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Project Overview

Project Overview
Publication date: 
Sep 2019
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Since 2016, the United States Agency for International Development (USAID) Tuberculosis (TB) South Africa Project has provided technical support to the South African TB Program at national, provincial and district levels. Working closely with the National Department of Health (NDoH), the USAID TB South Africa Project currently supports 14 districts in six provinces, works directly with more than 30 local non-governmental organizations (NGOs), civil society organizations and faith-based organizations and engages private providers and other private sector partners for important programmatic gains.

The project’s main priorities include reducing TB infections, ensuring the sustainability of an effective TB response system, and improving TB care and treatment among vulnerable populations. Within these priorities, the project implements strategies to align with global and national goals of ending TB by 2030, combatting multidrug-resistant TB and finding missing TB patients, all while leading the country toward self-reliance.

Reducing TB Infections

Increasing Public Awareness of the TB Epidemic

The USAID TB South Africa project works extensively in advocacy, communication and social mobilization (ACSM) at all levels of implementation. These activities include infection prevention and control (IPC) screening campaigns – which have reached over 40,000 people and have identified 256 new TB patients, the My TB Survival Toolkit adherence support package, which has been delivered to over 200 patients, public service announcements in over 160 locations, and commemoration of major health days like World AIDS Day, World Diabetes Day and World TB Day, which have cumulatively led to the screening of nearly 23,000 people and diagnosis of 44 new TB patients.

Infection Prevention and Control

The USAID TB South Africa Project has been a pioneer in implementing the Finding cases Actively, Separating safely and Treating effectively, or FAST, strategy in hospitals throughout supported districts. With 81 hospitals currently implementing FAST in multiple hospital wards, the project has facilitated diagnosis of nearly 6,000 TB patients, 266 of which were Rifampicin-resistant (RR) TB.

The project also innovates in its use of the Urine-Lipoarabinomannan (U-LAM) diagnostic test in certain FAST-supported sites, meant to improve diagnosis of TB among HIV patients with a CD4 count of under 100. The project has identified an additional 332 TB cases with this strategy.

Improved Linkage to Care using Rifampicin Resistant Alerts (Rif Alerts)

The USAID TB South Africa Project implements a variety of innovative strategies to improve linkage to care and reduction of initial loss to follow up (ILFTU). Through Rif Alerts, the project has received 2,292 notifications of Rifampicin Resistant patients and has managed to link 616 of the 766 among them to care that were considered lost. This activity has reduced initial loss to follow up by 80% in the supported areas.

Ensuring Sustainability of an Effective TB Response System

Capacity Building

The USAID TB South Africa Project is a premier partner in technical assistance and continuous quality improvement for the NDoH, District Departments of Health and at the facility level. At the national level, the project provides technical assistance to the NDoH through the secondment of a technical advisor and two Quality Improvement Officers. These staff oversee the implementation of the national QA/QI initiative in ten districts across four provinces. The project has established 32 QI teams in eight subdistricts to implement QA/QI activities and oriented over 1,200 HAST managers, Primary Healthcare (PHC) supervisors and local area managers on DS and DR TB management, FAST and infection prevention and control procedures. At the facility level, the project has trained nearly 4,200 health care workers on DS and DR TB management, FAST and infection prevention and control.

A FOCUS ON QUALITY
Low-dose, High-frequency Training

Low-dose, high-frequency training is an innovative training approach meant to address identified know-do gaps in clinical practice. The USAID TB South Africa Project employs this method through on-site and on-the-job trainings during supportive visits.

The USAID TB South Africa Project employs this training approach for TB Care Management, FAST, DR-TB, and other topics.

Data quality

The USAID TB South Africa Project works closely with the NDoH on ensuring quality data in the country through provincial and district program data reviews, in which project staff work to review performance indicators and compare these results across provinces and districts. These reviews are often paired with training activities to target areas of highest need.

The DR-TB Supportive Care Package

The drug-resistant tuberculosis (DR-TB) Supportive Care Package pilot was implemented in South Africa under the USAID TB South Africa Project to support the National Action Plan for Combatting Multidrug-Resistant Tuberculosis (MDR-TB) within eight clinics in three provinces. The care package focused on home-based risk assessments for infection control, treatment education and counseling for patients and family members, community- and home-based care, management of negative side effects, assessment of patient nutrition, nutritional supplements, referral for HIV treatment as necessary, stigma reduction campaigns through radio broadcasts and community dialogues, assistance to patients for obtaining access to social grants, and transport assistance through the provision of social grants. Patient satisfaction showed that patients in the pilot group felt that providers treated them with respect, made them feel at ease, and that providers listened to them. A provider satisfaction survey showed that 100% of providers felt that the approach to care under the care package was an improvement over the previous method. The model will be scaled up to further improve DR-TB care experiences.

Improving TB Care and Treatment among Vulnerable Populations

Engaging Local Organizations for Improved Patient Care

The USAID TB South Africa Project’s Small Grants program engages local NGOs at the grassroots level to find missing TB patients, to engage patients in supportive care and to improve overall patient outcomes. As the graph shows, the supportive NGO model, which works to provide patients with daily treatment supporters who further engage patients in care, improved outcomes among DR-TB patients in Nelson Mandela Bay Metro (NMBM) district in the Eastern Cape Province. Treatment success rate was uniformly higher in the project sample compared to the district patients. Further, as the model continued to be implemented in 2016, treatment success rates strengthened accordingly within the project. Overall, the small grants component has screened 215,293 people through ACSM activities, 50,311 adult contacts and 4,867 child contacts to date. Additionally, the grants program alone has started 1,014 patients on treatment through ACSM activities, 827 adult contacts and 160 child contacts. Additionally, the grants component has led to 688 children under five being initiated on isoniazid preventive therapy. 

mHealth Innovations for Improved Outcomes

The USAID TB South Africa Project implements multiple mHealth solutions to improve patient care and infection prevention and control. The ConnecTB system helps treatment supporters to keep track of patients at their homes, to record daily medication dosage and side effects from medications. A geo-mapping module allows for identification of high burden TB areas or hotspots for efficient and rapid management.

The IPConnect suite of applications is focused on improving IPC in the facility setting, serving as a job aid for health care workers, and working as a facility-based IPC risk assessment tool. The suite of applications is used widely in South Africa and places IPC at the forefront of TB management at the facility level. 

Engaging Private Providers in the Community Setting

The USAID TB South Africa Project coordinates closely with NEXT2People, an organization which works to collaborate with private General Practitioners (GPs) to improve TB case finding in partnership with the NDoH. In partnership with the National Health Laboratory Services (NHLS), patients who are identified through GPs are linked to public facilities for TB treatment and management. Over 41,000 people have been screened through this program, and among 6,177 presumptive TB patients, 328 people tested positive for TB. To date, 267 of these people have already been initiated on TB treatment. 

THE NATIONAL ACTION PLAN (NAP) FOR COMBATING MULTIDRUG-RESISTANT TUBERCULOSIS

The five-year National Action Plan for Combating Multidrug-Resistant Tuberculosis aims to address the increasing health and security threats of MDR-TB and XDR-TB globally and within the US through the achievement of three goals: 

  1. Strengthen domestic capacity to combat MDR-TB, 
  2. Improve international capacity and collaboration to combat MDR-TB, and 
  3. Accelerate basic and applied research and development to combat MDR-TB.

The USAID TB South Africa Project works directly to advance the achievement of Goal 2 through its numerous MDR-focused activities.