Evaluation of the Tuberculosis Control Assistance Program (TB CAP)

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TB CAP needs more capacity and methods for disseminating information about available tools andpromoting their use.GLOBAL RESULTS AND IMPACTSuccessful experiences should be systematically collected, analyzed, and discussed by TB CAP fieldofficers and NTP staff, and used for capacity building, for example, through group visits to selectedsites.The use of TA capacity and the availability of TB CAP in countries should be further promoted to theSecretariat of the Global Fund, country focal points, and other partners that fund TB control. The staffof USAID country missions could also use TB CAP consultants to update their knowledge of TBcontrol and discuss strategies appropriate to each country.IMPACT ON NATIONAL TB CONTROL PROGRAMSFuture support should center on building NTP capacity so that it can take over control of projectplanning, identify gaps, decide on TA needs, and make the TB program sustainable. Analysis of thenational program to establish priorities for action within the DOTS and Stop TB strategies should bestrengthened. Although all components require TA, some basic areas should receive special attention(e.g., guidelines consistent with international recommendations, regular availability of first-line drugs,and good-quality microscopy) before expansion of, or in concert with, case detection or MDRmanagement.A future TB CAP project should address the issues of drug supply and management systems andlaboratory systems quality in an IR.Laboratory training and technical advice should cover direct supervision and organization of a systemfor microscope maintenance and repairs.Staffing support by TB CAP should be limited-term, with clear terms of reference, to be replaced bygovernment staff where possible.Training workshops should be complemented by increased coaching of participants in joint missionswith experienced laboratory or program consultants.IMPACT ON PATIENTS AND TB EPIDEMIOLOGYFuture support should target the national program and the TB problem as a whole, measure impactwith the same data as the NTP, and complement this with evaluation of activities. Many TA activitiesimpact the whole country (such as technical guidelines, central laboratory and network, and humanresource development).RESULTS AND IMPACT BY INTERMEDIATE RESULT (IR1)Future TB CAP country projects should include a strong component of advocacy to governments(national, state/provincial, and district) to increase political commitment and program sustainability.Such advocacy should not be limited to ministries of health but should also extend to, for example,ministries of finance and planning.IMPACT BY INTERMEDIATE RESULT (IR2)TB CAP activities should include periodic assessment of the appropriateness of the national strategyby external consultants and the national partners.36 EVALUATION OF THE TUBERCULOSIS CONTROL ASSISTANCE PROGRAM (TB CAP)
Periodic visits by experienced staff of the coordinating or collaborating partners should be used tostrengthen the advisory role of TB CAP country staff.Periodic assessment of the appropriateness of the national strategy by external consultants andnational partners should be included in TB CAP activities.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 a program indicator. Simplestudies can provide the denominator at the health facility level.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 culture 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 to supportthe NTP managerial capacity to organize basic interventions to cure TB in HIV-infected patients andprevent further development of drug resistance.Investment of funds and staff time in MDR should be balanced with investments in the basic controlstrategy: treating MDR patients is of little benefit to the community if more drug resistant cases arecreated by inadequate treatment of new patients.IMPACT BY INTERMEDIATE RESULT (IR3)Successful experiences in the public-public and public-private mix supported by TB CAP should bereplicated and used to train national staff and consultants.TB CAP should test strategies to involve private practitioners in TB diagnosis according to nationalguidelines and in referral for treatment, with rapid expansion of the more effective strategies in TBCAP-supported countries. Guidelines developed with TB CAP support should be disseminated toinvolve different types of providers.IMPACT BY INTERMEDIATE RESULT (IR4)TB CAP should improve coordination with PEPFAR, and advocate for PEPFAR focus on support tocountries to prevent and manage opportunistic diseases in the HIV-infected, especially TB.TB CAP should identify and share examples of practices where TB/HIV has been effectivelyintegrated within health services.The TB CAP Board should develop a strategy to mobilize PEPFAR resources and efforts inprevention, diagnosis and treatment of opportunistic diseases in HIV/AIDS patients, of which themost important is tuberculosis.RESULTS AND IMPACT BY INTERMEDIATE RESULT (IR5)Successful experiences should be used to train international consultants and selected NTP staffthrough intercountry visits. Description, analysis, and dissemination of those experiences should beincreased and methods developed to facilitate access to the information.Tool development and training should be complemented by TA to NTPs to develop systems forcontinuing education (including identification of training needs and staff) and by advocacy to ensuresufficient staffing for TB program management and patient care.The supply of international consultants and qualified NTP staff should be expanded by exposing themto successful in-country experiences within and outside their countries.EVALUATION OF THE TUBERCULOSIS CONTROL ASSISTANCE PROGRAM (TB CAP) 37
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Page 36 and 37: to ensure a regular supply of drugs
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Page 40 and 41: ProportionFigure 4. TB patients Tes
Page 42 and 43: The Compendium of Indicators is oft
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Page 56 and 57: How has TB CAP met the intermediate
Page 58 and 59: Team Planning MeetingA team plannin
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Page 70 and 71: March 19, SurabayaVisit to Puskesma
Page 72 and 73: April 1, Team 2Travel to Kachia LGA
Page 76 and 77: DateThursday, April 2, 2009Intervie
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86 EVALUATION OF THE TUBERCULOSIS C
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Global Health Technical Assistance
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