TB CARE / Zimbabwe

The Union Zimbabwe Office in Harare coordinates the USAID-funded 5-year TB CARE I and the PEPFAR-funded TB-HIV integrated care programmes. 

Key TB CARE Year 2 and PEPFAR year 1 achievements:


Universal and early access to TB diagnosis and treatment:
 The sputum transport system became fully functional in 5 targeted rural districts in the 4th quarter, resulting in doubling of the number of TB suspects with a sputum examination result from 1244 in the 3rd quarter to 2525. A total of 1036 community TB treatment supporters were mobilized in 10 districts. Lessons learned from the exercise will inform the development of national community TB support guidelines and subsequent expansion nationally.


Programmatic Management of Drug Resistant TB (PMDT):
 PMDT guidelines were introduced, for the first time, followed by development of PMDT training materials. The first national course in the clinical management of multidrug resistant (MDR–TB) was conducted for 31 clinicians from all the 8 rural provinces and 3 main cities. This has provided clinical capacity at provincial levels for the management of MDR-TB.


TB-HIV:
 A roll out of decentralization and integrated care of persons with TB and HIV co-infection commenced, following a successful pilot of HIV Care for TB Patients Living with HIV (IHC) project conducted by The Union. Thirteen (13) integrated care clinics were established in 9 urban areas. Lessons learned from the 13 clinics will inform further expansion.


Health Systems Strengthening (HSS):
  Thirty out of 37 districts were visited by provincial teams and 804 peripheral health facilities were visited by district teams for support supervision and onsite mentoring. Twenty nine (11 female and 18 males) health workers - mostly young district team leaders who had not received any management training before - from all 8 rural provinces and 2 cities were trained in health management and finance. A total of 896 health workers (431 males and 465 females) were trained in TB and TB/HIV programmatic and clinical management.


M&E and Surveillance:
 Data verification missions were conducted to assess data quality in 5 districts, selected on account of either poor or particularly good surveillance reports. A total of 24 district performance review sessions
were held to review programme implementation and resolve challenges. One national TB performance review meeting was held, and recommended among other issues, a) mobilisation of resources to procure more Xpert MTB/Rif instruments b) expediting establishment of a surveillance system for TB among HCW c) establishment of an electronic TB register nationally and d) establishment of a formal TB partnership forum. These recommendations were included in the 3rd year plan. TB and TB-HIV data analyses and feedback including comparative performance indicators by province and by district were conducted quarterly.


Operations Research:
 Seven studies out of 12 planned from Year 1 made progress: at close of year 1 was at data analysis stage, 2 were collecting data and 4 were waiting for protocol approval by the Medical Research Council of Zimbabwe (MRCZ). 


Key outcome indicators (TB CARE-supported areas):

The sputum transport system became fully functional in the 5 targeted rural districts during the second half of the financial year. Direct Sputum smear microscopy has become the standard method for diagnosis of Tuberculosis in the
country. The proportion of new pulmonary TB patients without a smear microscopy result has decreased from 29% in 2009 to 9% by June 2012.  The cure rate for confirmed TB cases improved from a baseline of 63% in 2008 to 76% in 2011 (June 2011). The proportion of HIV-positive TB patients started on ART increased from 28% in 2009 to 60% by June 2011. In 2012 there were 172 confirmed DR TB cases of which 122 were put on treatment. 


Plans for year 3:

The Union support for the NTP through TB CARE in Year 3 will focus on consolidating above activities plus 1) strengthening community TB care 2) expansion of Xpert MTB/Rif implementation 3) strengthening PMDT 4) expansion of decentralised integrated TB-HIV care and 5) introduction of electronic TB recording and reporting.