Tuberculosis (TB): Under the U.S. TB strategy required by ... · Tuberculosis (TB): Under the U.S....

Tuberculosis (TB): Under the U.S. TB strategy required by the Lantos-Hyde Act, the U.S. contributes to the successful treatment of 2.6 million new sputum smear positive TB cases per year and 57,200 multi-drug resistant (MDR-TB) cases, as well as contributing to a 50 percent reduction in TB deaths and prevalence relative to the 1990 baseline. As part of GHI, and as outlined in the six-year TB strategy, the U.S. government collaborates with partners to sustain or exceed detection of a high proportion of all TB cases and successfully treat at least 85% of smear positive cases reported in countries with established U.S. -supported tuberculosis programs; successfully treat a minimum of 2.6 million new sputum smear-positive TB patients under DOTS programs, primarily through support for implementation of the Stop TB Strategy and through coordinated multilateral efforts; and diagnose and initiate treatment of at least 57,200 new MDR-TB cases and provide additional treatment through coordinated multilateral efforts.

GHI includes conservative treatment targets based upon the total estimated costs of existing drugs, diagnostic tests and services to diagnose and treat basic TB and MDR-TB. These targets could be surpassed substantially with the introduction of new technologies and enhanced donor contributions to the Global Fund and other TB control programs.

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Tuberculosis

Required Information Response

Indicator Percent of new smear positive pulmonary TB cases registered for treatment that were cured and completed treatment (Treatment Success Rate)

Definition Numerator: Number of new sputum smear positive pulmonary TB cases registered for treatment in a specified time period that were cured plus the number that completed treatment in the same specified time period Denominator: Total number of new smear positive TB cases registered for treatment in the same specified time period (x100) The indicator measures National TB Program capacity to retain patients through a complete course of chemotherapy with a favorable clinical result. “Cured” are the cases that have been bacteriologically confirmed as sputum and/or culture negative at the end of treatment, and “completed” are the cases that complete a full course of treatment with clinical improvements but without bacteriological confirmation of cure. Treatment success rate is an outcome measurement of the quality of the program to initiate and maintain each patient put on treatment for a full six month course of medication.

Primary Program Area (Program Element for IIP) Linkage

Tuberculosis 3.1.2

Primary Program Element (Program Sub-Element for IIP) Linkage

3.1.2.1

Linkage to Long-Term Outcome or Impact

The indicator measures National TB Program capacity to retain patients through a complete course of TB treatment with favorable clinical results. There is a direct link between the treatment success rate and the impact of reduced TB mortality. There is also an indirect link with reduced TB prevalence, as successful treatment of smear positive TB cases results in decreased transmission of TB and ultimately, fewer cases. The global target for treatment success rate is 85%.

Indicator Type Outcome Unit of Measure Percent Use of Indicator Program Performance, Trends of Country Progress, Congressional Reporting Methodology for Aggregation

The numerator is calculated as the sum of smear-positive TB patients cured plus the sum of smear-positive TB patients completing treatment for all

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USAID priority countries. For the denominator, we sum number of smear-positive TB patients in the treatment cohort for all USAID priority countries.

What countries are included in the aggregate data point – please note changes over time

Prior to FY2011, data from 40 countries were included in the treatment success rate calculation including: Afghanistan, Armenia, Azerbaijan, Bangladesh, Belarus, Bolivia, Cambodia, Djibouti, Dominican Republic, DR Congo, Ethiopia, Georgia, Ghana, Haiti, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Liberia, Malawi, Mexico, Mozambique, Namibia, Nigeria, Pakistan, Peru, Philippines, Russia, Senegal, South Africa, Sudan, Tajikistan, Tanzania, Turkmenistan, Uganda, Ukraine, Uzbekistan, Zambia and Zimbabwe. In FY2011, data from the same countries were used with the exception of Pakistan. For FY2012, the number of countries was reduced 28 including: Afghanistan, Bangladesh, Cambodia, DR Congo, Ethiopia, Georgia, Ghana, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Malawi, Mozambique, Namibia, Nigeria, Philippines, Russia, South Africa, Sudan, Tajikistan, Tanzania, Turkmenistan, Uganda, Ukraine, Uzbekistan, Zambia and Zimbabwe. FY 2013 countries are still TBD.

Is this data reflective of USG funding only?

We report national level data that is collected by WHO from each country on an annual basis and included in the WHO Global TB Control Report. Therefore the data is reflective of all funding support to a country, not just USG.

Data Source For most countries, the facilities send their treatment registries to the district level. The district level develops a quarterly report on treatment outcomes. The NTP combines them for all the districts and creates a national report for the year. These reports are provided to WHO and they produce an annual report for all the reporting countries. The annual report can be found at the following website: http://www.who.int/tb/country/en/index.html

Reporting Frequency Annual Known Data Limitations

Reports at the facility level are sometimes incomplete and each person in the cohort is not assigned an outcome, which can result in unaccounted and/or incorrect outcomes of some cases. Since the full course treatment takes approximately 6 months to complete and programs aggregate their data on an annual basis, there is a two year delay between the time the entire cohort of patients begins treatment and final outcomes are assigned for everyone in the cohort and reported to the National TB Program, then to WHO. For example, treatment outcomes reported for FY11 are from cases registered in calendar year 2009.

2008 Baseline Data & Comments

84%

2009 Data & Comments

85%

http://www.who.int/tb/country/en/index.html

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85%


85%


86%

2013 Projection & Comments

86%


87%

Responsibility Charlotte Colvin, [email protected], USAID/GH/HIDN Disaggregate(s)


Indicator Percent reduction in TB Prevalence Rate

Definition Prevalence is defined as the number of TB cases (all forms) per 100,000 population at a given point in time during the year. The best way to measure the prevalence of TB is through national population-based surveys of TB disease. Data from such surveys are available for an increasing number of countries; however, for a large number of USAID priority countries, TB prevalence is estimated by WHO using available indirect data and expert consultations. (Information regarding estimation methods can be found in Annex I of the 2012 WHO Global TB Control Report: http://www.who.int/tb/publications/global_report/en/index.html We calculate the percent reduction in TB prevalence rate by comparing the current year’s TB prevalence rate to the 1990 level. Numerator: (Number of estimated prevalent TB cases per 100,000 population in current year) minus (Number of estimated prevalent TB cases per 100,000 population in 1990) Denominator: Number of estimated prevalent TB cases per 100,000 population in 1990 (X 100)


http://www.who.int/tb/publications/global_report/en/index.html

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One of the Millennium Development Goals for TB is to halve the TB prevalence rate compared to the 1990 level by 2015. One of the major goals for National TB Programs is to ensure that all TB cases are detected and treated as quickly as possible so that further transmission is prevented, thereby decreasing the pool of infected persons. Monitoring the trend in TB prevalence over time will help determine whether or not countries are detecting TB cases and putting them on appropriate treatment quickly and breaking the cycle of transmission.

Indicator Type Impact Unit of Measure Percent Use of Indicator Program Performance, Trends of Country Progress, Congressional

Reporting Methodology for Aggregation

For all USAID priority countries, the cumulative TB prevalence rate per 100,000 population (using the total number of prevalent TB cases and total population in all priority countries) is used in both numerator and denominator.


Prior to FY2011, data from 40 countries were included in the treatment success rate calculation including: Afghanistan, Armenia, Azerbaijan, Bangladesh, Belarus, Bolivia, Cambodia, Djibouti, Dominican Republic, DR Congo, Ethiopia, Georgia, Ghana, Haiti, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Liberia, Malawi, Mexico, Mozambique, Namibia, Nigeria, Pakistan, Peru, Philippines, Russia, Senegal, South Africa, Sudan, Tajikistan, Tanzania, Turkmenistan, Uganda, Ukraine, Uzbekistan, Zambia and Zimbabwe. In FY2011, data from the same countries were used with the exception of Pakistan. For FY2012, the number of countries was reduced 28 including: Afghanistan, Bangladesh, Cambodia, DR Congo, Ethiopia, Georgia, Ghana, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Malawi, Mozambique, Namibia, Nigeria, Philippines, Russia, South Africa, Sudan, Tajikistan, Tanzania, Turkmenistan, Uganda, Ukraine, Uzbekistan, Zambia and Zimbabwe. FY 2013 countries are still TBD.


We report national level data estimated by WHO using available information from the country and included in the annual WHO Global TB Control Report. Therefore this data is reflective of all funding support to

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a country, not just USG. Data Source We use estimates of TB prevalence from WHO reported in the WHO

Global TB Control Report. The 2012 annual report can be found at the following website: http://www.who.int/tb/country/en/index.html


TB prevalence estimates may vary significantly from year to year as new data are collected, the quality of routine data on which estimates are based improves and prevalence surveys are implemented. Additionally, WHO is continually improving their estimation methods, thus we often see shifts in the value of in this particular indicator depending on the latest information available from the country and differences in the estimation method from year to year.


14%


28%


31%


33%


35%


37%


41%

Responsibility Charlotte Colvin, [email protected], USAID/GH/HIDN Disaggregate(s) None


Indicator Percent reduction in TB Mortality Rate

Definition According to the latest revision of the international classification of diseases (ICD-10), TB mortality rate is the number of deaths caused by TB in HIV-negative people per 100,000 per year. Estimates of TB mortality are produced directly by WHO from treatment outcome data, vital registration data or mortality surveys, or indirectly from estimates of TB incidence and case-fatality rates. We calculate the percent reduction in TB mortality rate by comparing the current year’s TB mortality rate to the 1990 level.


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Numerator: (Number of estimated TB deaths per 100,000 population in current year) minus (Number of estimated TB deaths per 100,000 population in 1990) Denominator: Number of estimated TB deaths per 100,000 population in 1990 (X 100)




One of the Millennium Development Goals for TB is to halve the TB mortality rate compared to the 1990 level. One of the major goals for National TB Programs is to ensure that all TB cases are detected and successfully treated, resulting in as few deaths as possible. Monitoring the trend of TB mortality over time will help determine whether or not countries are implementing quality TB programs, detecting TB quickly, and ensuring adherence to treatment.

Indicator Type Impact Unit of Measure Percent Use of Indicator Program Performance, Trends of Country Progress, Congressional


For all USAID priority countries, the summation of TB mortality rates per 100,000 population (using the total number of estimated TB deaths and total population in all priority countries) is used in both numerator and denominator.


Prior to FY2011, data from 40 countries were included in the treatment success rate calculation including: Afghanistan, Armenia, Azerbaijan, Bangladesh, Belarus, Bolivia, Cambodia, Djibouti, Dominican Republic, DR Congo, Ethiopia, Georgia, Ghana, Haiti, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Liberia, Malawi, Mexico, Mozambique, Namibia, Nigeria, Pakistan, Peru, Philippines, Russia, Senegal, South Africa, Sudan, Tajikistan, Tanzania, Turkmenistan, Uganda, Ukraine, Uzbekistan, Zambia and Zimbabwe. In FY2011, data from the same countries were used with the exception of Pakistan.

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For FY2012, the number of countries was reduced 28 including: Afghanistan, Bangladesh, Cambodia, DR Congo, Ethiopia, Georgia, Ghana, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Malawi, Mozambique, Namibia, Nigeria, Philippines, Russia, South Africa, Sudan, Tajikistan, Tanzania, Turkmenistan, Uganda, Ukraine, Uzbekistan, Zambia and Zimbabwe. FY 2013 countries are still TBD.


We report national level data estimated by WHO using available information from the country and included in the WHO Global TB Control Report. Therefore this data is reflective of all funding support to a country, not just USG.

Data Source We use estimates of TB mortality from WHO is reported in the WHO Global TB Control Report. The annual report can be found at the following website: http://www.who.int/tb/country/en/index.html


The estimates of TB mortality may vary significantly from year to year as new information is collected, routine data quality is improved and vital registration systems are strengthened. WHO is continually improving their estimation method and therefore we often see shifts in the value of this particular indicator depending on the latest information available from the country and changes to the estimation method.


29%


30%


34%


35%


34% This decrease from 35% to 34% reduction in TB mortality is due to the decrease to 28 countries, which include countries with higher TB burden in general and higher baseline mortality than the original 40 countries included in the earlier data points.


37%


40%



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Indicator TB Case Detection Rate (all forms)

Definition TB case detection rate allows us to track the extent to which countries are detecting the estimated number of all TB cases in a country. This indicator is based on WHO estimates of incidence that vary in reliability depending on the country and the estimation method used. Very few countries have completed TB prevalence surveys so estimates often change significantly year by year. Numerator: Number of all TB patients notified in a given year Denominator: Number of estimated incident TB cases in the same year (X 100)




The trend in case detection rate in a country over a number of years can indicate progress towards detecting all TB cases estimated to exist in that country. An improvement over time in the case detection rate indicates that a country is implementing appropriate case detection activities to find additional cases of TB.

Indicator Type Outcome Unit of Measure Percent Use of Indicator Program Performance, Trends of Country Progress, Congressional


For all USAID priority countries, the numerator is calculated as the cumulative number of TB patients notified in a given year. For the denominator, we use the cumulative number of estimated incident TB patients for the same year.


Prior to FY2011, data from 40 countries were included in the treatment success rate calculation including: Afghanistan, Armenia, Azerbaijan, Bangladesh, Belarus, Bolivia, Cambodia, Djibouti, Dominican Republic, DR Congo, Ethiopia, Georgia, Ghana, Haiti, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Liberia, Malawi, Mexico, Mozambique,

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Namibia, Nigeria, Pakistan, Peru, Philippines, Russia, Senegal, South Africa, Sudan, Tajikistan, Tanzania, Turkmenistan, Uganda, Ukraine, Uzbekistan, Zambia and Zimbabwe. In FY2011, data from the same countries were used with the exception of Pakistan. For FY2012, the number of countries was reduced 28 including: Afghanistan, Bangladesh, Cambodia, DR Congo, Ethiopia, Georgia, Ghana, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Malawi, Mozambique, Namibia, Nigeria, Philippines, Russia, South Africa, Sudan, Tajikistan, Tanzania, Turkmenistan, Uganda, Ukraine, Uzbekistan, Zambia and Zimbabwe. FY 2013 countries are still TBD.


We report national level data collected from the country and included in the WHO Global TB Control Report. Therefore this data is reflective of all funding support to a country, not just USG.

Data Source and Reporting Frequency

Numerator: For most countries, facilities that detect and report TB cases to the National TB Program send their TB registries to the district level. The district level develops a quarterly report on the number of TB cases notified for the whole district. The National TB Program aggregates these for all the districts and creates a national report for the year. These reports are provided to WHO and they produce an annual report for all the reporting countries. The annual report can be found at the following website: http://www.who.int/tb/country/en/index.html Denominator: WHO estimates the total number of incident TB cases per year based on data reported through their annual data collection activity to support the WHO Global TB Report, using methods described in the annual report. Annual reporting frequency by WHO.

Known Data Limitations

Case detection reports at the facility level are sometimes incomplete which can result in unaccounted and/or incorrect notifications of some cases. Additionally, the denominator is a rough estimation of the number of incident TB cases and as WHO improves estimation methods and has greater access to prevalence survey data to inform case detection rate, we see shifts in the value of the denominator over time, which affects annual data points and the trend over time.


57%


60%


11


61%


61%


62%


65%


70%



Indicator Number of smear-positive TB cases successfully treated

Definition The number of TB cases successfully treated is the total number of smear-positive TB cases registered in the treatment cohort that were cured plus the number that completed treatment. This indicator is another outcome measurement of the quality of the program to ensure that each patient put on treatment completes the full regimen with a favorable clinical outcome. It is calculated by adding together the number of TB cases in the cohort who were cured and the number who completed treatment.




Successfully treating smear-positive TB cases interrupts the cycle of TB transmission and reduces the number of TB deaths. Increasing the number of successfully treated smear-positive patients will lead to a smaller pool of infectious persons who are able to transmit the disease to others, thereby reducing transmission and TB incidence.

Indicator Type Outcome Unit of Measure Number Use of Indicator Program Performance, Trends of Country Progress, Congressional

Reporting

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Methodology for Aggregation

For USAID priority countries, the number of successfully treated cases is calculated for each country and these values are summed across the priority countries for a grand total.


Because we are projecting the absolute number of successfully treated cases for FY2013 and FY2015, we limited the data for previous and current years to the 26 countries that supported in FY2012: Afghanistan, Bangladesh, Cambodia, DR Congo, Ethiopia, Ghana, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Malawi, Mozambique, Namibia, Nigeria, Philippines, Russia, South Africa, South Sudan, Tajikistan, Tanzania, Uganda, Ukraine, Uzbekistan, Zambia and Zimbabwe.


We report national level data that is collected from the country and included in the WHO Global TB Control Report. Therefore this data is reflective of all funding support to a country, not just USG.

Data Source For most countries, the facilities send their summary treatment outcomes for each cohort of patients registered for treatment to the district level. The district level develops a quarterly report on the treatment outcomes for each cohort of patients who has finished treatment during the quarter. The NTP combines them for all the districts and creates a national report for the year. These reports are provided to WHO and they produce an annual report for all the reporting countries. The annual report can be found at the following website: http://www.who.int/tb/country/en/index.html


Reports at the facility level are sometimes incomplete, and this is a limitation of the data. It could result in unaccounted and/or incorrect notifications and outcomes of some cases. Additionally, because TB treatment requires six months and a whole cohort is assessed at one point in time each year, the data lag by up to two years. For example, treatment outcomes reported for FY11 are from cases registered in calendar year 2009.


1,261,369


1,295,268


1,316,902


1,323,468


1,364,610


1,450,000

2015 Projection & 1,650,000


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Comments Responsibility Charlotte Colvin, [email protected], USAID/GH/HIDN Disaggregate(s) None


Indicator Number of new multi-drug resistant TB (MDR-TB) patients initiated on treatment

Definition This indicator represents the total number of all MDR-TB patients who were initiated on treatment during the reporting period. MDR-TB is defined as TB that is bacteriologically confirmed to be resistant to at least the two most powerful anti-TB drugs, isoniazid and rifampicin. This indicator measures the total number of MDR-TB cases that are diagnosed as resistant to at least isoniazid and rifampicin through drug susceptibility testing and who initiate appropriate second-line drug treatment. It is not the number of MDR-TB cases currently on treatment, as this may include many people who began treatment in previous years due to the 18 to 24 month treatment period.


Tuberculosis 3.1.2


3.1.2.4


The presence of MDR-TB is an indication that the country’s TB program is performing poorly, either now or in the past. MDR TB is often associated with clinical and/or programmatic mismanagement of TB and poor TB treatment outcomes, including high rates of patients who either failed or defaulted from treatment. For example, providers who do not follow standard treatment regimens for TB may put patients on treatment that creates MDR-TB, and if there is unreliable or poor quality drug supply in the country, there are opportunities for MDR-TB to develop because patients may not receive a full course of treatment. An increasing number of MDR-TB patients diagnosed and put on treatment can also be an indication of a strengthened laboratory network of culture and drug susceptibility testing, as well as improvements in the programmatic management of MDR-TB (i.e.

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treatment facilities or community services to treat MDR-TB patients). Since a small number of the estimated number of MDR TB patients in developing countries have been diagnosed and initiated on treatment, this is an important indicator to monitor over the next five years. One of the two TB targets for GHI is to diagnose and initiate on treatment 57,200 MDR-TB cases among the USG TB countries.

Indicator Type Output Unit of Measure Number Use of Indicator Program Performance, Trends of Country Progress, Congressional


In all USAID priority countries, we count the number of MDR-TB patients who were diagnosed and initiated treatment in a given year.


Because we are projecting the absolute number of successfully treated cases for FY2013 and FY2015, we limited the data for previous and current years to the 26 countries that we plan to support in FY2012: For FY2012, the number of countries was reduced 28 including: Afghanistan, Bangladesh, Cambodia, DR Congo, Ethiopia, Georgia, Ghana, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Malawi, Mozambique, Namibia, Nigeria, Philippines, Russia, South Africa, Sudan, Tajikistan, Tanzania, Turkmenistan, Uganda, Ukraine, Uzbekistan, Zambia and Zimbabwe. FY 2013 countries are still TBD.


We report national level data that is collected from the country. Therefore this data is reflective of all funding support to a country, not just USG.

Data Source Since the number of MDR-TB patients diagnosed and initiated on treatment has been difficult to quantify in many countries, we have not relied on WHO data for this indicator. For FY2011, we surveyed USAID Missions and National TB Control Programs to collect this data. We also collected some data from implementing partners in priority countries to compare values and look for inconsistencies. As the data are more routinely collected and reported to WHO, we will shift how we collect this information.


Because MDR-TB treatment has traditionally taken many months to diagnose and second-line treatment is not available for all confirmed cases, there is often a significant gap from presentation to the time to diagnosis and from diagnosis to initiation of treatment. Often countries do not accurately disaggregate MDR-TB cases diagnosed and initiated on treatment by cohort.

2008 Baseline Data & 0 (because of the data limitations described above, reporting has been

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Comments delayed and most countries have not systematically collected this information until recently.


N/A


N/A


19,121


44,875 This increase is indicative of the rapid expansion of capacity to implement programmatic management of MDR-TB among USAID priority countries and improved data collection and reporting systems and national and global level.


42,000


50,000

Responsibility Charlotte Colvin, [email protected] USAID/GH/HIDN Disaggregate(s)


Indicator Number of individuals trained in any component of the WHO Stop TB Strategy with USG funding

Definition The total number of individuals who were supported to attend and complete training in any component of the Stop TB Strategy, including clinical and programmatic aspects, with USG funding




Human resources development, including training, is an important part of ensuring the implementation of quality DOTS programs. This is especially true in countries that are rapidly introducing and scaling up new tools (ex, new diagnostic tests) or expanding Stop TB strategy elements for which there was little support in the past, for example, advocacy, communication and social mobilization or infection control.

Indicator Type Output Unit of Measure Number

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Use of Indicator Program Performance, Congressional Reporting Methodology for Aggregation

This indicator should be available in routine USG partner reports and aggregated across the quarterly or semi-annual reports to produce an annual figure for each country.


FY 2013 countries are TBD.


In some countries, the results reported for this indicator include individuals who are trained with the support of USAID funding only. However, this is an area where we are often able to leverage USAID’s investments and have other donors or the local government share costs, so there are some individuals included in this result who may have received partial support from another funding source.

Data Source Reporting Frequency Annual Known Data Limitations

Depending on which elements are prioritized for training and specific human resources at the country level, there may be some double counting if the same individuals are trained in more than one element.


It is very difficult to determine baseline and set targets for training outputs. Annual results are highly dependent on the annual work plan and priorities of the National TB Program in the USAID focus country, for example, which Stop TB elements need to be emphasized in each year’s work plan.







Responsibility Charlotte Colvin, [email protected] USAID/GH/HIDN ***Question for P3: If this is to be reported through PPR at mission level, should this be further specified?

Disaggregate(s) This indicator should be reported as a total and as the number of males and females.

Required Response

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Information

Indicator Treatment success rate among multi-drug resistant TB (MDR- TB) cases

Definition Numerator: Number of MDR-TB cases registered for treatment in a specified time period that were cured plus the number that completed treatment in the same specified time period Denominator: Total number of MDR-TB cases registered for treatment in the same specified time period (x100) The indicator measures National TB Program capacity to retain MDR-TB patients through a complete 18 to 24 month course of chemotherapy with a favorable clinical result. “Cured” are the cases that have been bacteriologically confirmed as sputum and/or culture negative at the end of treatment per WHO and NTP guidelines, which usually specify the need for at least five consecutive negative cultures during the last phase of treatment, and “completed” are the cases that complete a full course of treatment with clinical improvements but without bacteriological confirmation of cure. Treatment success rate is an outcome measurement of the quality of the program to initiate and maintain each patient put on treatment for a full course of medication, which is quite challenging with MDR-TB due to the lengthy course of treatment and debilitating side effects.




The indicator measures National TB Program capacity to retain MDR-TB patients through a complete 18 to 24 month course of treatment with second line antibiotics with favorable clinical results. There is a direct link between the treatment success rate and the impact of reduced TB mortality. There is also an indirect link with reduced transmission of MDR-TB, as successful treatment of MDR TB cases results in decreased transmission and ultimately, fewer cases.

Indicator Type Outcome Unit of Measure Percent Use of Indicator Program Performance, Trends of Country Progress

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Methodology for Aggregation

Countries vary widely in their approach to monitoring cohorts of MDR-TB patients, depending on the number of patients enrolled on treatment, the degree to which programmatic management of drug resistant TB is centralized and the maturity of the PMDT activities. Countries send their treatment outcome data to WHO as part of their annual data submission and they are included in the annual WHO Global TB Report. The annual report can be found at the following website: http://www.who.int/tb/country/en/index.html


For FY2012, the number of countries was reduced 28 including: Afghanistan, Bangladesh, Cambodia, DR Congo, Ethiopia, Georgia, Ghana, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Malawi, Mozambique, Namibia, Nigeria, Philippines, Russia, South Africa, Sudan, Tajikistan, Tanzania, Turkmenistan, Uganda, Ukraine, Uzbekistan, Zambia and Zimbabwe. FY 2013 countries are TBD.



Data Source Depending on the country, these data may be available directly from the NTP and/or from the WHO Global TB Control Report. Where it is not submitted to the WHO for inclusion in the annual report, we may work with the local implementing partner to get the data. Alternatively, the data are sometimes available through the Green Light Committee.


Many countries have only recently implemented programmatic management of drug resistant TB and several have not yet assessed treatment outcomes for a full cohort of patients. The cohorts include all patients initiating treatment during a six month period and are assessed at the end of treatment for the last patient in the cohort, so the data lag is usually at least three years. Data quality may be poor; many countries have not set up adequate monitoring systems to report on cohorts.


None


None


None


None


None


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None


None

Responsibility Charlotte Colvin, [email protected] USAID/GH/HIDN ***Question for P3: If this is to be reported through PPR at mission level, should this be further specified?

Disaggregate(s)


Indicator Percent of TB patients tested for HIV

Definition Numerator: Number of TB cases notified to the NTP during the reporting period with an HIV test result recorded in the TB register Denominator: Total number of TB cases notified to the NTP during the reporting period (x100)


(UNCLEAR/PEPFAR INDICATOR?)



The provision of HIV testing for people with TB or suspected of having TB is important for linkage to HIV care and treatment services for HIV positive people who first present at the TB clinic in need of diagnosis and treatment services. The burden of both TB and HIV can be reduced when individuals affected by both illnesses have access to care and treatment services.

Indicator Type Outcome Unit of Measure Percent Use of Indicator Program Performance, Trends of Country Progress, Congressional


For most countries, the facilities send their summary notifications for all confirmed TB cases to the district level, including the number of HIV tests performed among those cases. The district level develops a quarterly report on case notifications and uptake of HIV testing. The NTP combines them for all the districts and creates a national report

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for the year. These reports are provided to WHO and they produce an annual report for all the reporting countries. The annual report can be found at the following website: http://www.who.int/tb/country/en/index.html


For FY2012, the number of countries was reduced 28 including: Afghanistan, Bangladesh, Cambodia, DR Congo, Ethiopia, Georgia, Ghana, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Malawi, Mozambique, Namibia, Nigeria, Philippines, Russia, South Africa, Sudan, Tajikistan, Tanzania, Turkmenistan, Uganda, Ukraine, Uzbekistan, Zambia and Zimbabwe. FY 2013 countries are TBD.



Data Source For most countries, the facilities send their summary notifications for all confirmed TB cases to the district level, including the number of HIV tests performed among those cases. The district level develops a quarterly report on case notifications and uptake of HIV testing. The NTP combines them for all the districts and creates a national report for the year. These reports are provided to WHO and they produce an annual report for all the reporting countries. The annual report can be found at the following website: http://www.who.int/tb/country/en/index.html


Reports at the facility level are sometimes incomplete, and this is a limitation of the data. It could result in unaccounted and/or incorrect notifications. Where HIV testing information is incomplete, the value may be underestimated.


To be completed


To be completed


To be completed


To be completed


To be completed


To be completed


To be completed

Responsibility Charlotte Colvin, [email protected] USAID/GH/HIDN



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***Question for P3: If this is to be reported through PPR at mission level, should this be further specified?

Disaggregate(s)

Tuberculosis (TB): Under the U.S. TB strategy required by ... · Tuberculosis (TB): Under the U.S....

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