel and is designed to be used by TB Program Managers at national and sub-national levels. It has a user guide, is user-friendly and transparent and modifications can be made by the user. Although the tool was developed for TB services, it could be adapted for other vertical programs, such as malaria and HIV/AIDS and it can be used in any country.
  • The Economic Burden of Tuberculosis in Indonesia
  • Understanding the economic burden to society from a disease like TB is important as it can be used as evidence when advocating for greater investment. This report describes the development of a tool to estimate the economic burden of TB in Indonesia and the results stemming from its use. The development and use of the tool was requested by the NTP in Indonesia to assist with advocacy for greater resources.
  • TB Services Costing Tool (Zipped Package)
  • The TB Services Costing Tool allows the user to develop 10 year cost projections based on incidence and treatment targets for TB and MDR-TB and more years can be added if necessary. It has been used in Indonesia to develop national cost estimates for national strategic planning and also to develop cost estimates for Central Java Province. The package contains two excel files - one filled example and one empty version.
  • Costs faced by Multi-drug Tuberculosis Patients During Diagnosis and Treatment - Report from a pilot study in Ethiopia, Indonesia and Kazakhstan
  • This report summarizes the main findings on (MDR) TB patient costs in the three pilot countries, and recommendations from respective policy workshops.
  • Costs faced by Multi-drug Tuberculosis Patients During Diagnosis and Treatment - Report from a pilot study in Ethiopia, Indonesia and Kazakhstan
  • In most countries, MDR-TB is more prevalent in vulnerable groups, for which the economic impact of the disease may be even bigger. Policy makers such as Ministries of Health and NTPs need to understand patient costs to identify and mitigate potential bottlenecks in access and adherence to (MDR)TB treatment and the negative impact on the economic status of patients and their families.
  • Costs Faced By Multi-drug Tuberculosis Patients During Diagnosis and Treatment - Report from a Pilot Study in Indonesia
  • In most countries, MDR-TB is more prevalent in vulnerable groups, for which the economic impact of the disease may be even bigger. Policy makers such as Ministries of Health and NTPs need to understand patient costs to identify and mitigate potential bottlenecks in access to and adherence to (MDR)TB treatment and the negative impact on the economic status of patients and their families.
  • Costs faced by Multi-drug Resistant Tuberculosis Patients during Diagnosis and Treatment - Report from a Pilot Study in Ethiopia
  • Ethiopia has a high prevalence of TB and it is also one of the countries where many people who develop TB every year do not get treated. One of the reasons why infected people delay or do not seek diagnosis and treatment is economic access – the cost to patients and their families. This report documents a pilot study, which was undertaken to determine the financial impact of MDR-TB diagnosis and treatment.
  • Coverage of TB Services under Social Health Insurance in Indonesia
  • An analysis of national claims data obtained from the public health insurance schemes and carried out via interviews with health and insurance managers and non-governmental organizations in three Indonesian provinces – Aceh, Jakarta and West Java.
  • The Cost of Scaling Up TB Services in Central Java, Indonesia
  • To assist the Indonesian NTP to analyze and project service delivery costs, a simple, user-friendly costing tool was developed for use by national, district and provincial program managers (see TB Services Costing Tool link above). The tool was developed because there was no existing tool suitable for sub-national levels, and it was tested in Central Java, a large province with 32 million people.
  • Coverage of TB Services under Social Health Insurance in Indonesia
  • To facilitate the development and implementation of the exit strategy for TB, it is necessary to have a good understanding of the cost of current and future services at all levels so that the necessary domestic funding can be provided and areas can be identified where greater efficiency and cost- effectiveness might be achieved. To assist the NTP to analyze and project service delivery costs, a simple, user-friendly costing tool was developed for use by national, district and provincial program managers. The tool was developed because there was no existing tool suitable for sub-national levels, and it was tested in Central Java and the resulting model was then used to estimate the projected costs for the whole country.

Website

The TB CARE I website (www.tbcare1.org) has shown a continued rise in interest over the past year with visits up by 17% over the previous year. 15% more pages were viewed and most importantly and impressively the number documents downloaded nearly doubled from 6,973 to 13,830 this year.

Visitors

22,248

Pages Viewed

50,673

Downloads

13,830

Top Ten Downloads

How to Contact TB CARE I