Evaluation of the Tuberculosis Control Assistance Program (TB CAP)

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TreatmentDrugsM&EMDRNumber of suspected cases detectedand examined by microscopy (trend).Data from TB microscopy registersPositivity of suspects (trend)Proportion of pulmonary smear–positive TB out of total cases andpulmonary cases# labs with culture and population perculture laboratory# with DSTTreatment success rate (treatmentoutcomes)Drug stockouts:at central levelat peripheral levelRegistration consistent with WHOrecommended system (patient cards;TB register, lab register and quarterlyreports at district level)Quarterly analysis and reporting atdistrict levelDRS conductedTreatment policy, guidelines, andtraining materialsIn facilities it can be compared with adult outpatient load (expected 3%,the real % can be studied easily); nationally with the population(average no. of health visits/ person/ year is fairly constant). The trendmeasures expansion of case detection. Gives weight to CDR.Complementary, indicates efficiency of microscopy and TB prevalence.Should be 1% (at less than 1%, the predictive value islow); >10% in specialized facilities or high self-referralRough indicator of the capacity to diagnose and report children andEP, and quality of clinical diagnosis of pulmonary TB. Expected isabout 50% of total cases and 2/3 of pulmonary cases. Low proportionof pulmonary cases suggests X-ray over-diagnosisOptimum 1 per province or 1 per million inhabitants. Need more culturelabs when implementing MDR treatmentOne good one per country is enough, in large countries 1 per province.Need more when implementing MDR treatmentStrong, reliable. Calculated on a cohort of new pulmonary smear–positive cases is the main indicator of program performance.Complemented by % cured (most cases should be cured, with smearcontrols in second phase of treatment); failure rate (high due to MDRand poor drug quality); deaths during treatment (high due to HIV andlate diagnosis); and default rate (optimum
PPMTreatment of MDR with GLC GLC reduces cost and also ensures rational use of drugs 3% MDR in new TB casesImpact/quality of previous TB control. Must be studied according tostandard (IUATLD) protocols by quality assured laboratoriesNumber of MDR patients treated Indicates expansion of access to MDR diagnosis and treatment 2Number of MDR patients thatconverted culture at 6 monthsPiloting or scaling up PPMinterventionsNumber of private providerscollaborating with the NTP% of total notified TB casesdiagnosed by PPM partnersISCT promoted and endorsed byprofessional organizationsEquivalent to smear conversion in first-line drugs, early predictor oftreatment successDifficult to define unit of measure 3There is a problem of definition: Is one MD equivalent to one privatehospital or NGO?Very difficult to collect routinely, special studies are a better option. 3Minimum 3TB/HIV Policy re testing for HIV in TB patients Minimum 3HRDTB mortalitySurveillance of HIV in TB patients Minimum (available data from surveys or surveillance system) 3% TB tested for HIV The usefulness and target depends on HIV prevalence 1% TB HIV+ on CPT Useful in countries with high HIV prevalence 2% TB HIV+ on ART Depends on national criteria (based on CD4 count or not) 3Plan for HRD in placeUseful but insufficient. Permanent training program required for newstaff and retraining; including system to identify training needs andstaff.Job descriptions up to date Not well defined 3% health facilities with staff trained inlast 3 yearsAnnual survey, not well defined 3HRD focal point and funds at NTP Also indicates government commitment. 1Number of staff trained, by type Useful for planning and monitoring 3Deaths due to TB, from deathcertificatesShows rapidly the impact of interventions (diagnosis and treatment).Epidemiological indicator, not very influenced by program, useful forshort-term projects; data coverage is usually partial so not very good tocompare countries but good for trends.33321EVALUATION OF THE TUBERCULOSIS CONTROL ASSISTANCE PROGRAM (TB CAP) 83
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EVALUATION OF THE TUBERCULOSISCONTR
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This document (Report No. 08-001-19
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iiEVALUATION OF THE TUBERCULOSIS CO
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PVOTATBTB CAPTBCTATB/HIVTREAT TBThe
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Impact on Patients and TB epidemiol
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TB CAP is a highly successful proje
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value this coordinated approach to
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Meanwhile, team members in Washingt
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while providing for annual adjustme
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C. PARTNERS AND PARTNER COORDINATIO
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The TB CAP CTO seems to have provid
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The PMU should adopt a definition o
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International Standards for Tubercu
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According to data from the PMU, the
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two weeks). There is a solid consen
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Whether national policies, guidelin
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Field observation showed a substant
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to ensure a regular supply of drugs
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Periodic visits by experienced staf
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ProportionFigure 4. TB patients Tes
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The Compendium of Indicators is oft
Page 44 and 45: TB CAP should intensify its efforts
Page 46 and 47: Relying on that monitoring instrume
Page 48 and 49: TB CAP needs more capacity and meth
Page 50 and 51: TB CAP should develop a strategy to
Page 52 and 53: (CTO) resides in GH/HIDN in Washing
Page 54 and 55: - Integrate TB control efforts with
Page 56 and 57: How has TB CAP met the intermediate
Page 58 and 59: Team Planning MeetingA team plannin
Page 60 and 61: Other Skills: The following general
Page 62 and 63: . Develop a work plan, which will i
Page 64 and 65: 52 EVALUATION OF THE TUBERCULOSIS C
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
Page 80 and 81: Country Organization Name PositionI
Page 82 and 83: Country Organization Name PositionI
Page 84 and 85: Country Organization Name PositionN
Page 90 and 91: Country Organization Name PositionU
Page 100: Global Health Technical Assistance
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Evaluation of the Tuberculosis Control Assistance Program (TB CAP)

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