FIDELIS: Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB

FIDELIS was a five-year case-finding initiative to rapidly assess and implement innovative local tuberculosis control activities designed to find and cure new smear-positive patients. Funding for the initiative was provided by the Canadian International Development Agency (CIDA).

Approximately 70% of the FIDELIS projects were in the world's 10 highest-burden countries for tuberculosis. Populations with limited access to health services, including modern TB treatment, were specifically targeted.

The philosophy of FIDELIS was that solutions to delivering TB treatment in poor and remote areas can best be found locally. Through FIDELIS local groups received not only funds, but also the technical and management support from The Union that they needed to help them implement their solutions.

Between 2003 and 2008, 51 FIDELIS projects were implemented in 18 countries. Each project contract was for a 12-month period, with budgets ranging from US $150,000–$250,000. If a project was successful – able to achieve an additional weighted treatment success for less than $80 per case – it became eligible for further funding.

Highlights of some successful projects include:

• introducing DOTS services in army, police, and prison health services in Sudan
• mobilising 2.3 million primary and secondary school students in China to detect possible TB cases in their families
• training cured TB patients so that they would be better equipped to detect TB cases within their communities in Bangladesh
• inviting cured patients to participate in radio talk shows to describe their experience with diagnosis and treatment in Pakistan

The reach of the initiative was very broad. For example, in China alone, FIDELIS projects covered 415 million people in 700 counties. In addition, more than 130,000 Chinese health workers received training about TB as part of the projects there.

As if July 1, 2008, the 51 phase I projects had detected a total of 272,216 new smear positive cases – an increase of 85,185 cases compared to the same settings in the year before the projects took place.

TB CAP: Tuberculosis Control Assistance Program

TB CAP was funded by the United States Agency for International Development (USAID) from 2005–2010. The Union coordinated TB CAP activities in Uganda, the Democratic Republic of Congo and Zimbabwe. At the conclusion of TB CAP in December 2010, The Union offices in Uganda and DR Congo were closed. The Zimbabwe Office is now participating in the new USAID initiative, TB CARE.

UGANDA

Between May 2007 and December 2010, The Union served as the coordinating partner for TB CAP in Uganda. TB CAP was supported by the Ministry of Health (MoH) and districts in Uganda to deliver integrated services for TB and HIV and to strengthen Community-Based Directly Observed Short Course Therapy (CB-DOTS). The goal of the programme was to decrease the burden of TB among people living with HIV/AIDS (PLWHAs) and the burden of HIV among notified TB patients.

Key output areas for the programme were:

• Improved quality of CB-DOTS and TB-HIV collaborative activities, including TB infection control in the 12 TB CAP districts
• Technical assistance provided to USAID TB Implementing partners and United States Government President's Plan for Emergency AIDS Relief (PEPFAR) partners in order to scale up TB-HIV collaborative activities and strengthen/consolidate CB-DOTS

TB CAP final repport (PDF 5,7Ko)

DEMOCRATIC REPUBLIC OF CONGO

From 2009 through the end of 2010, The Union served as a collaborating partner for the TB Control Assistance Program (TB CAP) in Democratic Republic of Congo, alongside La Ligue Nationale Anti-Tuberculeuse and the National Tuberculosis Programme (NTP). In addition to central level support in the form of epidemiological surveillance, laboratory improvement, MDR-TB treatment and operational research, the project focused on DOTs implementation, support to TB ex-patients' organisations and TB-HIV initiatives in four provinces.

ZIMBABWE

From October 2008 through 2010, The Union acted as the coordinating partner for the TB Control Assistance Program (TB CAP) in Zimbabwe. This project started during a time of severe economic hardship in the country, which was characterised by near total lack of TB control activity.

The Union progressed quickly from setting up an office in Harare and putting systems into place to implementation of TB CAP. The focus was on three strategic areas – leadership and management capacity building; human resource capacity building at service delivery levels and TB-HIV scale-up strengthening. This work contributed towards the return of TB onto the health agenda, particularly in the two pilot provinces of Midlands and Masvingo.

Specific outputs included:

• development of several management tools including a strategic plan, various guidelines and M&E tools
• training of over 1,500 health workers in TB and TB-HIV
• strengthened TB-HIV collaborative activities
• strengthened monitoring and evaluation
• introduction of a sputum transport system in the three largest cities in the country.

Key facilitating factors in The Union's work included strong collaboration with the NTP and other partners at national and provincial levels and the strong support from the local USAID mission.