TB REACH PROJECT
TB REACH, established in 2010 with leadership of Global Affairs Canada, has funded ground-breaking approaches and technologies aimed at increasing the number of people diagnosed and treated for TB, decreasing treatment time and improving treatment success rates. TB REACH combines fast-track, results-based financing and rigorous, external monitoring and evaluation, so other donor agencies and/or national governments can scale-up successful approaches and maximize their own investments.
TB REACH Project in southern Ethiopia:
Tuberculosis is a leading cause of illness and death in Ethiopia. Whilst TB is a government priority, the national programme is reliant on identifying patients when they visit the health centre. TB diagnostic centres are located in urban and semi-urban areas and patients often need to make several visits before initiating treatment. People who are infirm, old, young, or disabled find it particularly difficult to access diagnosis and treatment services. In October 2010 LSTM and the Southern Nations, Nationalities and Peoples’ Regional Health Bureau of Ethiopia initiated a project in Sidama zone with support from the TB REACH Programme of the Stop TB Partnership funded by CIDA.
Through our project we introduced a package of interventions including advocacy, communication and social mobilization with stakeholders; training HEWs, TB clinic staff and TB coordinators. As part of the project HEWs conducted house-to-house visits and identified people who they thought had TB, collected sputum samples, and prepared and fixed smears. Supervisors collected and transported smeared slides to laboratories for smear-microscopy. People who tested positive were given treatment and were supported by Health Extension Workers.
The TB REACH project was further expanded to five zones to cover a population of 7.5 million, demonstrating its up-scalability and acceptance by the population. The project received three awards of the National TB Conference in Ethiopia (6th – TRAC , 8th – TRAC and 9th National TB Conference) and one international award – the prestigious Kochon prize 2014 –
The project has shared experiences in different national and international forums. The National TB Control Programme decided to up-scale the approach to other Regions in the country. In 2015-17 the programme will initiate activities in four major regions and selected zones and districts to implement the package with financial support from the Global Fund to Fight Aids, Tuberculosis and Malaria.
concept note (2014 – HIV/TB)
Read more publications:
REACH Ethiopia wins different projects of Stop TB Partnership
Such as WAVE I, III and Wave V for more click here
Innovative community-based approaches for enhanced case finding and treatment outcome in southern Ethiopia
The first wave of TB REACH funding was announced on 25 January 2010 with a deadline of 5 March 2010 for proposal submission.
In March 2010 the TB REACH Proposal Review Committee (PRC) selected 30 projects for funding from among 192 applications. The recommendations of the PRC were presented to the Stop TB Partnership Coordinating Board in April 2010 and the endorsement of the Board was obtained. The total budget committed for these 30 projects was US$ 18.4 million.
Of the 30 approved projects, 20 of the primary recipients are NGOs or civil society organizations, seven are National TB Programmers and three are other government agencies.
TB REACH – Results Wave 1
TB REACH collects case finding data quarterly from all of its grantees and has an independent agency that is tasked with monitoring and evaluating progress of all projects.
Analysis for 28 Wave 1 TB REACH projects showed that intervention areas delivered an average of 25.9% increase in case detection while some projects have seen increases of 60% to over 100%. In human terms, this translates into an additional 17,223 people so far that would otherwise have continued to infect others – many of whom would have died.
Cost: Through March 2012, 28 projects spent $14.9 million with some reaching additional cases for as low as $140. The projects covered a population of almost 90 million people. Average spent per capita of population covered per year is 0.17 USD.
WAVE V towards a community test and treat strategy for TB
Wave5 Project Summary
The evaluation population (EP): comprise the rural communities of West Arsi Zone (Oromia Region) and Sidama Zone (Southern Region). In West Arsi zone, we will include the two woredas (or districts) called Shashemene Zuria and Kofole and in Sidama zone we will includethe woreda Wondo Genet. Shashemene Zuria, Kofole and Wondo Genet are geographically adjacent to each other, have similar socioeconomic conditions and culture and comprise about 623,472 population. The main economic activities are subsistence farming and cash crops such as coffee, sugar, khat and avocado. The areas have a poor road infrastructure resulting in poor utilization of the health services. Similar to the rest of the country, it is estimated that only 30% of the population access the services provided at health centers.
Description of health facilities: There are 23 health centers and 92 health posts in the evaluation area. All 23 health centers provide TB treatment services and 19 conduct smear microscopy. Most individuals accessing smear microscopy services are self-referred and are screened using spot-spot sputum examinations, as recently endorsed by the NTP. There are no XRay facilities, hospitals, GeneXpert or culture facilities in the EP.
Health centers are staffed by medics, nurses/midwifes and support staff, including five health officers. Each health officer supports one health post of the five assigned to the health center. The health posts at located at kebele (village) level and are staffed by two Health Extension Workers (HEWs). The HEWs visit the households to implement the 16 basic packages of health care within the Ethiopian Health Extension Program (HEP) and staff the health posts. The villages are also organized in a grass root network for health promotion called the Health Development Army (HDA) in which one female community leader promotes healthy lifestyles among her five neighboring families (thus commonly named the 1:5 network).
TB epidemiology: Passive case finding is the main stay for getting patients to care, which is compromised by the limited access to diagnostics. A total of 639 all forms TB cases were reported from the evaluation population in 2015. This number translates to a case notification rate of 102 per 105 population and a case detection rate of 49%. This low case detection suggests there are large numbers of cases that did not reach or were not reported by the health services.
Population size: The intervention will focus on two rural districts of Oromia (Shashemene Zuria and Kofole) and one district in the Southern Region (Wondo Genet) which altogether have 93 rural villages. Districts in Ethiopia are called Woredas. The project area has an estimated population of 623,472 inhabitants, of which 470,294 (75%) live in Oromia and 153,178 (15%) in the Southern Region. The targeted population represents about 70 % of the population in these areas after exclusion of young children unable to expectorate.
Project Goal and Objectives
The major goal of the project towards a community test and treat strategy for TB through community based intervention in 2 districts of West Arsi Zone of Oromia region.
- To Engage the HDA in 1:5 household networks to identify TB cases in the community and improve access to TB diagnosis and treatment in the targeted districts
- To use Xpert MTB/RIF and ULTRA as the first diagnostic test for TB screening
- To identify 47,029 (10% of total population) individuals with TB symptoms and in support by the project improve linkage to treatment by providing TB treatment in the community
- To evaluate a transport preservation medium to maintain the integrity of sputum for molecular testingandarrange referral systems for identified TB patients
- Building the capacity of the project and government staffs engaged on improving TB diagnosis
Through the course of project implementation the project will employ the following strategies:
- engaging HDAs and HEWs who are expected to make a house to house visits to establish contacts and find TB cases from among families and communities;
- establishing strong collaborations with all relevant government structures at all levels and the communities;
- launching the project and creating awareness to all involved directly or indirectly in the process of project implementation;
- Identification of TB suspects and communication;
- conducting training and workshops to professionals and HEWs as well as HDAs who will be involved throughout the project implementation;
- undertaking x-ray and laboratory investigations with better equipment, treatment and case finding and applying gender sensitive approaches.