Zimbabwe is one of 19 countries whose TB control campaigns have been awarded funds through Challenge TB, the new funding mechanism for global TB response, launched by the United States Agency for International Development (USAID). In December, it became the first country to receive approval for its Year 1 work plan, after intensive work on the part of The Union as lead partner, the National TB Programme, the Project Management Unit, USAID mission and other collaborators.
In planning the new project, The Union drew on its experience as lead partner for the national TB and TB-HIV response through the previous USAID funding mechanism, TB CARE I. During that time, The Union helped to articulate the critical gaps and priorities for 2015–17 – providing a context for the new project.
Through Challenge TB (CTB), Zimbabwe will seek to consolidate the gains made over the past decade. Zimbabwe remains one of the 22 high-burden countries for TB and HIV prevalence is 15.2% among adults aged 15 to 49.
Previous support saw the successful delivery of an integrated TB-HIV care model in select urban primary care settings. Supported sites sustained gains in key TB-HIV indicators. For instance, antiretroviral uptake among co-infected TB-HIV patients increased from 70% for the January to March 2013 cohort to 84% for the July to September 2014 cohort. Through CTB, it is envisaged that this “One Stop Shop” integrated model of care will be decentralised beyond the urban setting towards universal coverage for greater impact.
TB CARE I support played a significant role in the deployment of more than 60 Xpert MTB/RIF machines across the country as of December 2013. Preliminary findings from a TB CARE I core project in Mutare city and rural district clearly point to the feasibility of optimising use of Xpert to increase TB case finding among people living with HIV in this setting. CTB will replicate this model to more sites including all supported integrated TB-HIV clinics.
Until recently, the national TB surveillance system has largely been paper-based. To improve quality and timeliness of TB surveillance data, an electronic recording and reporting system (ETRR) with in-built quality checks has been introduced through TB CARE I support in 6 provinces. CTB will support a comprehensive evaluation of the current pilot to inform phased roll out, as well as systems integration with existing electronic systems.
Following development of the 1st edition of a Data Collection, Analysis and Use Guide through TB CARE I support, there has been a need to strengthen capacity on its use at all levels. CTB will support capacity building of health care workers on the collection of quality data and its analysis and use for decision making based on the new guide. The training will include a module on the new ETRR.
In 2010, TB CARE I piloted a motorcycle specimen transport (ST) system to transport sputum specimens for microscopy examination. Following the successful pilot, the system was scaled up to 24 districts. It currently consists of close to 50 dedicated motorcycles serving 649 health facilities – over 40% of the country’s primary care facilities. The ST system significantly improved access to TB sputum examinations and general laboratory services for those communities in the rural areas that would otherwise be hard to reach in the absence of this system. Beyond the current model of support, CTB will review on-going support, as informed by key recommendations from a recent USAID-funded evaluation of the system, to ensure more sustainable implementation and integration with existing similar transport systems.