Nepal TB REACH ProjectWave 2

Year 1 (Nov 2011 - Dec 2012)Year 2 (Jan 2013 – Jun 2014)

TB REACH (BNMT)TB REACH (BNMT)

“Intensified case finding through contact tracing and initial default tracing to reach the Nepal National TB Program National Strategic Plan 2010-2015 Targets”

“Intensified case finding through contact tracing and initial default tracing to reach the Nepal National TB Program National Strategic Plan 2010-2015 Targets”

Funded By: WHO / Stop TB PartnershipImplementation By: BNMT, NTP, Partner

organizationsImplementation Area: 9 districts (Year 1) and 15

districts (Year 2) in Central and Eastern Regions of Nepal

Funded By: WHO / Stop TB PartnershipImplementation By: BNMT, NTP, Partner

organizationsImplementation Area: 9 districts (Year 1) and 15

districts (Year 2) in Central and Eastern Regions of Nepal

Objective

o To increase new smear positive TB case detection in the project districts that do not meet the Nepal’s national target of 82%.

o To ensure new SS+ve cases are enrolled in DOTS centres and NTP programmes

o To increase the treatment success rate in the selected project districts from 85% to 90%.

Objective

o To increase new smear positive TB case detection in the project districts that do not meet the Nepal’s national target of 82%.

o To ensure new SS+ve cases are enrolled in DOTS centres and NTP programmes

o To increase the treatment success rate in the selected project districts from 85% to 90%.

TB REACH (BNMT)TB REACH (BNMT)

EDR Districts and Partners1. Ilam2. Jhapa Sahara Nepal3. Morang SCDC Nepal4. Sunsari5. Saptari6. Siraha7. UdayapurCDR Districts and Partners8. Dhanusha9. Mahottari10. Sarlahi MOPP11. Rautahat Bagmati Sewa Samaj12. Bara13. Parsa14. Makwanpur BIJAM15. Chitwan NATA

DemographicsNumber of

people

Total Population 9,950,345

NSP estimated new smear positive (SS+)

10,817

ARI estimationTerai- 2.1Hill- 1.1

Microscopy centres 120

Total index cases [estimated NSP + retreatment cases]

7,033

TB REACH TargetsNumber of

people (Year 1)

Number of people (Year

2)

Contacts screened per index case 5 5

Total screening 32,450 35,169

Primary defaulters traced and enrolled

225 30

Total SS+ detection (based on positive yield of 5% of screened population)

1623 1838

Project Approach Project Approach

Project ApproachProject Approach

• Mobilization of trained Female Community Health Volunteers (FCHVs)•Active case-finding through contact tracing of index patients

o Identification and verification of index caseso Prioritization and interview of cases (consent) o Door to door visit by FCHVs for sputum

collectiono Sputum collection and delivery to microscopic

center

• Serve hard-to-reach populations using microscopy camps• Develop and disseminate BCC materials•Refresher courses to train frontline staff

Door to Door sputum collection

SS+ve

Basic Health Education

Interview with index cases

Prioritization of contacts

Screening of contacts

Contact Tracing

Follow up for treatment adherence

MicroscopyIdentification and verification of index case and

primary defaulter

Treatment centre

Microscopy centre

SS-ve

Enroll for treatment

Active Case Finding ProcessActive Case Finding Process

Intervention/Activities Intervention/Activities

o 510 (Year 1) and 420 (Year 2) FCHVs and local volunteers orientated and mobilised across project districts

o 750 treatment centre staff trained across project districts

o 105 lab personnel orientated and mobilized for quality TB microscopy

Intervention/Activities Intervention/Activities

o 86 Microscopy Camps conducted across project districts

o Field level activities closely monitored and supervised by NTC, RHD, RTLO, DHO /PHO, DTLO, Laboratory personnel and TBRP staff to verify identified cases.

o 27 Technical Support Network meetings conducted (405 participants from D/PHO, district level stakeholders and partners)

ProjectProject AchievementsAchievements

Summary case finding data for Year 1 Summary case finding data for Year 1 and Year 2and Year 2

Year 1 Year 2

Total index case verification 98% 107%

Total no. suspects screened 115% 146%

Total new SS+ TB cases 92% 110%

Total primary defaulters identified 17% 7%Positive yield from active case finding 3.97% 3.78%

Positive yield from contact tracing 4.18% 4.20%Gap between prioritised and examined 8.10% 0.20%

Summary case finding data for Year 1 Summary case finding data for Year 1 and 2and 2

Key findings in Year 1 Key findings in Year 1

• Total index case verification 98% of target

• Total no. suspects screened 115% of target

• Total new SS+ TB cases 92% of target

• Total primary defaulters identified 17% of target

• Positive yield through active case finding is 3.97%.

• Positive yield through contact tracing is 4.18%.

• Gap between prioritized and examined cases is 8.10%.

Key findings in Year 1Key findings in Year 1

• Total index case verification 107% of target

• Total no. suspects screened 146% of target

• Total new SS+ TB cases 110% of target

• Total primary defaulters identified 7% of target

Key findings in Year 2Key findings in Year 2

• Positive yield through active case finding is 3.97%.

• Positive yield through contact tracing is 4.02%.

• Gap between prioritized and examined cases is 6%.

Key findings in Year 2Key findings in Year 2

Result SummaryResult Summary• We verified almost all of target index cases in Year 1

and more than the target number in Year 2

• We screened more than the target number of index cases in both Year 1 and Year 2

• We found more than the target number of new cases of SS+ve TB in Year 2

• TB reach BNMT is showing additionality in case finding in the project regions compared to the control regions

• Treatment outcomes for Year 1 show positive results. Year 2 are being analysed at present and compared to control data.

Financial AnalysisFinancial AnalysisTB REACH Project Year 2 Year 1Total Budget $617,614 $630,497 Total Expenses $553,288 $507,416 Budget Utilization % 90% 80% Total Target SS+ 1868 1848Target achievement SS+ 1940 1525Achievement % 104% 83% Standard cost per case $330 $341 Actual cost per case $285 $333

o Committed community level volunteers.

o Targeting of hard to reach communities (via

microscopy camps)

o Working experience and existing set up of

BNMT.

o Committed and supportive donor.

o Addressing major global health issue

alongside international, local and

governmental organizations.

Project StrengthsProject Strengths

o Challenges in identification of index patients• Exact location is unspecified especially in urban

areas (rental units), and current address is not updated in register.

• Incomplete record• Diagnosed in Nepal but citizen of India and

recorded false address of Nepalo Gap between suspected and examined

cases in Year 1(8%), but improved in Year 2 (6%)

o Positive yield is only 4%. Target 5% in the project proposal.

o Persistent difficulty addressing certain groups (Women, children, migrant workers)

Project ChallengesProject Challenges

1. Active case finding through contact tracing of index cases

2. Microscopy camps in hard-to-reach and inaccessible areas from microscopy centres

Recommendations from Recommendations from BNMT-TB REACH adopted by BNMT-TB REACH adopted by NTC NTC

“When I found out that TB is curable and the treatment is free, I committed to completing the full course of medicine. I hope to get well and start working again.”

“I can move and start to do my work thanks to the treatment and your help.”

‘Project staff told me that TB is curable if treatment is taken on a regular basis and that this is free of cost. My depression lifted’

THANK YOU