Nepal TB REACH Project Wave 2 Year 1 (Nov Dec 2012) Year 2 (Jan 2013 – Jun 2014)

TB REACH (BNMT) “Intensified case finding through contact tracing and initial default tracing to reach the Nepal National TB Program National Strategic Plan Targets” Funded By: WHO / Stop TB Partnership Implementation By: BNMT, NTP, Partner organizations Implementation Area: 9 districts (Year 1) and 15 districts (Year 2) in Central and Eastern Regions of Nepal Funded By: WHO / Stop TB Partnership Implementation By: BNMT, NTP, Partner organizations Implementation 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)

EDR Districts and Partners 1. Ilam 2. Jhapa Sahara Nepal 3. Morang SCDC Nepal 4. Sunsari 5. Saptari 6. Siraha 7. Udayapur CDR Districts and Partners 8. Dhanusha 9. Mahottari 10. SarlahiMOPP 11. RautahatBagmati Sewa Samaj 12. Bara 13. Parsa 14. Makwanpur BIJAM 15. Chitwan NATA Demographics Number of people Total Population9,950,345 NSP estimated new smear positive (SS+) 10,817 ARI estimation Terai- 2.1 Hill- 1.1 Microscopy centres120 Total index cases [estimated NSP + retreatment cases] 7,033

TB REACH Targets Number of people (Year 1) Number of people (Year 2) Contacts screened per index case55 Total screening32,45035,169 Primary defaulters traced and enrolled22530 Total SS+ detection (based on positive yield of 5% of screened population)

Project Approach

Project Approach Project Approach Mobilization of trained Female Community Health Volunteers (FCHVs) Active case-finding through contact tracing of index patients o Identification and verification of index cases o Prioritization and interview of cases (consent) o Door to door visit by FCHVs for sputum collection o 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 Microscopy Identification and verification of index case and primary defaulter Treatment centre Microscopy centre SS-ve Enroll for treatment Active Case Finding Process

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 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)

ProjectAchievements Project Achievements

Identification and verification of index cases No of suspects Screening New Positive TB cases Primary Defaulter Total New and Primary defaulter Target Achievement % Target Achievement % Target Achievement % Target Achievement % Target Achievement % Year Year Summary case finding data for Year 1 and Year 2

Summary case finding data for Year 1 and 2

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 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 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 2

Result 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 Analysis TB REACH ProjectYear 2Year 1 Total Budget $617,614$630,497 Total Expenses $553,288$507,416 Budget Utilization % 90%80% Total Target SS Target achievement SS Achievement % 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 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 Nepal o 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 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 BNMT-TB REACH adopted by 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