Challenge TB Technical Briefs and Highlights

Ending the global tuberculosis (TB) epidemic requires leadership, broad stakeholder and community engagement, proven interventions and innovations. The USAID-funded Challenge TB project provided global technical leadership and support to national TB control programs and other in-country partners. The collection of technical briefs and highlights document MSH’s collaboration in Afghanistan, Bangladesh, Ethiopia, and Nigeria on topics including infection prevention and control, contact investigation, case notification, point-of-care testing, new drug formulations, and digital health.

Taking Urban DOTS to Scale in Afghanistan
Afghanistan – Technical Brief
With the achievements made by urban DOTS implementation in Kabul, the USAID-funded Challenge TB project and the National TB Control Program and partners expanded this approach to other major cities across Afghanistan bringing TB treatment closer to TB patients and better positioning the program to respond to the growing TB epidemic.

Reaching Vulnerable Population in Afghanistan: Addressing TB among People Who Use Drugs
Afghanistan – Technical Brief
Afghanistan accounts for two-thirds of the global area under opium poppy cultivation and produces 70 percent of the world’s opiates. The co-morbidity between TB and drug use results in an increased risk of developing TB and worsens TB treatment outcomes. This technical brief describes Challenge TB’s strategies, achievements, and lessons when working with people who use drugs in Afghanistan.

Community-based DOTS interventions improved TB case detection and treatment outcomes in Afghanistan
Afghanistan – Technical Brief
In Afghanistan, CB DOTS has been implemented in more than 715 health facilities and 15 provinces, and the national Ministry of Public Health is integrating the CB DOTS strategy into the nationwide basic package of health services. This technical brief describes Challenge TB’s strategies and achievements partnering with national stakeholders and communities to extend and sustain TB services at the local level.

Increasing TB case notification by enhancing GeneXpert optimization
Nigeria – Technical Brief
Sub-optimal GeneXpert utilization due to modular failures, power supply issues, and inadequate samples contributes to low TB case finding. This technical brief describes the design, development, and dissemination of standard operating procedures and tools to ensure that TB case detection becomes a permanent, routine, and consistent activity resulting in increased case detection and notification in Nigeria.

Optimizing the Use of e-TB Manager for TB Case Management in Resource-Constrained Areas in Nigeria
Nigeria – Technical Brief
e-TB Manager, an electronic TB management system, is a web-based tool used to manage all TB-related data and information needed by national TB control programs. This technical brief documents the implementation of e-TB Manager offline mode mobile application to manage data entry in low connectivity locations across Nigeria.

Introduction of point of care testing for multidrug-resistant tuberculosis patients
Ethiopia – Technical Highlight
The Ethiopian National TB Program has made important contributions to the decentralization of multidrug-resistant treatment and follow-up sites across the country. In an effort to alleviate the challenges related to electrolyte analysis, the Challenge TB project and the Ethiopian Health Research Institute introduced the i-STAT point-of-care analyzer to be used at treatment initiating centers to ensure bedside laboratory follow-up tests to improve the quality of care.

Introduction of second line probe assay in laboratory system in Ethiopia
Ethiopia – Technical Highlight
The recently introduced second-line probe assay (SL-LPA) delivers results for mycobacteria culture and drug susceptibility testing in just 24-48 hours, a vast improvement over the conventional method. The Ethiopian Public Health Institute and the Challenge TB project developed an implementation plan that encompassed practical training on SL-LPA for all TB culture laboratories.

Strong partnership for improved TB and HIV indicators: IPT uptake and completion
Ethiopia – Technical Highlight
The Challenge TB project partnered with the Ethiopian National TB Program and other local partners to ensure the delivery of a continuum of care to expand TB preventive therapy for latent TB infection among persons living with HIV (PLHIVs). This technical highlight describes partnership activities and the feasibility of improving protection from TB disease progression amongst PLHIVs.

Telephone monitoring to improve IPT uptake: Experience from Tigray, Ethiopia
Ethiopia – Technical Highlight
In Ethiopia, the uptake of live-saving treatment among people living with HIV/AIDS has remained low at the national level. With the Ethiopian Federal Ministry of Health, a comprehensive package of program support was provided that included mentoring and supportive supervision, regular quarterly program review meetings, and TB-related formal trainings and material support.

Intensive support for improved TB case detection: Lessons from Ethiopian public hospitals
Ethiopia – Technical Highlight
The Challenge TB project collaborated with the Ethiopian National TB Control Program and regional health bureaus to integrate TB screening into all health service outlets across the country. The intensive support included mentorship of hospital staff by zonal and regional teams​, ​routine check-ins, on-site capacity building, and follow-up.

Introduction of New Pediatric TB Drug Formulations in Ethiopia
Ethiopia – Technical Highlight
In Ethiopia, more than 15,000 pediatric, drug-sensitive TB cases were reported in 2017 and 2018. In alignment with revised guidance by the WHO on therapeutic dosage of first-line TB medicines for children, the Challenge TB Project and the National TB Program supported the transition to new pediatric formulations and phase out of existing medications.

Advances in TB contact investigation in Ethiopia
Ethiopia – Technical Brief
Contact investigation (CI) refers to the systematic evaluation of individuals who have been in close contact with potentially infectious TB cases within three months of TB treatment initiation. In Ethiopia, the USAID-funded HEAL TB and Challenge TB projects implemented three CI approaches: routine or prospective, reverse, and retrospective. This technical brief describes the implementation, results and achievements, lessons learned, and recommendations for CI.

Expanding ambulatory care to treat drug resistant TB in Ethiopia
Ethiopia – Technical Brief
The National TB Programme in Ethiopia is committed to decentralizing and scaling up implementation of drug resistant TB management by using an alternative ambulatory model to increase access to care. Challenge TB in collaboration with the NTP supported the implementation of programmatic management of DR-TB across the country by expanding treatment initiating centers and treatment follow-up centers to ensure access.

Blended learning to build the capacity of TB program officers and clinicians: Experience from Ethiopia
Ethiopia – Technical Highlight
Blended learning is an approach that combines independent reading with short off-site training. This technical highlight describes the blended learning approach for TB training and the outcomes of the MSH and ALERT partnership toward ensuring sustainable delivery of quality TB services in Ethiopia.

Preventive Treatment Demonstration in Bangladesh
Bangladesh – Technical Highlight
It is estimated that a person with TB can infect up to 15 individuals each year until they are treated and non-infectious. This technical highlight documents that identification of household contacts for preventive treatment and high treatment completion could be achieved through a well-designed, community-based program involving appropriately trained health workers.

Institutionalizing Infection Prevention and Control in a TB and Lung Disease Hospital in Bangladesh
Bangladesh – Technical Highlight
TB infection prevention and control (IPC) is a combination of measures to minimize the risk of transmission from a TB case to other patients, health care providers, and the wider population. Since health care providers are most at risk of TB infection and disease, Challenge TB collaborated with the National Tuberculosis Control Programme and the National Institute of Diseases of the Chest & Hospital to strengthen TB IPC practices among nurses and patients.

Institutionalizing a prefabricated Bio-Safety Level-3 laboratory: Lessons from Bangladesh
Bangladesh – Technical Highlight
Challenge TB established a high-quality Bio-Safety Level-3 Laboratory (BSL-3 lab) in Sylhet to accelerate TB and DR-TB diagnosis and treatment in the northeast region of the country. This technical highlight describes the implementation process to establishing this laboratory as a center of excellence to provide TB and DR-TB diagnostic services, build staff capacity at the regional level, conduct operational research, and serve as a TB education center.

Patient enrollment in shorter treatment regimen under national DR-TB Program: Lessons from Bangladesh
Bangladesh – Technical Highlight
The longer duration of MDR-TB treatment regimens and the toxicity of certain agents discourage many patients from completing treatment. Through the Challenge TB project, the standard operating procedure for shorter treatment regimen were revised, incorporating active drug safety monitoring and management and adapting current recording and reporting forms to accommodate shorter treatment regimen data.


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