Evaluation of the Tuberculosis Control Assistance Program (TB CAP)

ANNEX I. SCOPE OF WORKI. IDENTIFICATION OF THE TECHNICAL ASSISTANCEGeneral Description: The U.S. Agency for International Development, Global Health, Office of Health,Infectious Diseases and Nutrition (USAID/GH/HIDN) seeks the services of GH Tech to review theperformance, impact, and lessons learned of the Tuberculosis Control Assistance Program (TB CAP), aUSAID-sponsored project formed to control tuberculosis (TB) globally.II. BACKGROUNDTB is an ancient disease that continues to plague millions of people each year despite a curable treatmentfor the disease. In 2006, the World Health Organization (WHO) estimates there were 9.2 million newcases and 1.7 million deaths from TB. After a decline in TB through the late 1980s, the global TB burdenhas grown alongside the HIV epidemic, and HIV-infected patients are at greatly increased risk fordeveloping TB. In 2006, an estimated 709,000 of the new TB cases were in HIV-infected patients, and insome African countries more than half of new TB cases were in HIV-infected patients.TB imposes a heavy economic burden in both the developed and developing world. Families coping withTB lose 20% to 30% of their annual income to the disease. Overall, TB costs the global economy around$12 billion annually.There have been some hopeful signs of improving TB control in recent years. Although the number ofpeople developing TB continues to rise each year along with the global population, the estimated rate ofinfection per capita has been fairly stable since 2003. Serious challenges remain, however, including theemergence of multi-drug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). Thesestrains have grown resistant to the most powerful anti-TB drugs due mainly to the improper use ofantibiotics, poor adherence to TB treatment, and poor quality drugs.Strategy for Tuberculosis ControlGlobal TB control is guided by the Stop TB Partnership’s Second Global Plan and the World HealthOrganization’s (WHO) Stop TB Strategy. In line with the Millennium goals, the Second Global Plan aimsto halve TB prevalence and deaths by 2015 relative to 1990 levels. The Stop TB Strategy identifies the sixmain components required to achieve these targets, including the provision of high-quality DOTSexpansion and enhancement; address TB/HIV, MDR-TB, and other challenges; contribute to healthsystem strengthening; engage all care providers; empower people with TB and communities; and enableand promote research.DOTS is at the heart of the Stop TB Strategy. For countries to successfully implement DOTS they mustdemonstrate political commitment to fund and implement an effective national TB control program.DOTS also requires an integrated network of capable laboratories, surveillance through a standardizedrecording and reporting system, and a robust logistics system that ensures a secure supply of drugs. Inaddition, implementation of DOTS requires improved access to primary care services that are affordable,equitable, committed, and well-organized. Education and training are essential elements to ensure theavailability of human resources. The WHO established the Green Light Committee to help control andprevent MDR-TB through access to quality-assured second-line anti-TB drugs and prevention of thedevelopment of resistance to anti-TB drugs by assuring the appropriate use of these drugs.The Tuberculosis Control Assistance ProgramTB CAP is a five-year $150 million ceiling cooperative agreement competed by USAID.USAID/GH/HIDN manages TB CAP in close coordination and collaboration with the USAID RegionalBureaus and USAID Missions providing funding. The USAID-designated Cognizant Technical OfficerEVALUATION OF THE TUBERCULOSIS CONTROL ASSISTANCE PROGRAM (TB CAP) 39