Achievements

UK Parliamentary Delegation Report on TB REACH
Kochon Prize
UK Parliamentary Delegation Report on TB REACH

TB REACH is a results-driven funding mechanism, which has proven itself to be a cost effective mechanism for investment through its mid-term evaluation launched in November 2012. TB REACH’s goal is to find and treat the 3 million TB cases that aren’t reached by the Global Fund and national governments every year. In areas with limited or non-existent TB care, TB REACH supports innovative and effective techniques to find people with TB quickly, avert deaths, stop TB from spreading and halt the development of drug-resistant strains.
The delegation visited an outreach programmed to increase TB detection and coverage in the rural area of Awasa. The project is integrated within the Ethiopian Ministry of Health’s existing Health Extension Programmed which has been successful in delivering primary healthcare to communities by training 36,000 Health Extension Workers. The current TB REACH programmed has already doubled TB detection rates compared to its control area during the two year pilot period.

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Kochon Prize

Ethiopian partner REACH wins prestigious 2014 Kochon Prize for innovative tuberculosis project
28 OCT 2014
KIT congratulates REACH Ethiopia, a local initiative that has run a very successful innovative community based tuberculosis project with winning the prestigious Kochon Prize in Barcelona today.
KIT supported this project in its monitoring and evaluation as part of the (HLSP-KIT) consortium that is contracted as independent monitoring and evaluation agency for TB REACH (Stop TB Partnership).
The theme for this year’s Kochon Prize was innovators working with communities to reach the three million people with tuberculosis (TB) who are missed every year. The REACH project in Ethiopia received funding from global fund TB REACH and within one year doubled the number of TB patients diagnosed and successfully treated. This has been accomplished by actively engaging health extension workers in screening community members in rural Ethiopia and following up treatment of patients close to their homes. A great result and therefore the 2014 Kochon Prize is well deserved!
Dr.Daniel Accepted the 2014 Stop TB Kochon Prize on behalf of REACH Ethiopia at the WHO global TB symposium on Tuesday,28 October KimDoo Hyun of the Kochon foundation and Lucica Ditiu of STOP TB Partnership presented the $65000 award. for more Click here

This Award is funded for communities of different districts of Sidama zone.
This fund is used for the following project activities in the implementing areas:

Canadian Parliamantary Deligates

Welcome to Ethiopia and Hawassa beautiful city in southern Ethiopia. We are very delighted to host you for the field visit to the rural community to understand how the innovative community based approach works and share our experience, performance, challenges and future direction.
Short description of the field visit

  1. Pay short visit to our office where the innovative approach is coordinated
  2. Visit shebedino district about 35 kms south of Hawassa to health centre and health post to learn how they implement community-based TB activities

i. Nure Dulecha Health Post  Brief community based activities
Performance of TB control program before and after the project period Integration of the activities in the community Benefits to the patients, the community and the health system What is interesting in the intervention in relation to HEP and the community?
Discuss with Health Extension Worker, Health Development Army and beneficiaries

ii. Dulacha Teberako health centre Performance of TB control program before and after the project Integration of the activities in the community Benefits to the patients, the community and the health system Discuss with health centre head, laboratory professional and TB focal person

iii.District health office Performance of TB control program before and after the project Contribution of the project to health system strengthening Discuss with District Health Office head, TB focal person and their team

Tb Reach Project Year One
Tb Reach Project Year Two
Tb Reach Project Year Three
Tb Reach Project Year One

Tuberculosis is one of the major causes of morbidity and mortality in Ethiopia. Despite the expansion of the DOTS programme in the country, the number of cases notified remained low. The National TB programme follows a passive case finding approach and TB cases are identified among patients visiting health facilities. However, TB diagnostic centres are located in urban and semi-urban areas and patients often need to make several visits before initiating treatment. These visits are onerous for rural population, women, children, elderly and patients with disabilities. Geographic accessibility, socioeconomic and cultural barriers affect health seeking behaviour of the communities. Stigma associated with TB and lack of awareness about the disease and availability of the services further compromise service utilization. In October 2010 LSTM and the Southern Region Health Bureau of Ethiopia initiated a project in Sidama zone with financing of the TB REACH initiative. The main objectives are to improve TB case detection, treatment uptake and adherence among populations with limited access to diagnosis and treatment and to improve the routine TB recording and reporting system.

A package of interventions include conducting extensive advocacy, communication and social mobilization (ACSM) activities, engaging all stakeholders, councils, communities and Health Extension Workers (HEWs) in TB control activities, training of HEWs, staff working in TB clinics and TB coordinators. HEWs conduct house-to-house visits as part of the routine community-based activities and identify TB suspects, collect sputum samples, prepare and fix smears. Then, HEWs contact supervisors by telephone to collect and transport smeared slides to laboratories for smear-microscopy. Supervisors initiate treatment for smear-positive TB cases within their community and examine contacts of index cases and initiate Isoniazid preventive therapy (IPT) for asymptomatic young children. HEWs support and supervise treatment and report drug adverse effects and treatment outcome. The field team and the supervisors conduct regular supportive supervision and review meetings with HEWs and staff, discuss progress and challenges encountered and agree on action points

Key project activities

During the project period (Oct 2010 to Dec 2011), the HEWs identified 49,857 TB suspects,; of these, 2,262 (4.5%) were diagnosed as smear-positive TB cases and initiated treatment. 60% of TB suspects screened by HEWs and 53% of smear-positive TB cases diagnosed at community level were women. During the same period (including the estimated number for January 2012), a total of 5,429 cases with smear-positive TB and 7,553 with all forms of TB were diagnosed and initiated treatment in the zone. This corresponds to an increase in case notification of 100% and 78% respectively in comparison to the period preceding the implementation of the project. The additionality achieved exceeded the targets in the first year of implementation. In addition, 8,005 contacts of smear-positive TB cases were visited, 1,949 (13%) were symptomatic, 1290 (66%) were screened by smear-microscopy and 62 (6.9%) were diagnosed as smear-positive TB cases and 7 children were diagnosed as smear-negative and/or EPTB cases. All TB cases started treatment. A total of 2,477 young children in contact with smear-positive TB cases were identified and 1,080 (44%) asymptomatic children were offered IPT.

The project was conceived and designed to address the key problems and gaps of the TB control programmed, which in turn was based on evidences and experiences in the area. It engaged the existing community-based health systems and actors with a component of innovation and strong monitoring and evaluation.

TB Reach Project Year Two

From March 2012 – April 2013, a total of 103,606 individuals with symptoms compatible with TB (called here ‘presumptive TB’ were identified. Of these HEWs identified 100,114 individuals with presumptive TB. Of presumptive TB identified by HEWs, 3,536 (3.5%) were diagnosed as smear-positive. During the project period, a total of 4,972 cases with smear-positive TB and 9,023 with all forms of TB were diagnosed and initiated treatment. This corresponds to the case notification of 226 per 105 populations for all forms of TB and 124 per 105 populations for smear positive cases.
In addition, 11,468 contacts of smear-positive TB cases were visited at home, 1,246 (11%) were symptomatic. Of the symptomatic contacts examined 54 smear positive and 21 smear-negative cases were diagnosed. All TB cases started treatment. Among asymptomatic under five children, 1,153 children were put on IPT.
The treatment success rates achieved were 93% for new smear positive and new extra pulmonary TB cases, 91% for new smear negative and 90% for retreatment cases compared to about 77% during the baseline period (before project implementation). The proportion of patients lost to follow up dropped from 11% to 2.9%.
The project distributed 20 LED-FM microscopes during year 1 and 2 GeneXpert machines (the 1st in the country) during year 2 to improve laboratory capacity. Below is the performance of the project in Sidama zone over two years

TB Reach Project Year Three

The project was scaled up to other four zones due to its effectiveness in the community-based intervention to a population of about 7.5 million living in five provinces and about 70 districts in southern Ethiopia.
The project continued the scale-up process in close collaboration with the Ministry of Health in the region and provinces. Policymakers of the health sector were engaged during the discussion at Butajira town. The TB REACH project shared its experience and discussed the packages to be introduced. These are two packages, called the full and targeted packages.
During the year, 58,049 presumptive TB cases (49,160 from a house-to-house visits with smear prepared by HEWs and 8,889 referred) were detected in the community. A total of 12,449 all forms of TB and 6,139 smear-positive TB cases were identified and started treatment in the project area. Contact tracing was conducted for 13,816 household members of 3,864 index smear-positive cases. Of these 2,588 were symptomatic and were examined to diagnose 116 TB cases. 1,269 under five years children living with index smear-positive cases were started on preventive therapy. We have imported additional five gene Xpert machines (making a total of seven machines in the project area) and tested 1,464 presumptive TB cases using the machine of which 194 were diagnosed to have active TB and started treatment. We have supported MDR treatment initiating and follow up centers for MDR patients to start treatment. Below is the performance of the project in five zones

Lessons learned from the community based
Rural community

  1. Improved awareness about TB and availability of service in the community
  2. Reduced stigma about TB in the community
  3. Increased health-seeking behaviour of the community members
  4. Improved access to the poor, remote rural, and disabled
  5. Reduced the extra out of pocket and opportunity cost of the community
  6. Found to be acceptable and feasible

Health System

  1. Improved the health seeking behaviour of the community
  2. Improved the capacity of TB focal persons
  3. Improved the skill of laboratory technicians
  4. Improved the diagnostic capacity by intruding LED FM and Gene Xpert
  5.  Improved diagnostics among children, PLWHIV and smear negative
  6. Improved the engagement of the health system
  7. Improved the program monitoring and evaluation capacity

Beyond the health System
a.Increased engagement of different stallholders

  1. District council, District administrators and District health office
  2. Education sector: schools a
  3. Religious institutions
  4. Women group and community leaders

Community-based institutions

Task Shifting

  1. HEWs were engaged in smear preparation which reduced laboratory workload
  2. Community based treatment was introduced and strengthened

Challenges   

  1. Work overload in some districts due to topography and high number of community per district
  2. Relative shortage of supplies for supporting children, PLWHIV and poor to support x-ray examination
  3. Working under short project period
  4. Huge number of smear negative presumptive cases who need further examination for other lung diseases in the community

Future direction 

  1. Working with the National TB Program for possible scaling up of the project
  2. Looking for continued financial support to scale up within the region
  3. Integration of the community based-work with other health priorities including HIV and maternal health

please follow the following links for more information

http://www.results-resultats.ca/en/2014/09/how-to-get-a-zero-default-rate-on-tb-treatment/

http://www.lstmed.ac.uk/news-events/news/plos-one-innovative-community-based-approaches-double-tb-case-notification-and

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REACH Ethiopia grew out of a TB project that started in 2010. This project introduced an innovative community package that engaged health extension workers (HEWs) to increase TB case detection and treatment adherence.
Addis Ababa, Ethiopia
info@reachet.org.et

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