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This publication shares stories from the Strengthening TB and HIV & AIDS Responses in Eastern Uganda (STAR-E) project. STAR-E is a key partner with the government of Uganda in scaling up HIV and TB services. When the project began in 2009, STAR-E supported just 16 health facilities, with only one that provided antiretroviral therapy (ART).

Afghanistan faces a burden of tuberculosis (TB) among the highest in the world, according to the World Health Organization (WHO). An estimated 60,000 new cases arise yearly, with 110,000 Afghans now living with TB; 14,000 Afghans died from the disease in 2015. Only about two in three presumed patients are found, and the treatment success rate is only 49 percent on average in the country.

Afghanistan faces a burden of tuberculosis (TB) among the highest in the world, according to the World Health Organization (WHO).

At the beginning of the HEAL TB project in 2011, culture and drug susceptibility testing (DST) using solid media was available to the program in two regions to detect drug-resistant tuberculosis (DR-TB) and for monitoring treatment response, which made identifying drug- resistance patterns possible and allowed health care workers to provide more appropriate drug treatment for DR-TB patients.

In Bangladesh tea and rubber garden workers and indigenous communities live in isolated areas with difficulties to access government health facilities. In addition, the level of poverty of some of these groups put them at risk of getting TB.

GeneXpert has revolutionized the diagnosis of tuberculosis (TB) and drug resistant TB (DR-TB) by effectively detecting M. tuberculosis in clinical specimens and RMP resistance in less than two hours without sophisticated laboratories. This enables patients to begin treatment for rifampicin resistant TB on the same day, rather than after several months of ineffective treatment.

The e-TB Manager was used for drug resistant TB case management from 2010. The number of active DR-TB cases being managed in the system increased from 23 in 2010 to 1,037 in 2016.

Challenge TB was implemented in Ethiopia as part of Management Sciences for Health’s (MSH’s) Innovation Challenge Fund (INCH)2 initiative designed to encourage innovative interventions across MSH supported projects. MSH used the ExpandNet Framework3 to scale up the innovation.

Together with Borena and Guji zonal health department and the Oromia Regional Health Bureau (RHB), MSH, through the HEAL TB project (December 2015-June 2016) and now through Challenge TB (December 2016-present), identified six districts within the mining areas. Six woreda coordinators were trained and deployed to coordinate case finding and treatment observation.

Afghanistan has made remarkable improvements in health indicators since 2005. However, a wide range of barriers prevent rural communities in Afghanistan from accessing tuberculosis (TB) and other health services.

Blended learning is an approach that combines independent reading with short off-site training. Management Sciences for Health (MSH), under the guidance of the Ethiopia National TB Program and in partnership with the All-Africa Leprosy, Tuberculosis and Rehabilitation Training Center (ALERT), pioneered a blended learning approach for TB training in Ethiopia.

Urban health facilities present particular challenges in TB service provision.

Mobile applications play an important role in field data collection in developing countries. However, poor infrastructure remains a challenge to fully utilizing mobile services. e-TB Manager, an electronic tuberculosis (TB) management system, is a web-based tool used to manage all TB-related data and information needed by national TB control programs.

The National TB Programme (NTP) in Ethiopia is committed to decentralizing and scaling up implementation of drug resistant TB (DR-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 (PMDT) across the country by expanding treatment initiating centers (TICs

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.

In Nigeria, tuberculosis (TB) is a major public health problem and low case finding remains a challenge to its eradication. The USAID-funded Challenge TB project supports GeneXpert sites across the country. However sub-optimal GeneXpert utilization due to modular failures, power supply issues, and inadequate samples has contributed to low TB case finding.

TB infection prevention and control (IPC) is an important strategy to prevent disease transmission—it 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.

Bangladesh is one of the world’s high MDR-TB burden countries. According to the WHO, the MDR-TB burden is 1.6% among new cases and 29% among retreatment cases. The longer duration of MDR-TB treatment regimens and the toxicity of certain agents discourage many patients from completing treatment.

In collaboration with the National TB Control Program (NTP) in Bangladesh, the USAID-funded 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. The BSL-3 lab, the highest level of safety of its type in Bangladesh, provides rapid and quality services.

Tuberculosis is a major cause of morbidity and mortality among children. In Ethiopia, more than 15,000 pediatric, drug-sensitive TB cases were reported in 2017 and 2018. Until recently there were no appropriately dosed TB medicines for children.

The primary mode for the spread of TB is person to person, and it is estimated that a person with TB can infect up to 15 individuals each year until that patient starts treatment and is rendered non-infectious. The USAID-funded Challenge TB project implemented a demonstration initiative that provided preventive treatment for household contacts of TB patients.

Previously, Ethiopia used conventional methods for mycobacteria culture and drug susceptibility testing, which take 4-12 weeks to get results and require sequential procedures for the diagnosis. The recently introduced second-line probe assay (SL-LPA) delivers results in just 24-48 hours, a vast improvement over the conventional method.

The Ethiopian National TB Program (NTP) has made important contributions to the decentralization of multidrug-resistant (MDR) treatment and follow-up sites across the country.

The dual burden of TB and HIV infection has prompted global attention as well as WHO policies and guidelines.

Ethiopia is among high TB-HIV burden countries and uptake of live-saving treatment among people living with HIV/AIDS (PLWHA) has remained low at the national level.

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