Evaluation of the Tuberculosis Control Assistance Program (TB CAP)

Periodic visits by experienced staff of coordinating or collaborating partners should be used toreinforce the advisory role of TB CAP country staff.Detection of suspected cases attending general health facilities should be promoted as a method toincrease case detection and improve TB infection control, and used as program indicator. Simplestudies can provide the denominator for health facility level, and standard operating procedures forcase detection at the health facility level should be developed.The indicators for MDR activities in future projects should be expanded to patient management.Possible indicators are number of MDR patients treated and proportion of cultures negative at sixmonths (equivalent to sputum conversion for first-line drugs).TA should be balanced to include strategies to manage TB/HIV and MDR but give priority tosupporting NTP managerial capacity to organize basic interventions to cure TB in HIV-infectedpatients and prevent further development of drug resistance.Investment of funds and staff time in MDR should be balanced with investments in basic control:treating MDR patients is of little benefit to the community if more drug-resistant cases are created byinadequate treatment of new patients.IR 3: Increased public and private DOTS participation and collaborationThe TB CAP-supported PPM-subgroup meeting organized in Kenya was a key launch pad for PPMglobally.The meeting brought together stakeholders, outlined the strategic way forward for PPMimplementation, and facilitated detailed planning of country-level PPM activities. TB CAP also helpeddevelop the National Situation Assessment Tool, which has been instrumental in helping countries decideif and how they could pursue PPM, and TB CAP–trained consultants helped countries initiate PPM. Forinstance, in TB CAP’s second year consultants used the NSA tool for situation assessments in 10countries in the African and Eastern Mediterranean regions.There is very little documentation on the linkages, lessons, and best practices of engaging a diversity ofproviders, such as informal providers, social security organizations, businesses, and hospitals, but TBCAP is helping build a solid evidence base through site visits. Its documentation has been useful informulating practical guidance to help countries employ different strategies to engage each type ofprovider.TB CAP support facilitated the development, packaging, piloting, training for and dissemination of theInternational Standards for Tuberculosis Care as well as the engagement of health professionalassociations in PPM.Field observation discerned very good examples of private hospital involvement in TB control and ofcoordination between academic hospitals and the public health network. The ISTC has also been usefulfor mobilizing academic clinical leadership, large hospitals, and medical associations in TB control.Private practitioners are not much involved. Their importance varies with health-seeking behaviour andaccess to public health services, so the priority will vary from country to country.There were clear widespread functional gaps between peripheral health facility and community-basedDOT services. Country systems of drug procurement and especially distribution and the organization andservice quality of laboratory services are two areas often seen to be deficient.RecommendationsSuccessful experiences in the public-public and public-private mix supported by TB CAP should bereplicated and used to train national staff and consultants.26 EVALUATION OF THE TUBERCULOSIS CONTROL ASSISTANCE PROGRAM (TB CAP)