ENGAGE-TB Operational Guidance Paris, 1 November 2013 1 | ENGAGE-TB Operational Guidance | November 1, 2013
Outline Background Purpose Target audience Integrating TB activities The ENGAGE-TB approach 2 | ENGAGE-TB Operational Guidance | November 1, 2013
3 | ENGAGE-TB Operational Guidance | November 1, 2013
Background TB second largest killer after HIV; but is curable A third of those with TB are either not diagnosed or Persons with TB not reported MDR-TB growing; requires longer treatment and 33% adherence 67% A wider range of stakeholders needs to be involved NGOs and other CSOs are able to reach remote Reached/reported and marginalized populations Unreached/not reported Community-based TB activities can help to reach many more 4 | ENGAGE-TB Operational Guidance | November 1, 2013
Who carries the burden of TB? People living in crowded & poorly ventilated settings 10 million “TB” orphans in 2010 Migrants, prisoners, minorities, refugees face risks, discrimination & barriers to care TB linked to HIV infection, malnutrition, alcohol, drug and tobacco use, diabetes 5 | ENGAGE-TB Operational Guidance | November 1, 2013
Risks from TB in pregnancy for mothers and neonates Risk Normal TB Neonatal effects (per 1000 pregnancies) Low birth weight (< 2.5Kg) 165 342 Prematurity (< 37wk) 111 228 Small for dates 79 202 Perinatal death 16 101 Fetal death (16-28wk) 2.3 20.1 Maternal effects Pre-eclampsia 47 74 Vaginal bleeding 22 44 Bj er erked edal 1975 1975;Jan ana a 1994 1994;Bot ha ham ley y 2001 2001;Kha han n 2001 2001; Figueroa-Dam am ian an R,1998 1998 6 | ENGAGE-TB Operational Guidance | November 1, 2013
Purpose Provide guidance on Provide guidance on collaboration between the implementation of NTPs and NGOs and community-based TB other CSOs working on prevention, diagnosis, community-based TB treatment and care activities activities ENGAGE-TB approach 7 | ENGAGE-TB Operational Guidance | November 1, 2013
Target audience NGOs and other CSOs NTPs and their equivalents Patients and communities affected by TB Funding agencies Researchers 8 | ENGAGE-TB Operational Guidance | November 1, 2013
Integrating TB Assisting early detection Assisting treatment support Preventing TB transmission Addressing the social determinants 9 | ENGAGE-TB Operational Guidance | November 1, 2013
Integrating TB into projects HIV – screen for TB; help them receive IPT MCH – pregnant women test for HIV; screen for TB. Watch children under 5 Education – TB messages in curricula; children recognize TB symptoms Agriculture/income generation/water and sanitation – Raise awareness – Encourage those with symptoms to get their sputum examined – Provide support eg nutritional, psychosocial, treatment adherence, transport 10 | ENGAGE-TB Operational Guidance | November 1, 2013
Principles Mutual understanding and respect Consideration for local contexts and values A single national system for monitoring with standardized indicators 11 | ENGAGE-TB Operational Guidance | November 1, 2013
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Situation analysis Collect basic data Review the main actors and factors Gather qualitative information Analyse SWOTs 13 | ENGAGE-TB Operational Guidance | November 1, 2013
Enabling Environment • Supportive policies; simple procedures 14 | ENGAGE-TB Operational Guidance | November 1, 2013
Enabling Environment • NGO coordinating body and regular meetings with NTP 15 | ENGAGE-TB Operational Guidance | November 1, 2013
Guidelines and tools National operational guidance Standardized tools - forms for referrals, diagnosis, treatment; registers Training curriculum Locally tailored “how-to” manual 16 | ENGAGE-TB Operational Guidance | November 1, 2013
Task identification NTPs should include engagement of NGOs in their plans NGOs should consult with NTPs and link with facilities Full range of options for community-based TB services and advocacy – e.g. prevention, screening, referral, treatment support, advocacy 17 | ENGAGE-TB Operational Guidance | November 1, 2013
Capacity building Human resources Financial resources Physical assets Management and leadership Systems and processes 18 | ENGAGE-TB Operational Guidance | November 1, 2013
Monitoring and evaluation Two indicators monitored: – Referrals and new notifications: how many referred by CHWs and CHVs – Treatment success rates among those receiving support from CHWs and CHVs Periodic evaluation – qualitative information as well – Presence of an NCB, trends in membership, etc – Quality of NTP interaction with NCB 19 | ENGAGE-TB Operational Guidance | November 1, 2013
Community contributions to TB case notifications and treatment adherence support, 2012 Notified patients Patients who received from referrals treatment support Country (2011 cohort) Source of data Source of data %age %age 9% 33% Burkina Faso All districts All districts 16% Côte d'Ivoire 59/82 districts N/A Democratic Republic 10% 45/515 districts 3% 8/515 districts of Congo 33% 40% * Ethiopia 98/821 districts 98/821 districts 3% 50% India 374/662 districts All districts 5% 88% Kenya All districts All districts 20% 91% Malawi 2/28 districts 2/28 districts 2% 2% Myanmar 92/330 districts 92/330 districts 5% Nigeria N/A 36 districts 28% 46% Rwanda All districts All districts 6% Senegal All districts N/A 14% 86% Tanzania 63/162 districts All districts 20 | ENGAGE-TB Operational Guidance | November 1, 2013 N/A 35% Uganda All districts
Indicator 1: Referrals and new notifications Definition Number of new TB patients (all forms) diagnosed and notified with TB who were referred by community health workers and community volunteers expressed as a percentage of all new TB patients notified in the basic management unit (BMU) during a specified period Numerator Number of new TB patients (all forms) referred by community health workers or community volunteers to a health facility for diagnosis and notified in the BMU(s) in a specified period Denominator Number of new TB patients (all forms) notified in the BMU(s) in the same period Purpose To measure the level of engagement of community health workers and community volunteers in increasing new notifications of TB. It can also indicate the effectiveness of the referral system in ensuring the flow of persons with presumptive TB from community-based structures to the BMU. Method Entries on tuberculosis treatment cards, the presumptive TB register (also known as ‘TB suspects’ register) kept at facilities, the BMU TB register and the laboratory register should be modified to include ‘Referral by community health workers and community volunteers’, to allow standardized recording of the community contribution to referral . The quarterly report on TB registration in the BMU should also be adjusted to record this contribution. 21 | ENGAGE-TB Operational Guidance | November 1, 2013
Indicator 2: Treatment success Definition New TB patients (all forms) successfully treated (cured plus completed treatment) who received support for treatment adherence from community health workers or community volunteers among all new TB patients (all forms) provided with treatment adherence support by community health workers or community volunteers (number and percentage) Numerator Number of new TB patients (all forms) successfully treated and provided with treatment adherence support by community health workers or community volunteers in the BMU(s) in a specified period Denominator Total number of new TB patients (all forms) given treatment adherence support by community health workers or community volunteers in the same period Purpose To measure the scope and quality of implementation of community-based TB activities particularly relating to treatment outcome of patients. It can also indicate the acceptability of community health workers or community volunteers to patients with TB as treatment adherence support providers. Method Treatment adherence includes all efforts and services provided by community health workers and volunteers to TB patients receiving treatment to help them complete their treatment successfully. These can include treatment observation, adherence counselling, pill counting and other activities to monitor both the quantity and timing of the medication taken by a patient. 22 | ENGAGE-TB Operational Guidance | November 1, 2013
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