Challenge TB - India Year 3 Quarterly Monitoring Report ...pdf.usaid.gov/pdf_docs/PA00MPX6.pdf · Quarterly Monitoring Report January – March 2017 Submission date: ... Cover photo:

Challenge TB - India

Year 3

Quarterly Monitoring Report

January – March 2017

Submission date: April 30, 2017

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Table of Contents

1. YEAR 3 ACTIVITY PROGRESS 7

3. CHALLENGE TB’S SUPPORT TO GLOBAL FUND IMPLEMENTATION IN YEAR 3 25

4. SUCCESS STORIES – PLANNING AND DEVELOPMENT 27

5. QUARTERLY REPORTING ON KEY MANDATORY INDICATORS 30

6. CHALLENGE TB-SUPPORTED INTERNATIONAL VISITS (TECHNICAL AND MANAGEMENT-RELATED TRIPS) 32

7. QUARTERLY INDICATOR REPORTING 35

Cover photo: Shri J P Nadda, Health Minister, launched TB- Free India multi-media campaign featuring Mr. Amitabh Bachchan on World TB Day, 2017. Photo Courtesy: The Union, USEA

This report was made possible through the support for Challenge TB provided by the United States Agency for International Development (USAID), under the terms of cooperative agreement number AID-OAA-A-14-00029.

Disclaimer The authors’ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

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Country India

Lead Partner The Union

Other partners PATH, KNCV, FIND (Sub-Recipient)

Work plan timeframe October 2016 – September 2017

Reporting period January – March 2017

Most significant achievements:

A. Challenge TB (CTB) provided communication support for active TB case-

finding drive by Government of India (GOI) and made 360-degree

campaign on TB/MDR TB leveraging $1.5 million resources for airing by

GOI CTB provided communication support for active case finding drive (Jan 15-Jan

30th, 2017): CTB provided communication support to The Central TB Division (Ministry of

Health & Family Welfare, Government of India) in the Active TB Case Finding (ACF) drive

launched in 50 districts in 17 states across the country. The drive was launched from

January 15- January 30th, 2017. CTB developed the active case finding

communication campaign. The campaign was developed in Hindi and five regional

languages. The ACF communication campaign with awareness raising messages about TB

symptoms was disseminated through media channels across a population of nearly 9.2

million people in 50 districts). During the time that the campaign aired, the Ministry of

Health and Welfare conducted 48,291 sputum examinations and 2,513 patients (5%)

were diagnosed with TB in the period January 15-- 30, 2017.

CTB develops new 360-degree mass media campaign featuring iconic actor and

TB survivor, Amitabh Bachchan: As part of technical assistance provided to GOI,

Challenge TB developed a new 360-degree mass media campaign on TB/MDR TB. The TB-

Free India Campaign was launched by Shri J P Nadda, Minister of Health and Family

Welfare, Government of India on World TB Day, 24 March 2017. The campaign was

directed by the national award-winning director Shoojit Sirkar, and featured Mr Bachchan.

It focuses on tackling TB as a social issue, not just a medical disease, highlighting

symptoms and the importance of treatment completion and prevention of MDR-TB. GOI is

spending ten crores (approx. US$1.5 million) in airing the campaign nationally through

National TV & Radio (National Television i.e., Doordarshan and AIR FM), from 24 March,

2017 till June 2017.

Mr. Bachchan, as the ambassador for the Call to Action for a TB Free India also

highlighted the campaign on social media through his Facebook page (26,329,933

followers) and on Twitter (534,000 followers). On social media, the campaign received

9100 likes, 171 shares, 277 comments on FB, 18 retweets and 1,332 likes on Twitter.

The campaign videos can be accessed at:

https://www.youtube.com/watch?v=UX1ZBJxQKs0

https://www.youtube.com/watch?v=aP6RHLU7uic

https://www.youtube.com/watch?v=mh0qZ1QK-wI

B. CTB helped facilitate Bedaquiline access to 377 eligible patients in 6

sites across the country:

The National TB Programme of India has developed implementation guidelines for use of

Bedaquiline, under PMDT, in accordance with WHO policies. Bedaquiline has been made

available through the Conditional Access Programme (CAP) at 6 identified sites across the

country. This rollout is being facilitated by the Challenge TB project. The support includes

provision of additional human resource including a medical officer, site coordinator and

outreach workers for coordinating enrolment of patients, counseling, monitoring

adherence and pharmacovigilance. CTB supported essential investigations and equipment

(such as ECG machines) which are critical for initial evaluation and follow up of the

https://www.youtube.com/watch?v=UX1ZBJxQKs0

https://www.youtube.com/watch?v=aP6RHLU7uic

https://www.youtube.com/watch?v=mh0qZ1QK-wI

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patients on Bedaquiline. CTB provided technical support and facilitated review meetings

and training activities to ensure quality implementation of the access program. By 31st

March, there were 377 patients on Bdq, and a total of 435 new patients eligible for Bdq

have undergone pre-treatment evaluations. CTD has also taken a decision to expand

access to Bdq throughout the country and CTB will continue to assist with the scale-up.

C. CTB launched the India TB Caucus, a part of Global TB Caucus Through support from CTB, the India TB Caucus, a network of elected representatives

committed to END TB in India was launched on 8 March 2017 in New Delhi. Four co-

chairs were appointed: Mrs. Viplove Thakur (Rajya Sabha MP, Indian National Congress),

Mr. Majeed Memon (Rajya Sabha, MP, Nationalist Congress Party), Dr. Kirit Solanki

(Loksabha MP, Bharatiya Janta Party), and Dr. Boora Narsaiah Goud (Loksabha MP,

Telenaga Rashta Samithi) and Prof. P. J. Kurien, Deputy Chairman - Rajya Sabha was

appointed as Patron of the Caucus. Twenty-six members of the parliament from both

Rajya Sabha and Lok Sabha, including two former MPs and four Members of the

Legislative Assembly became active members of the Caucus and agreed to a) advocate

with the Prime Minister’s Office and Ministry of Finance for increased resources for TB; b)

raise awareness among PRIs (Panchayati Raj Institution members) in their constituencies;

c) fight stigma against TB patients/ families by addressing it in their public gatherings.

The Union was asked to act as the secretariat for the India TB Caucus and the seven

founding organizations (IAPPD, CLRA, GHS, Reach, GCAT, Aequitas, and The Union) will

be part of the Advisory Group. After the Caucus launch, members of the Caucus have

taken measures in their constituencies to increase awareness of TB and raise questions in

parliament. Shri Viplove Thakur invited the Health Minister of HP, Shri Kaul Singh Thakur

to be part of the panchayat sensitization on TB in Nurpur, Kangra district, which is

included in the group of 100 highest prevalence districts in the country. A total of 300

local elected representatives were sensitized as a result. Two members of the Caucus

attended the Berlin TB summit sponsored by the Global TB Caucus and on their return

raised questions in parliament on need for vaccines/ research and nutritional support for

patients on TB.

D. CTB provided technical assistance to launch 4 large TB projects with

businesses and Rotary India As part of the Call to action, CTB did advocacy and sensitization efforts with businesses through the Mumbai and Delhi Dialogues in the previous year and engaged with various corporate/other partners to launch projects on TB. As a result, these partners have

announced projects in their selected geographies.

1. GAIL, the largest gas transmission and marketing public sector undertaking

company in India launched a TB project worth INR 1.12 crore ($165,000) for

awareness, screening, diagnosis and nutritional support for TB patients in

Pata (where GAIL has a petrochemical plant) and surrounding areas of

Auraiya district (Uttar Pradesh). The project will have provision for a Mobile

Medical Unit (MMU) with a trained team including a medical officer, technician and

outreach workers; digital microscopy and cartridge-based nucleic acid amplification

test (CBNAAT) testing service for 2 years. In the first year, the van will provide both

awareness and screening services. It will operate on a fixed day at a fixed venue

basis for 6 days a week.

2. DLF Foundation launched “TB-Free Delhi/ NCR” project to establish an MDR-TB

rapid diagnosis center and to provide nutritional support to the identified MDR-TB

patients in Delhi and adjoining areas. Key components of the project include i.)

awareness generation campaigns (est. INR 23 lakhs or $35,000), ii.) CBNAAT

machine with required cartridges (CBNAAT machine-one-time cost of INR 15.50 lakhs

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or $23,000; cartridges for a year- INR 15.12 lakhs or $23,000, approximately 120

tests/ month costing INR 1050 or $17 each), iii.) Lab Technician for the CBNAAT

machine (INR 5 lakhs/year or $7,352), and iv.) Nutritional support to the identified

MDR patients. DLF sponsored the installation of CBNAAT machine at Wazirabad

Primary Health Centre (PHC). The screening through CBNAAT machine will be

done free of cost at the PHC - the referral centre for 7 sub-centers that caters to an

estimated population of 30,000. The move is expected to reduce workload on the lone

CBNAAT machine installed at Civil Hospital, Gurgaon (serving a population

of 1,514,085, Census 2011) and also help in early diagnosis of the disease.

3. Institute of Driving & Traffic Research (IDTR- joint venture between the

Department of Transport of State Governments and Maruti Suzuki India Ltd.) Under

this partnership, IDTR (through its 6 centers) will reach out to 300,000 drivers

applying for new license/ renewal of license annually and raise TB awareness along

with HIV & Tobacco use. IDTR will also issue advisory directives to all its branches and

training institutes to integrate elements of TB prevention and care in its trainings

modules and display all materials of the TB-Free India Campaign.

4. Rotary India conducted TB awareness and screening drives to commemorate

World TB Day: Rotary districts conducted 6 awareness and sensitization meetings

reaching approximately 1,200 people; 3 health camps reached 480 people in urban

slums in Delhi and Gurgaon; 1 mass media activity to increase TB awareness was

conducted in Chennai. The Rotary District 3080 organized a sensitization meet in

Ambala, Punjab, covering 6 states and 76 clubs. Rotary National TB Control

Committee committed INR 30 lakhs ($44,000) for TB Activities and a Rotary

Trophy for best performing clubs was announced. Out of 480 who came for health

camps in Delhi and Gurgaon (camp provided other health services too). A total of 106

chest symptomatic TB cases screened. 45 patients had Chronic Obstructive Airway

disease, Bronchial Asthma, Interstitial Lung disease. One suspected lymph node TB

(child case) referred to All India Institute of Medical Sciences (results not yet known).

But so far no cases of tuberculosis identified.

Comprehensive, high quality diagnostics (FIND) During the reporting period, a total of 10,792 presumptive pediatric TB and DR TB patients were

tested. Of the total tested, 739 (6.8%) cases were diagnosed as Xpert-positive under the project

with 68 (9.2%) patients being diagnosed with rifampicin resistance. As observed in the previous

quarter, more than half of (52.5%) non-sputum specimens were tested on Xpert reflecting better

utility of the test. In line with Year 3 objectives, focus remained on detailed analysis of project

data to identify areas for improvement as well as the broadening of continued medical education

(CMEs) on pediatric TB including specimen collection and treatment regimens. In addition, as per

the plan, four initial sites (Delhi, Hyderabad, Chennai and Kolkata) were transitioned to the

National TB Program (NTP) by the end of the quarter in a smooth phased-in manner.

Patient-centered care and treatment Under CTB, PATH implemented GIS mapping of the private health sector through mobile phone-

based application called I-Monitor in Mumbai, Thane and Pune. State level consultation was

conducted in Maharashtra on February 9, 2017 for sensitization of public officers from state TB

cell, State AIDS Control Society, WHO and district officers. The operational road map was

discussed in consultation with state officers with commitment from corporation offices for support

in the field. In Uttar Pradesh and Odisha, the state Project team for Global Health (GH), including

the program officers, treatment coordinators, sputum collecting agents and data management

staff have been established and training of the project field team (as mentioned above) on skills

and capacity building for private sector engagement as well as the DRTB implementation model

has been completed. Sensitization of leading chest physicians/physicians and office bearers of

professional medical bodies was completed in- Odisha by Champion Provider from Mumbai-Dr

Vikas Oswal at a state level annual conference.

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Progress on CTB end-of-project SMART expected achievements:

CTB end-of-project SMART expected achievement

Baseline

2014

Actual Result

2015

Actual Result

2016

Remarks (progress

to date, challenges, achievements)

By 2019, 10 comprehensive partnerships will be

established that leverage Challenge TB technical assistance (and act as private sector cost share to CTB

efforts) to address early detection of TB/DR-TB

0 2 17

The amount of money these partnerships have leveraged will be shared annually.

By 2017, 50,000 presumptive pediatric TB patients will be tested with GeneXpert

6,732

15,345 30,977 We are on track to

reach the target for year 3; 20,626 patients have been tested until 31st 17

By 2017, 1,600 eligible patients will be started on bedaquiline as a part of their treatment regimen in 15

sites, and by 2019, 7,600 patients will be started on

bedaquiline-containing regimens (cumulatively in all 35 sites) in the country

0 N/A 377 Since site expansion to new sites besides 6 is still awaited, it is difficult to estimate if

we will be on track. however, this has

been announced and should rapidly expand once the sites have been selected.

Technical/administrative challenges and actions to overcome them:

Delay in process of sub-contract between FIND and KNCV. It is planned to be signed in April 2017. This led to a delay in initiation of new activities at the project sites. We will be expediting our efforts once MoU is signed.

During the process of workplan approval, CTB PATH team initiated the preparatory activities (i.e. selection of the state project team for UP, Odisha and Maharashtra, coordination with the state government officials in the TB and HIV cell, sensitization of the district officers and private providers) to be able to kick off the activities as soon as

possible after the approval is received. PMDT Unit- There is delay in establishing the PMDT Unit, as the National program /

Central TB Division (CTD) is still in the process of getting the selections approved by the health ministry. While the candidates have been selected by the CTD, they are yet to get clearance from the Ministry of Health.

The proposed expansion to 20 Sites for Bedaquiline this year, is also delayed as CTD has

not yet shared the list of sites that they want CTB to support.

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1. Year 3 activity progress

Sub-objective 2. Comprehensive, high quality diagnostics

Planned Key Activities for the Current Year

Act. #

Planned Milestones Milestone status Milestone met? (Met, partially, not met)

Remarks Oct-Dec 2016 Jan-Mar 2017 Apr-Jun 2017

Jul-Sep 2017

Year end Oct 2016 – Mar 2017

Operations of the rapid diagnostics

2.4.1 All field staff in place.

All 18 GeneXpert

machines functional

All 18 GeneXpert machines functional

All 18 GeneXpert machines functional

All 18 GeneXpert

machines functional

All 18 GeneXpert machines are functional

Met

Introduction of

GXAlert to connect Xpert and other TB diagnostics in 3 states

2.4.2 GXAlert

introduced in 3 states

Not in FIND’s scope of work N/A As per our

discussions with the CTD, we will not be supporting implementation of GX Alert and in the

year 3 sub contract, no funds have been allotted for this activity to FIND. Instead, as

requested by CTD,

we will be supporting CTD in implementing the Machine to Nikshay Connectivity solution which will perform the same

function as GX-Alert while hosting

the server in country on the Govt website. Concurrence from

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USAID/India was sought and the

same has received for initiating this activity using available funds under APA3.

Laboratory preparatory

activities including AC/ UPS and upgrading

2.4.3 All sites renovated

Sites have been renovated Met All 9 sites were operational in year

2 of the CTB project and no major additional activity was undertaken in year 3. Overall, we have undertaken

need based maintenance of

existing equipment under the project at the sites

Laboratory consumables, ancillary

equipment, and other miscellaneous items,

Development of ICT innovations

2.4.4 25,000 GX cartridges procured

Increase referral sites from 575 to 2,000;

We have adequate cartridges to carry out project activities and additional cartridges will

be procured before the end of quarter 3.

Referral sites as of 31st March, 2017 were 1,106.

Partially met

Advocacy

meetings / CMEs, media briefings and outreach activities

2.4.5 1,000

providers reached

1,000

providers reached

1,000

providers reached

2,000

providers reached

5,000

providers reached

2,299 providers approached (Oct 2016 to Mar 2017)

Met

Documentation of project findings

2.4.6

Draft manuscript developed

Submission of at least

one

4 manuscripts have been drafted

Met Draft manuscripts will be shared as

soon as they are

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manuscript for Publication

finalized after inputs from all

authors

ICT Innovations

2.4.7 Use of GIS/GPS mapping and analytical

tools operationalized

ICT applications for rapid reporting developed

/adapted to local needs and piloted

E-modules developed for remote

learning

ICT applications and e-modules developed

and piloted

We have planned to connect all

Xpert machines to Nikshay and

we have initiated this activity

under the project. We will shortly

be sending a formal request to

KNCV PMU for reallocation of

the budget under ICT innovations

to allow us to carry out this

activity.

Not met The sub-agreement for Year 3 has been signed in April 2017 and we have already

initiated ICT innovation activity

Review

meeting for Project staff

2.4.8 Review

meeting for project staff

Review

meeting for project staff

2 Review

meetings for the project staff

Not met The MoU for Year 3

has been signed in April, 2017 and review meeting will be conducted in May, 2017

Transition of project sites to NTP

2.4.9 Handing over Lab logistics

(supply of consumables) to NTP by RNTCP for 4 sites;

Lab activities

(key lab operations, including conducting tests, reporting of results,

advocacy

with providers) to be supported

Phasing out of support for lab

activities for 4 labs and labs fully handed

over to NTP

Lab logistics and

activities handed over to NTP for remaining 5 sites

Handing over of all Project sites to NTP

Initial 4 project sites have been transitioned to NTP smoothly in a phased manner on 31st March, 2017

Met

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in the form of HR

Access,

operation and utilization of rapid diagnostics (i.e. Xpert) ensured for

priority populations and Expedient laboratory specimen transport and results

feedback system operational

2.6.1 22,000

children tested

36,000

children tested

50,000

children tested

Upfront

Xpert MTB/Rif testing for 50,000 children with presumptive

TB

20,626 (93,8%) children were tested

Partially met

At Guwahati site,

there were issues related to biomedical waste which led to halt of activities for almost a month.

Currently, the site is functional. Further, we were redirecting the samples from the initial 4 transitioned sites’

providers/facilities to nearest RNTCP

Xpert lab in order to sustain the referrals beyond the project

Sub contract to FIND

2.6.2 Sub contract awarded

screening of 50,000

symptomatic TB patients, covering more than

5,000 provider through CME's

Subcontract for Year 3 is awaited

Not met The sub-contract planned to be

signed in April 2017

Sub-objective 3. Patient-centered care and treatment

Planned Key Activities for the Current Year

Act. #

Planned Milestones Milestone status Milestone met? (Met, partially, not met)

Remarks (reason for not meeting milestone, actions to address challenges)

Oct-Dec 2016

Jan-Mar 2017 Apr-Jun 2017 Jul-Sep 2017 Year end Oct 2016 – Mar 2017

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BCC campaign for TB/MDR TB

3.1.1 Agencies hired/

Contracts extended

Materials developed

Materials developed

Materials developed

CTB developed active TB case finding campaign, featuring

Shri Amitabh Bachchan to support GOI’s Active TB Case Finding (ACF) drive in 50 districts across the country. The ACF communication campaign with awareness

raising messages about TB

symptoms was disseminated through media channels across a population of nearly 9.2 million people in 50 districts. ). During the time that the campaign aired, the

Ministry of Health and Welfare conducted 48,291 sputum examinations and 2,513 patients (5%) were diagnosed

with TB in the period January 15-- 30, 2017.

The TB-Free India Campaign was launched by Shri J P Nadda, Minister of Health and Family Welfare, Government of India on World TB Day 2017, 24 March 2017. GOI

will spend $1.5 Million in

airing through Doordarshan and AIR FM, from 24 March, 2017.

Mr. Bachchan also shared the campaign on his Facebook page reaching 26,329,933 followers and twitter 534,000 twitter followers ; the

campaign received 9.1 K

likes,171 shares, 277 comments on FB, 18 retweets & 1332 likes on Twitter.

Met

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Map the private sector doctors,

hospitals and laboratories, Networking with engaged private providers and

notifications for

TB patients into Nikshay from private sector

3.1.6 Mapping and

selection of private sector providers

Mapping and

selection of private sector providers, Engage 15% of the

selected

private provider. Notification from the engaged providers

Engage 70% of

selected private providers. Notification from the engaged providers

Engage 100% of

selected private providers. Notification from the engaged providers

Mapping and selection of

private sector providers

- Mapping training on GIS tools and I-Monitor

software was completed. 30 field staff (15 Females,15 Males) were trained to conduct the mapping activity in Thane, Mumbai and Pune

- 24 private facilities in

Mumbai have been engaged for RDT in the private sector for TB patients

Partially met

The approval on work plan was

delayed by 1 quarter. The subcontracting with the Mapping agency was also delayed and thus

all mapping related

activities are delayed by 1 quarter. The field team has started mapping on April 1 and the target will

be achieved by the end of 3rd quarter

Sub-

contracting and hiring of local NGO, Hire staff for the PATH Project support

unit, and hiring staff for the DR-TB centre in Thane

3.1.7 Selection

process of the NGO

Orientation

and sensitization of NGO staff

1 workshop

2 workshops

Both local NGOs: Maharashtra

Janavikas Kendra and Alert India were selected and respective work localities geographies were assigned. (Alert: NMMC, 5 wards of

Mumbai, Cuttack and Bhubaneshwar)

MJK: Allahabad, Moradabad, Thane municipal corporation and 7 wards of Mumbai

2 orientation and sensitization workshops were conducted to sensitize project directors of ALERT and MJK about the :

DRTB model in Maharashtra, Odisha and U.P

Data collection tools and

techniques Roles and responsibilities

of the PMU staff Administrative procedures

Met

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of designing the MoU, Vouchers and trainings for

private sector engagement

CBO staff have been on-boarded in all three states.

Testing presumptive

TB cases GeneXpert (private and public), Reimburse the PTE test costs to private

networked laboratories,

Notify DR-TB patients

3.1.8 2,000 presumptiv

e DR-TB cases tested w/ Xpert;

160 RR-TB cases diagnosed by Xpert;

144 RR-TB patients received PTE

3,000 presumptiv




5,000 presumptiv




136 presumptive DR-TB cases received Expert testing from

4 wards of Mumbai from IPAQT accredited laboratories.

16 Rifampicin-resistant (RR-

TB) cases were diagnosed (12%)

All 16 RR- TB patients

received Pre- treatment evaluation, 10 patients were referred to Hinduja lab for Drug sensitivity test. 11 patients were initiated on treatment. (11 were started on treatment. Field operations

began on 23rd March 2017. This data is from 23rd March to 31st March only)

Partially met

After an accelerated

start-up of activities, field operations in Mumbai began on March 23rd 2017. GH component is

implemented in 4 out of 24

wards of Mumbai: S, N, T and R wards

All 136 received Xpert testing and hence registered as presumptive

DRTB cases

1. Workshop at State level for public sector to sensitize referral

mechanisms of private sector,

2. Workshops for private sector practitioners,

3.1.9 2 workshops for public and private sector to

be conducted

5

4 workshops for public and private sector to

be conducted

6

Total 17 workshops conducted.

1 workshop conducted in Maharashtra.

1 workshop for sensitization of private chest physicians was conducted in Odisha in Bhubaneshwar.

Champion provider from Mumbai delivered the session and 45 doctors from public

Partially met

1 more workshop was scheduled in Odisha but is postponed due to the unavailability

of the state TB officer

The remaining 15

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office of Indian Medical

Association (IMA) and TB champion providers from Mumbai,

3. Community mobilization activities for community empowerment

collaborative/impleme

ntation workshops

collaborative/impleme

ntation workshops

and private sector attended the training. 16 doctors were

from private sector out of which 6 were females and 10 were males. The training was on diagnosis and treatment of TB and DRTB and utilization of PATH’s model for early

diagnosis and initiation of treatment.

Participants included officials

from RNTCP, NACO, MCGM, other corporations, State TB Cell, MSACS and MDACS, WHO, USAID, PATH and other academic institute and hospitals. The discussion was

focused on Expansion of

TB/HIV and DR-TB services across 3 districts in Maharashtra in alignment and coordination with the state and district officials from RNTCP and NACO

workshops will be conducted in UP,

Odisha and Maharashtra.

2 state level workshops with TB departments in UP and Odisha in 3rd quarter.

2 inter departmental coordination workshops for

social linkages in each state. So 6 workshops in 3rd and 4th quarter.

5 more workshops for private sector sensitization : 2 in UP, 2 in Maharashtra and 1 in Odisha

2 workshops for

district level coordination in U.P and Odisha

Training of project staff Operation model of the project in selected cities

Facilitating

3.2.6 2 trainings

4 workshops for CMCs

1 training

4 workshops for CMCs

The team prepared 4 trainings with marketing associates for private sector engagement, and 4 staff were recruited under PATH.

The CBOs recruited a team of 20 field staff in UP and 20 in

Odisha for counseling, patient

tracking and coordination on field. Preparation for training the CBO staff was conducted by PATH team through

State officials in Odisha: government medical college HOD, PMDT

department officers, attended GeneXpert sites

In the first week of April, 50 CBO staff and 4 marketing associates across

15

sensitization of Community

Mobilization Co-coordinators in Uttar Pradesh

developing training modules and communication materials in this quarter.

Odisha and UP were trained

Create linkages in public sector,

Providing treatment adherence

support to DR-TB patients

Linking DR-TB patients with social and

economic support schemes of various

departments and ministries

Reminder SMS and calls for treatment

adherence to TB patients

3.2.7 64 DR-TB patients linked for

treatment,

64 DR-TB patients to be

provided treatment adherence services,

15 patients to be enlisted

120 DR-TB patients to linked for

treatment,

120 DR-TB patients to be

provided treatment adherence services

40 patients to be enlisted

12 DR-TB (of the 16) patients in Mumbai (4 wards) were linked to district TB officers

for initiation of treatment under RNTCP (Remaining 4 are in process for registration at the DRTB center since they were diagnosed during the end of quarter. This data is only from 23rd

March to 31st March. Updated data will be shared

in the next QMR)

Profiling for eligibility of all 16 DR-TB patients have been conducted for establishing linkages to social schemes.

Linkages to social schemes

will be established in the next quarter.

Adherence support through calls (once in 15 days) and home visits (LFU patients) is provided to all patients initiated on DR-TB treatment in public sector

Met

(over-achieved): According to the workplan targets,

GH PATH team were not expected to begin with testing and treatment in 2nd quarter, however we have registered

cases in this quarter due to the

preparatory work completed.

MIS for tracking of the patients

3.2.8 N/A Assess existing data

Develop data manageme

Establish data manageme

Develop, supervise and improve

MIS tracking format for DR-TB work plan has been

Met The tools and techniques for data management will

16

detected in private sector

and registered at DOTS plus site, project tracking and monitoring

management systems

in private and public sector

nt systems for

tracking and monitoring program activities and

information sharing

nt systems for

tracking and monitoring program activities and

information sharing

an established

internal data management systems for tracking and monitoring program

activities and

information sharing

developed.

Data collection tools for treatment coordinators and sputum collecting agents are developed

be rolled out in UP Odisha and Thane,

Mumbai in the third quarter after kick starting the DR-TB diagnosis and treatment model

PMDT review meetings and introduction TA on BDQ/ Shorter

regimen from KNCV/ The Union

3.2.1 1 of 4 TA visits and meetings for BDQ introduction

2 of 4 TA visits and meetings for BDQ introduction



1 of 4 TA conducted Partially met

Dr. Fraser Wares visited India with specific objective to Assess progress in introduction of

bedaquiline for drug-resistant TB

in two BCAP implementing sites in Delhi, India Review and discuss the progress in

introduction of new drugs and regimens for DR-TB patients in India with RNTCP

officials, USAID

and the Union

Training for BDQ/ Shorter regimen

3.2.2 1 of 2 trainings conducted

2 of 2 trainings conducted

2 Trainings conducted

No training conducted Not met New PMDT guidelines, including guidelines on Shorter Regimen

have been released by CTD; 4 Regional ToT have

been conducted by CTD/WHO between February & April. Dr Neerja Arora

participated in one

17

ToT workshop. CTB proposes to

organize sub regional/ state level ToT trainings in next quarter

1 workshop

with RNTCP and Tibetan

DoH in Dharamshala for strengthening linkages + 5

day MDR TB Course for Tibetan Health care providers by The Union .

STTA provided by Pepe

3.2.3 1

Workshop conducted

1 MDR TB

Course conducted

0 Workshop conducted

Not met Dr Pepe Caminero

was unavailable and this activity

has been deferred until December 2017

Establishment

of PMDT unit / provision of technical support for shorter regimen and

BDQ roll out

3.2.4 5 PMDT

consultants hired

Technical

consultants hired and PMDT activities conducted under

guidance of CTD & CTB

0 PMDT consultants hired

though recruitment was initiated, interviews held and candidates selected. Five successful applicants are now awaiting the MOHFW-CTD approval.

Not met Recruitment

process ongoing. Selection of candidates completed. CTD (Central TB Division) is

processing their candidature for approval from MOHFW. It is anticipated that all 5 consultants will have assumed duty by Q4.

Support for BDQ sites

3.2.5 6 BDQ

sites staffed and equipped with ECG

Total 10

BDQ sites staffed and equipped with ECG

Total 15


Total 20


20 sites staff

hired, equipment and tests conducted

6 BDQ sites staffed and linked

to districts equipped with 100 ECG machines

Partially met

18

machines.

250 BDQ cases undergo

Pre-evaluation tests

machines.

300 new BDQ cases undergo


machines.



machines.



435 eligible BDQ cases underwent pre-evaluation tests including ECG and/or Lab investigations

Note: GH. – Update will be provided in Q2 since approval was not received until Dec 31, 2016

PEPFAR Updates Year 3:

Sub-objective 3. Patient-centered care and treatment

Planned Key Activities

for the Current Year

Activity

#

Planned Milestones Milestone status Milestone met? (Met,

partially, not met)

Remarks Oct-Dec 2016

Jan-Mar 2017

Apr-Jun 2017

Year end Oct 2016-Jun 2017

Map the private sector doctors, hospitals and laboratories, Networking with

engaged private providers and notifications for TB patients into Nikshay from private sector

3.1.1 Mapping and selection of private

sector providers

24 private facilities engaged

Mapping and selection of private

sector providers, Notification from the engaged providers

33 private facilities engage

Notification from the engaged providers

40 private

facilities engaged

Notification from the engaged providers

48 private facilities engaged

Mapping activity in Thane, Pune and Mumbai began on March 8th. Training of

field staff on I-Monitor, procurement of tablets, and module on GIS training through I-Monitor was

completed in march

24 facilities in Mumbai are engaged and are notifying TB patients for TB/HIV testing

Partially met

Late start of implementation of activity, led to delay in subcontracting the

Mapping agency. As a part of preparatory activities recruitment of field staff, identifying agency for GIS training and development of software prototype for

I-Monitor was completed

during this quarter. The field team started mapping on April 1 and the target will be achieved by the end of 3rd quarter.

Provide free HIV screening test to TB patients and reimburse the cost of the test

3.1.2 175 TB patients receiving free RDT

535 TB patients receiving free RDT



1,709 TB patients were screened for HIV from October 2016-March 2017 in 24

private facilities in Mumbai. 30 out of 1709 (1.8%) tested

positive on the rapid

Met The work plan approval was received on January 6th 2017. Prior to this approval, PATH was only

able to test patients in 17 facilities. Now that we are able to expand our

operations and network we

19

diagnostic test. Total number of TB

registered patients were 2,000 and remaining 291 are being followed up by the Link counselors to be tested. 30 HIV

positive patients were

provided post-test counseling by the link counselors and linked to nearest Integrated counseling and testing center for

confirmation. Ward wise report of these 1,709 patients is shared with MDACS

for notification into national data systems

expect the number of patients tested and placed

on free RDT to significantly increase.

MIS for tracking of the patients detected in private sector and project tracking and monitoring

3.1.3 3 review meetings

3 review meetings

3 review meetings

Data collection tools were improved based on APA 2 experience. 4 review meetings, 2 with each of the CBOs

(MJK and ALERT) for reviewing, adding

variables as per new work plan and disseminating the data tools. The meetings

included the project director, MIS assistant, operations manager. MIS officer is yet to

be recruited for both CBOs PATH has

facilitated sharing of monthly reports with

Met Data systems have been strengthened. PATH and CBOs are evaluating to introduce an ICT based system for data collection

through tablets. An update on this activity

will be provided in the next quarter. This activity also resulted in establishing information

sharing on HIV screening from the private facilities to Government of India (MDACS in Mumbai) under existing national private

sector engagement guidelines.

20

MDACS for Oct to March 2017

Capacity building of providers on TB - HIV screening Guidelines

3.1.4 4 sensitization sessions/trainings to be

conducted 2

implementation workshop with public

sector

4 sensitization sessions/trainings to be

conducted 2

implementation workshop with public

sector

4 sensitization sessions/tra

inings to be conducted

2 implementation

workshop with public sector

4 sensitization sessions/tr

ainings to be conducted

2 implementation workshop

with public sector

1 training for 3 days was conducted on mapping techniques with I-Monitor. 12

females and 18 males from both CBOs were trained. Total 30 field

staff were trained on GIS techniques, mapping indicators, and I-Monitor

software

Partially met

Implementation workshops with public sector such as ART and ICTC sensitization

workshops in Thane, Mumbai and Pune are targeted in the third and

fourth quarter.

Establish appropriate counseling and referral services at engaged

facilities

3.2.1 3 TB patients tested

positive on HIV test Post test counseling conducted:

3 HIV patients (100%)

90% of HIV positive patients

linked to ICTC for confirmation

10 TB patients tested















30 TB patients tested HIV positive in private sector

All positive patients were provided post test counseling

27 patients were linked to ICTC for confirmation

Pre ART registration also completed at the ART centers

Met MDACS has linked 24 facilities to 18 stand-alone ICTC for smooth referral.

CTB ‘link’ counseling platforms are established with the ICTC counselors for confirmation of private sector TB patients and further linkages to ART

centers.

Sub-objective 7. Political commitment and leadership

Planned Key Act. # Planned Milestones Milestone status Milestone Remarks (reason for not

21

Activities for the Current Year

Oct-Dec 2016

Jan-Mar 2017 Apr-Jun 2017 Jul-Sep 2017 Year end Oct 2016 – Mar 2017 met? (Met, partially, not met)

meeting milestone, actions to address challenges)

Workplace TB Policy

7.2.1 Sub contract with ILO awarded

Meetings with businesses

and Business association

s conducted



s conducted



s conducted

Draft Workplace policy prepared

Work in progress Not met Work plan approval received on Dec 30, 2016.

Contracting with ILO was initiated in Q2 and is expected

to be completed in Q3.

TA to partners who have committed

through LOI in APA2

7.2.2 Meetings with partners

Meetings with partners



• Meetings held with:

1. TA to Businesses

a) TA meetings held with Challenge TB’s corporate partners: Essar Foundation (Male: 16; Female:08) on

January 24, 2017, in Mumbai;

Omkar Foundation (Male: 37 Female:6); IL&FS(Male: 19 Female:17) March 06, 2017 in Bilaspur, HP, and J V Gokal, March 04, 2017 in Khambhaliya, Gujarat. Meetings were also one with

GAIL India , DLF Foundation and IDTR for launching of

corporate CSR initiatives on TB in Pata , UP ( Medical Mobile Unit by GAIL) and Wazirabad , Haryana

(CBNAAT machine installed at PHC by DLF).

2. TA to Rotary

a. The Rotary District 3080

(as part of Rotary district

sensitization meet in Ambala, Punjab), covering 6 states 76 clubs, also received a commitment equivalent to Rs.

Met

22

30 lakhs from Rotary for TB Activities specially to support

campaign for active case findings.

b. As part of Rotary India’s ongoing initiatives nine awareness sensitization meets were conducted.

Through these 1200 Rotary club representatives were

sensitized, 76 clubs in district 3060 (Ambala) will be conducting awareness camps on TB this year.

Three awareness and TB screening drives reaching 480 patients were held in Delhi & Gurgaon.

c. Extensive TB awareness drive was conducted in mass media to commemorate

World TB Day in Chennai. A talk on TB in Fever 104 FM channel on the eve of World TB Day and full day program(s) covering TB on

the World TB Day. •500

students walk to raise awareness. Tamil Actor Aari also participated. • 4 TV channels (Sun TV, News 7, Puthiya thalai murai, News 18) covered the events. Six newspapers published

reports/ news pieces.

3. CTB facilitated Parliamentarian action on TB: through launch of

23

India TB Caucus on March 08, 2017 in New Delhi.

Four co-chairs and patron were elected and The Union will work as secretariat. 26 MPs & MLAs signed the letter of commitment and joined the caucus. This resulted in:

a. Co-chair doing outreach in her constituency: A

sensitization meeting of Panchyati Raj Institution members was conducted on March 26 in Nurpur Block of Kangra District in Himachal Pradesh. The

meeting was chaired by

Health Minister, Government of Himachal Pradesh, Co-chair of India TB caucus Ms. Viplove Thakur, MP, and Shri. Ajay Mahajan, MLA. 300

panchayat members comprising of Sarpanch, Panchayati Samiti Members were sensitized

as a result. b. Members India TB Caucus

Shri Ananda Bhaskar

Rapolu (MP, Rajyasabha) and Shri Nadimul Haque (MP, Loksabha) represented India in the Berlin TB Summit from 20-22 March 2017

sponsored by Global Tb

caucus. c. Post Berlin TB Summit,

Shri Rapolu highlighted the need for safe medicines, TB vaccines

24

and the possibility of linking TB patients with

Antyodayo Yojana (a government scheme) to address the problem of nutritional support for TB patients. Recording of the speech is available at

https://www.youtube.com

/watch?v=TIvT1tLBNw4&feature=youtu.be

4. Mobile Van services for TB awareness/ screening launched

through HelpAge India- civil society partner of call to action by Health Minister, Government

of Himachal Pradesh on March 26, 2017. Services include TB Awareness and

screening in the state of Himachal Pradesh through nine Mobile Medical Units (vans). The Mobile Medical Unit (MMU) comprising of medical

doctor, health worker and

an attendant will operate in 4 districts viz. Shimla. Solan, Hamirpur and Kangda in Himachal Pradesh. The van has been supported by Cipla

Foundation.

Shifted to 3.1.1 7.2.3 Choose an item.

Dissemination

of corporate and other partnerships results/

7.2.4 Meetings

with stakeholders and

Meetings


Meetings


Meetings


a) CTB shared the project’s

achievements and lessons learned/ approach in USAID partners meet held on February 22-23, 2017.

Partially met

https://www.youtube.com/watch?v=TIvT1tLBNw4&feature=youtu.be



25

achievements of CTB and C2A

partners partners partners partners b) CTB discussed

“Tuberculosis: A Growing Public Health Challenge” at 67th Annual National OCCUCON 2017, held on February 9, 2017 at New Delhi.

c) CTB disseminated project learnings in panel discussion on “Emerging TB Challenge in India: how to strengthen public private partnerships” as part of the

national workshop on "India Towards Comprehensive TB Care: Building Partnerships", held on February 15, 2017 in

New Delhi. The audience comprised leading corporates, PSUs, Civil society and

academicians in India.

3. Challenge TB’s support to Global Fund implementation in Year 3

Current Global Fund TB Grants

Name of grant & principal

recipient (i.e., TB NFM - MoH)

Average

Rating* Latest Rating

Total

Approved/Signed Amount**

Total Committed

Amount

Total

Disbursed to

Date

Providing universal access to DR-

TB control and strengthening civil

society involvement-NFM (2015) -

World Vision India

B1 B1 $6,904,741 $4,865,478 $3,704,900

Providing universal access to DR-

TB control and strengthening civil A2 A1 $23,152,396 $16,212,253 $11,182,144

26

society involvement-NFM (2015) -

The Union

Consolidating and scaling up the

revised national tuberculosis control

program (RNTCP) –NFM (2015) -

Central TB Division

B1 A2 $207,785,667 $186,585,390 $104,289,630

* Since January 2011

** Current NFM grant not cumulative amount; this information can be found on GF website or ask in country if possible Source: https://www.theglobalfund.org/en/portfolio/country/list/?loc=IND&k=7c973abd-19b9-486b-956a-8ddeb7dd3f58 accessed on 17-04-2017 In-country Global Fund status - key updates, current conditions, challenges and bottlenecks Total allocation for the next three years (Jan 2018 to Dec 2020) from the Global Fund is USD 500 million, with USD 280 million allocated for the TB component. Preparations are on track to submit India’s TB grant proposal to the Global Fund in the May 2017 submission window. The national strategic plan (NSP) for TB elimination in India 2017-2021 has been drafted and posted on the RNTCP website for public comments till 3 March 2017 at http://tbcindia.nic.in

The GF TB proposal will be based on the priority areas identified by the Global Fund and aligned with the new NSP – the three priority areas being:

Scale-up and increase in coverage of MDR-TB diagnosis and improvement in treatment outcomes; Enhanced notification of missing cases, specifically through enhancing the private sector response, including follow up on treatment outcomes; and TB care and prevention for key affected populations

India CCM had invited Expression of Interests (EoI) for non-government Principal Recipients (PRs) in (i) Private sector engagement, (ii) Active case finding, and (iii) Implementation and operational research. In addition, the government PR, Central TB Division, had issued EoI for sub-recipients under CTB in MDR-TB diagnosis/lab strengthening, patient support systems for DR-TB patients, addressing TB/HIV co-morbidity, technical assistance, and health systems strengthening. India’s CCM shortlisted four non-government PRs – The Union consortium, CHAI/FIND/PATH consortium, HIV/AIDS India Alliance and CARE India. Further

decision was made to select two of the four shortlisted applicants - The Union consortium for active case finding among key populations, and the

CHAI/FIND/PATH consortium for private sector engagement. There are ongoing discussions on the role of the two other shortlisted non-government PRs at the time of writing this report.

Challenge TB & Global Fund collaboration this quarter – Describe Challenge TB involvement in GF support/implementation Challenge TB is collaborating with the Global Fund on the TB-Free India summit which includes a charity cricket match between celebrities and parliamentarians, India v/s TB, to be held in Dharamsala, India from 7-8 April 2017. The Global Fund team introduced the CTB team to Mr. Anurag Thakur, a Member of Parliament and president of the Himachal Pradesh Cricket Association (HPCA) who will co-host the Summit, and also introduced the CTB team to a potential corporate sponsor. Dr Christoph Benn, Director of External Relations at the Global Fund will lead a four member delegation from the Global Fund.

https://www.theglobalfund.org/en/portfolio/country/list/?loc=IND&k=7c973abd-19b9-486b-956a-8ddeb7dd3f58

http://tbcindia.nic.in/index1.php?lang=1&level=1&sublinkid=4712&lid=3266

27

4. Success Stories – Planning and Development

Planned success story title:

Challenge TB (CTB) provided communication support for active TB case-finding drive by Government

of India (GOI)

Intervention area of story: 3.1. Ensured intensified case finding for all risk groups by all care providers

Brief description of story idea:

CTB provided communication support for active case finding drive (Jan 15-Jan 30th, 2017): CTB provided

communication support to The Central TB Division (Ministry of Health & Family Welfare, Government of India) in the Active TB

Case Finding (ACF) drive launched in 50 districts in 17 states across the country. The drive was launched from January 15-

January 30th, 2017. CTB developed the active case finding communication campaign. The campaign was developed in

Hindi and five regional languages. The ACF communication campaign with awareness raising messages about TB symptoms

was disseminated through media channels across a population of nearly 9.2 million people in 50 districts). During the time

that the campaign aired, the Ministry of Health and Welfare conducted 48,291 sputum examinations and 2,513 patients (5%)

were diagnosed with TB in the period January 15-- 30, 2017.

Status update (including estimated date of

completion):

During the time that the campaign aired, the Ministry of Health and Welfare conducted 48,291 sputum examinations and 2,513 patients (5%) were diagnosed with TB in the period January 15-- 30, 2017.

Planned success story title: CTB helps establish India TB Caucus, part of Global TB Caucus with members of parliament

Intervention area of story: 7.2. In-country political commitment strengthened


Through support from CTB, the India TB Caucus, a network of elected representatives committed to END TB in India was

launched on 8 March 2017 in New Delhi. Four co-chairs were appointed: Mrs. Viplove Thakur (Rajya Sabha MP, Indian

National Congress), Mr. Majeed Memon (Rajya Sabha, MP, Nationalist Congress Party), Dr. Kirit Solanki (Loksabha MP,

Bharatiya Janta Party), and Dr. Boora Narsaiah Goud (Loksabha MP, Telenaga Rashta Samithi) and Prof. P. J. Kurien, Deputy

Chairman - Rajya Sabha was appointed as Patron of the Caucus. Twenty-six members of the parliament from both Rajya

Sabha and Lok Sabha, including two former MPs and four Members of the Legislative Assembly became active members of

the Caucus and agreed to a) advocate with the Prime Minister’s Office and Ministry of Finance for increased resources for TB;

b) raise awareness among PRIs (Panchayati Raj Institution members) in their constituencies; c) fight stigma against TB

patients/ families by addressing it in their public gatherings.

. After the Caucus launch, members of the Caucus have taken measures in their constituencies to increase awareness of TB

and raise questions in parliament. Shri Viplove Thakur invited the Health Minister of HP, Shri Kaul Singh Thakur to be part of

the panchayat sensitization on TB in Nurpur, Kangra district, which is included in the group of 100 highest prevalence districts

in the country. A total of 300 local elected representatives were sensitized as a result. Two members of the Caucus attended

the Berlin TB summit sponsored by the Global TB Caucus and on their return raised questions in parliament on need for

vaccines/ research and nutritional support for patients on TB.

28

Status update (including

estimated date of completion):

The Union was asked to act as the secretariat for the India TB Caucus and the seven founding organizations (IAPPD, CLRA, GHS, Reach, GCAT, Aequitas, The Union) will be part of the Advisory Group for period of 2 years.

Planned success story title: GeneXpert Services of USAID’s CBNAAT Project Move Closer to Pediatric Population: Transition to National TB Programme

Intervention area of story: 2.1. Access to quality TB diagnosis ensured


Under the guidance of Revised National TB Control Programme of India (RNTCP), FIND began implementing a novel pediatric initiative in 2014 with funding support from USAID for the diagnosis of TB in children in four cities, namely, Delhi, Kolkata, Chennai, and Hyderabad. Based on the project findings, the project was extended to 5 more cities in 2016. The project provides a comprehensive diagnostic solution for pediatric TB in the intervention cities through various low-cost advocacy

interventions. In addition, for the first time under RNTCP, both sputum and extra-pulmonary pediatric specimens were tested on Xpert, including gastric aspirate, gastric lavage, broncho-alveolar lavage, cerebrospinal fluid, pleural fluid, and pus etc. So far, the project has been able to cater to more than 72,000 presumptive pediatric TB patients. Further, the project has facilitated prompt access to quality diagnostic services with more than 90% of the specimen results being reported within 24

hours of specimen collection. Along with this, more than 1,100 facilities/providers have been linked with the project with significant proportion of private sector (approximately 40%) who have been sending referrals to the project sites.

Since the activities at the initial 4 sites have now gained significant momentum, with an increasing number of providers being engaged in each successive quarter, it was planned to transition these site activities and other logistics to the National Programme. All the major contributing providers/facilities were explained about the transition plan from January, 2017

onwards and their patient samples were redirected to the nearest RNTCP GeneXpert lab so that the providers become accustomed to sending samples to these labs as well as to sustain the referrals. On 31st March, 2017, the activities and other processes at 4 initial sites were handed smoothly over to the RNTCP in a phased manner. The engaged providers have been sensitized about the specimen collection and referral which will continue to address to the needs of the pediatric population.

Status update (including

estimated date of completion):

N/A As stated above, transition of the 4 initial sites to the National TB Control has been completed by 31st March 2017. The

transition of the remaining 5 sites would be carried out at the end of the project (30th September 2017)

Planned success story title: Mapping health care facilities the smartphone way

Intervention area of story: 3.2. Access to quality treatment and care ensured for TB, DR TB and TB/HIV for all risk groups from all care providers


Through collaboration with Dure Technologies, an Android application for smartphone users called I-Monitor was developed

according to the specifications in the CTB work plan.

The application has a feature for capturing evidence-based information about the geo-location of the provider, date and time

29

of the mapping and crucial indicators on the profile of the private provider, such as type of provider, qualification, services offered etc. The application captures data for

Ayurveda, Yoga, Unani Siddhi and Homoeopathy (AYUSH) and informal centers, hospitals, clinics, pharmacies, laboratories and chemists and more specific to HIV, it captures ICTCs and ART centers as well.

The user-friendly interface helps capture data with ease and minimal training and

provides an interactive dashboard to get real time access to the results. The dashboard

provides both a map of the providers and the statistics by location. These statistics

include number of facilities mapped, type of facilities mapped, highest mapped area,

highest performing field staff and graphs of all indicators under mapping activity

This application ensures smooth and timely communication and decision-making for

private providers, project managers and the field staff. At a later stage, there will be a

web-based interface.

The first phase of training the field staff on the application took place on March 8-10, 2017.

Image - A glimpse of the mapping Android application, being developed by Dure Technologies

Status update (including estimated date of completion):

30

5. Quarterly reporting on key mandatory indicators

Table 5.1 RR-/MDR-TB cases notified and started on MDR-TB treatment or shorter treatment regimens (STR) in country (national data) Quarter Number of RR-TB or MDR-TB cases

notified (3.1.4) Number of RR-/MDR-TB patients started on MDR-TB treatment (3.2.4)

Of which (3.2.4), number of RR-/MDR-TB patients started on STR (9.2.4)

Comments:

Total 2014 25,652 24,073 0 CTB’s formal request to the

RNTCP to provide quarterly data on MDR-TB was declined in the absence of a MoU for data sharing with CTB. As

advised, we will report on the data that is published in the annual report by RNTCP (usually in March for the previous year).

Total 2015 28,876 26,966 0

Total 2016 33,820 32,682 0

Jan-Mar 2017

Apr-Jun 2017

Jul-Sept 2017

To date in 2017

Table 5.2 Number of patients (eligibility based on WHO/NTP criteria) started on bedaquiline (BDQ) or delamanid (DLM) in country (national data) Quarter Number of eligible patients started on BDQ

nationwide (9.2.2) Number of eligible patients started on DLM nationwide (9.2.3)

Number of BDQ or DLM treatment initiation sites

Comments:

Adults (15 yrs. or>) Child (<15yrs) Adults (15 yrs. or>) Child (<15yrs)

Total 2014

Total 2015

Total 2016 226 0 0 0 6

Jan-Mar 2017 151 0 0 0 6

Apr-Jun 2017

Jul-Sept 2017

To date in 2017 377 0 0 0 6

Table 5.3. Indicator for active tuberculosis drug-safety monitoring and management (aDSM) Quarter Total number of reported serious adverse event (SAEs)

Disaggregate by: treatment regimen (STR, BDQ-containing regimen, DLM-containing regimen)

Number of reported SAEs which led to a death Disaggregate by: treatment regimen (STR, BDQ-containing regimen, DLM-containing regimen)

Comments:

Adults (15 yrs. or >) Child (<15yrs) Adults (15 yrs. or>) Child (<15yrs) Data are as reported by CTD. CTB does not have access to data on stratifications for SAEs or deaths.

Total 2016 24 0 5 0

Jan-Mar 2017 37 0 4 0

Apr-Jun 2017

Jul-Sept 2017

To date in 2017 61 0 9 0

31

Table 5.4 Number and percent of cases notified by setting (i.e. private sector, prisons, etc.) and/or population (i.e. gender, children, miners, urban slums, etc.) and/or case finding approach (CI/ACF/ICF) (3.1.1)

Reporting period

Comments

Jul-Sept 2016 Oct-Dec 2016 Jan-Mar 2017 Apr-Jun 2017 Jul-Sept 2017 Cumulative Year 3

Overall CTB geographic areas

TB cases (all forms) notified per CTB geographic area (List each CTB area below - i.e. Province name)

Delhi, Hyderabad, Chennai, Kolkata, Nagpur, Surat, Visakhapatnam,

Bangalore and Guwahati

TB cases (all forms) notified for all CTB areas 519 761 739

All TB cases (all forms) notified nationwide (denominator) N/A N/A N/A

% of national cases notified in CTB geographic areas N/A N/A N/A

Intervention (setting/population/approach)

Children (0-14)

CTB geographic focus for this intervention

Delhi, Hyderabad, Chennai, Kolkata, Nagpur, Surat, Visakhapatnam, Bangalore and Guwahati

TB cases (all forms) notified from this intervention 519 761 739

All TB cases notified in this CTB area (denominator) N/A N/A N/A

% of cases notified from this intervention N/A N/A N/A

32

6. Challenge TB-supported international visits (technical and management-related trips)

# Partner Name of consultant

Planned quarter Specific mission objectives

Status (cancelled, pending, completed)

Dates completed Additional Remarks (Optional)

Q1

Q2

Q3

Q 4

1 UNION WLC Travel - Year 2017: Project technical staff (5 no.s) participants

x 5 travels for WLC - PD, Deputy PD + 3 CTB staff

Pending N/A

2 UNION 1. Kavita Ayyagari 2. Deputy PD (to be hired) 3. Lopamudra Paul

X 3 participants for CD meeting

Pending Lopamudra Paul Attended M&E training organized by KNCV, March 13-17, Hanoi, Vietnam (This is replacement

of CD meeting)

3 UNION 1. Kavita Ayyagari 2. Deputy PD (to be hired) 3. Jamhoih Tonsing

X 1. 3 participants to Technical meetings on TB/ HIV technical meeting travel,( including one

day with the UNION and PMU on project Challenge TB)

Pending N/A

4 UNION 1. Kavita Ayyagari

2. Deputy PD (to be hired)

3. Neerja Arora

International

courses/trainings/ conferences

Pending N/A

5 UNION 1. Riitta Dlodlo 1 monitoring visit from Union HQ

Pending N/A

6 PATH Dr Shibhu Vijayan x Country Directors Meeting- 1 travel

Pending

7 PATH Amelia Kinter X Program Officer to support Community

Mobilization activities development and implementation planning

Complete Ms. Kinter traveled to Mumbai from

February 26-March 10 and was in Delhi from March 10-March 18.

33

8 PATH Lal Sadasivan Partner Representative for IMA meetings

development and review of progress for capacity building

Pending N/A

9 PATH Moe Moore X 1 travel engaging the project staff and orient to managing CTB India funding for staff across

India.

Complete Mr. Moore was originally schedule to travel to India from March 19-

March 24; but due to inclement weather which delayed his flights he traveled from April 2-April 8, 2017

10 KNCV 4 STTA Fraser Wares

X X X X STTA for Fraser Wares - PMDT review meetings and introduction TA on

BDQ / shorter regimen from KNCV / UNION

Pending Q2 (28th March to 4th April 2017)

Dr. Fraser Wares visited India with specific objective to Assess progress in introduction

of bedaquiline for drug-resistant TB in two BCAP implementing sites in Delhi, India

Review and discuss the progress in introduction of new drugs and regimens for DR-TB patients in India with RNTCP officials, USAID and the Union

11 PATH-PEPFAR

Jalpa Thakker X UNION Conference Complete Jalpa Thakker

Attended M&E training organized by KNCV, March 13-17, Hanoi, Vietnam (Will be MOT from savings)

12 PATH-PEPFAR

Syed Imran Farooq X UNION Conference Pending

13 PATH-PEPFAR

Lal Sadasivan X 1. Review program

activities and implementation. 2. Collaborate with Government officials

3.Provide technical

Complete February 01-10,

2017

Dr. Sadasivan completed his

travel in February 01-10, 2017.

34

assistance to improve activities and identify

next steps

14 PATH-PEPFAR

Amelia Kinter X 1. Work with team in scaling-up program activities to greater geographical areas

2. Collaborate with government officials

3. Provide technical support in reviewing current data on cases and identify areas to expand

Pending

Total number of visits conducted (cumulative for fiscal year) 6

Total number of visits planned in approved work plan 27

Percent of planned international consultant visits conducted 22.2%

35

7. Quarterly Indicator Reporting

Sub-objective: 2. Comprehensive, high quality diagnostics

Performance indicator Disaggregated by

Frequency of collection

Baseline (timeframe) End of year target Results to date (Jan-Mar, 2017) Comments

2.1.2. A current national TB

laboratory operational plan exists and is used to prioritize, plan and implement interventions.

None annually 2 (Lab Operational Plan Available)

Not Applicable (CTB is not

working on this area)

N/A

2.2.6. Number and percent of laboratories

performing C/DST that are implementing a

laboratory quality management system (LQMS).

None annually 100% (33/33) per RNTCP LQMS. National LQMS

does not involve use of GLI/SLMTA scoring system.

There are 6 NRLs and 27 NRLs. Lab quality control guide line is available at http://tbcindia.nic.in/pdfs/RNTCP%20

Lab%20Network%20Guidelines.pdf

Not Applicable (CTB is not working on this area)

N/A

2.2.7. Number of GLI-approved TB microscopy network standards met

None annually Not Applicable (RNTCP has its own certificate system)


N/A

2.3.1. Percent of TB cases tested for RR-/MDR-TB

Partner/CTB area

annually 29% (255897/878947)

in 2015 *

Numerator: Cases tested for RR/MDR-TB =

Total: 70,000 The Union:15,000

GeneXpert tests

through private sector providers in Axshya areas

FIND sites : 20,626 (Oct 2016

to Mar 2017)

10792 tested between Jan-Mar 2017

36

255,897 Denominator:

878,947 (754,268 among new + 124,679 among relapse cases) *Source: WHO Global TB report

2016

CTB areas: The Union=0 PATH=0 FIND=15347 (Oct2014-Sept2015)

PATH: 5000 MDR TB cases will be

tested FIND: 50,000 pediatric cases will be tested

2.4.3. MTB positivity rate of Xpert test results

For CTB areas only

quarterly 7.80% 8% 6.8%

2.4.4. Rifampicin resistance rate of Xpert test results

For CTB areas only

quarterly 8% 8% 9.2%

2.4.5. % unsuccessful Xpert tests

For CTB areas only

quarterly <1% <1% <0.5%

2.4.6. #/% of new TB cases diagnosed using GeneXpert

For CTB areas only

quarterly 4000 1500 (37.5%)

(739 in Jan-Mar 2017 +

761 in Oct-Dec 2016)

2.4.8. INDIA

SPECIFIC: % of TB patients diagnosed using GeneXpert residing within project area,

initiated on treatment

For CTB areas only

quarterly 82% 85% 89.2%

2.4.10. INDIA

SPECIFIC: # of

For CTB quarterly 575 2000 1106

37

Sub-objective: 3. Patient-centered care and treatment



Baseline (timeframe) End of year target Results to date Comments

3.1.1. Number and percent of cases notified by setting (i.e. private sector, pharmacies, prisons, etc.) and/or

population (i.e. gender, children, miners, urban slums, etc.) and/or case

Total TB case notified in 2015= 902732 * Of total cases notified by Private sector= 184802

Source: RNTCP Annual Report 2016

1,650,000 (RNTCP NSP target)

2,109 TB cases were diagnosed from PPIA sites at 24 private facilities from Oct 2016 to March 2017

These numbers are from PPIA project implemented by PATH in Mumbai. The numbers are notified from 24 private facilities from Oct 2016 to March 2017

referring health facilities linked per diagnostic centre

areas only

INDIA Specific # of FIND sites transitioned to NTP

For CTB areas only

quarterly 0 9 4 •

INDIA Specific # ICT innovations developed

For CTB areas only

annually N/A 1 0

2.6.1. Average turnaround time from specimen

collection/submission to delivery of result to the patient (stratified by microscopy, Xpert, culture, DST)

For CTB areas only

quarterly 2 days 1 day 1 day

2.6.2. % of

laboratory results disseminated via m-health or e-health systems to the provider

For CTB areas only

quarterly 100% 100% 100%

38





finding approach

3.1.4. Number of RR-TB or MDR-TB cases notified

Annually Total No. of MDR-TB cases detected in 2016=33820. Source: Annual

Report RNTCP 2017. (Note: information on bacteriologically diagnosis is not available)

Not Available (NSP target only for cases tested and initiated

treatment)

3.2.1. Number and percent of TB cases successfully treated (all forms) by setting

(i.e. private sector, pharmacies, prisons,

etc.) and/or by population (i.e. gender, children, miners, urban slums, etc.).

No. of TB cases successfully treated (all form)= 1,035138 (88.9%)

, Source: RNTCP Annual Report

2016

88% (RNTCP NSP target)

NA Annually

3.2.4. Patients started on MDR-TB treatment

Gender & Age

annually Total No. of MDR-TB cases initiated

treatment in

2016= 32682. Source: RNTCP Annual Report 2017 PATH: District level baseline figures (public sector

numbers) will be added after the

project activities begin and PATH engages with the public sector at

30,000 (RNTCP NSP target)

PATH: 180 DR-TB

patients to be started on treatment by linking to public sector DR-TB centers. The Union: Target

= 600

NA DRTB patients put on

treatment from March 23rd

2017: Male: 6 Female: 6 Total: 12 Age: 0: 0

5-9: 1 10-14: 0

15-19: 2 20:24: 3 >25: 6

39





site level. Public sector figures will be used as baseline since

currently the selected districts

(barring Mumbai) have no private sector engagement for RR-TB. The Union:

Baseline =0

3.2.5. # health facilities w/ PMDT services

none annually NA

3.2.7. Number and percent of MDR-TB

cases successfully treated

6750/19298 (35%). Source:

RNTCP Annual Report 2016 PATH: NA


PATH: N/A. PATH will track, through the course of project all DR-TB patients linked on treatment to public sector. Numbers

successfully

treated cannot be defined here since the treatment for DR-TB continues for 2 years. PATH will report the

figures that public sector will make available

NA

3.2.8. #/% of PMDT

sites reporting on

treatment cohort status quarterly

6 20 6

40





3.2.9. % of MDR-TB patients still on treatment and culture negative 6

months after starting MDR-TB treatment

N/A annually N/A As per figures available from public sector. Cohort reports are

available in public sector on an

annual basis

N/A

3.2.22. #/% of TB patients followed by

community-based workers/volunteers during at least the intensive phase of treatment

N/A 180 DR-TB patients linked to

public sector for treatment will be followed by community based workers

NA

3.2.24. % MDR

patients who receive social or economic benefits

age and gender

55 DR-TB patients

(that is 30% of total DR-TB

patients linked for treatment to public sector) will be enlisted on the existing public social benefit schemes to

support and

empower the community. This will be achieved by supporting the DR-TB patients for all necessary

processes to avail the socio-economic benefits and by mobilizing the

state level officials for coordination

between various departments and

Profiling for eligibility of all

16 DR-TB patients have been conducted for

establishing linkages to social schemes

Linkages to social schemes will be established in the next quarter, The patients were initiated on treatment from March 23rd 2017

onwards, which gives the project 7 days for the first patient initiated

41





ministries and increasing awareness in the community of the existing schemes

Carry forward from year 2


Performance indicator

Disaggregated by


Baseline (timeframe)

End of year target Results to date Oct 2016 – Mar 2017

Comments

3.2.4. Patients started on MDR-TB treatment

Gender & Age

annually Total No. of MDR-TB cases initiated treatment in 2015= 26,966. Source: RNTCP Annual Report 2016 PATH: District level baseline figures (public sector numbers) will be added after the project activities begin and PATH engages with the public sector at site level. Public sector figures will be used as baseline since currently the selected districts (barring Mumbai) have no private

30,000 (RNTCP NSP target) PATH: 180 DR-TB patients to be started on treatment by linking to public sector DRTB centers. The Union: Target = 600

Annual

42



Disaggregated by




Comments

sector engagement for RR-TB. The Union: Baseline =0

3.2.9. % of MDR-TB patients still on treatment and culture negative 6 months after starting MDR-TB treatment

N/A annually N/A As per figures available from public sector. Cohort reports are available in public sector on an annual basis

3.2.22. #/% of TB patients followed by community-based workers/volunteers during at least the intensive phase of treatment

N/A 180 DR-TB patients linked to public sector for treatment will be followed by community based workers

3.2.24. % MDR patients who receive social or economic benefits

age and gender

55 DR-TB patients (that is 30% of total DR-TB patients linked for treatment to public sector) will be enlisted on the existing public social benefit schemes to support and empower the community. This will be achieved by supporting the DR-TB patients for all necessary processes

43



Disaggregated by




Comments

to avail the socio-economic benefits and by mobilizing the state level officials for coordination between various departments and ministries and increasing awareness in the community of the existing schemes

PEPFAR Indicators: Carry forward from year 2




Baseline (timeframe) End of year target Results to date Oct 2016 – Mar 2017

Comments

3.1.4. Number of

MDR-TB cases detected

None Quarterly

and Annually

National

level(Annually): Total no. of MDR-TB cases detected in 2014= 24,073. Source: Annual report RNTCP 2015 (Note: information

on bacteriologically diagnosis is not available)

PATH project sites: 329 (July-Sept

2015)

National Level

(Annually): Not Available(NSP targets only for cases tested and initiated on treatment)

PATH project sites: 160

PATH project sites: 949

RR-TB cases were notified

These numbers are from PPIA

project implemented by PATH in Mumbai. The numbers are notified from 24 private facilities from Oct 2016 to March 2017

44

3.1.5. #/% health facilities

implementing intensified case finding (i.e. using SOPs)

Private Health care

Facility

Annually Not Available 24 24

3.2.1. Number and

percent of TB cases successfully treated

(all forms) by setting (i.e. private sector, pharmacies, prisons, etc.) and/or by population (i.e.

gender, children, miners, urban slums, etc.).

None Annually National

level(Annually): No. TB cases

successfully treated (all form) = 1084185 (88.3%); Source: RNTCP annual

report 2015.

National

level(Annually): 88% (RNTCP NSP

target)

Annually notified

3.2.4. Number of MDR-TB cases

initiating second-line treatment

None Quarterly and

Annually

National level(Annually):

Total No. of MDR-TB cases initiated treatment in 2014= 24073. Source: RNTCP annual report 2015.

National level(Annually):

30,000 (RNTCP NSP target)

Annually notified

3.2.7. Number and percent of MDR-TB

cases successfully treated

None

Annually 3486/7289 (48%) Source: RNTCP

annual report 2015.


Annually notified

3.2.5. # health facilities w/ PMDT services

None Annually 127. Source: RNTCP Annual Report 2015

NA

3.2.26 INDIA SPECIFIC (new as of

Q2): Number of TB patients tested for HIV

Quarterly N/A Results of TB/HIV Oct 2016 to March 2017

PATH project sites:

By gender: Male=837 Female= 872

45

By Age: 0-4= 6

5-9 years=11 10-15 years=85 15-19 years=287 20 and above=1,320 HIV status:

HIV positive=30

HIV negative=1,679 Total TB patients tested for HIV: 1,709

Sub-objective: 5. Infection control


Disaggregated by



End of year target Results to date Comments

5.2.3. Number and % of health care workers diagnosed with TB during reporting period

None annually Not Applicable (CTB is not working on this area)


N/A

Sub-objective: 6. Management of latent TB infection


Disaggregated by



End of year target Results to date Comments

6.1.11. Number of children under the age of 5 years who initiate IPT

none annually Not Applicable (CTB is not working on this area)


N/A

Sub-objective: 7. Political commitment and leadership




7.2.3. % of activity budget covered by

none annually 25% cost share for materials

N/A

46





private sector cost share, by specific activity

developed / aired

7.2.9. INDIA SPECIFIC: # stories

in media

none quarterly 500 stories covered in media

Total (Oct 2016-Mar 2017) =152

Total Facebook fan ( Mar 2016-Mar 2017) :2,20,234

Total No. of twitter followers ( Sept 2015-Mar2017) : 4762

Q1 (Oct-Dec, 2016) Total 86 (Print: 3 and Online 83)

Facebook page (https://www.facebook.com/ForTBFreeIndia/): 7428 new fans added Q2 (Jan- Mar, 2017) Total: 66 (Print: 1 and Online 65)

Facebook page (https://www.facebook.com/ForTBFreeIndia/): 2892 new fans

added Twitter (@TBFreeIndia) followers (new): 50

7.2.10. INDIA SPECIFIC: # of content/ materials developed and disseminated with Challenge TB support

that are in line with

the campaign strategy

none quarterly 10 materials developed for campaign

Total (Oct 2016-Mar 2017) = 51 Electronic (Film, digital

films & videos): 11 Social media (facebook

& twitter: 18

Print (postcard, print Ad, outdoors, standees, handouts, calendar): 22

Q1 (Oct-Dec, 2016) One Short Film (4.50 min) by

Mr. Amitabh Bachchan for WLC, 2016

One Invite Postcard for Symposium at WLC, 2016

Facebook and Twitter

Posts: 8 posts with graphics 4 Videos of TB champions (2

min): Amitabh Bachchan on his experience being a TB survivor ; Dr Naresh Trehan; Prof PJ Kurien; Ms Viplove

Thakur Q2 (Jan- Mar, 2017) 4 Videos of Amitabh

Bachchan

Digital films-2 Print Ads-9

Outdoors-8 Standee-2

47





Handouts-1 (TB information:4 pager)

Facebook and Twitter posts -10

Calendar - 1

7.2.13. INDIA SPECIFIC: India TB caucus has representation from Indian Parliamentarians

None annually 0 1 (Indian TB caucus formed)

India TB caucus formed The India TB Caucus launched on 8 March 2017 in New Delhi. The India TB Caucus, part of the Global TB Caucus will work collectively and individually to End TB in India. 26MPs and MLAs signed

declaration and joined the caucus. (details section 1 under 7.2.2 h)

7.2.14. INDIA SPECIFIC: Private

sector partnerships to implement TB program

none annually 12 TA to 12 partners N/A

Sub-objective: 8. Comprehensive partnerships and informed community involvement




8.1.3. Status of

National Stop TB Partnership

None annually 0 Not Applicable

(CTB is not working on this area)

N/A

8.1.4. % of local partners' operating budget covered by diverse non-USG

funding sources

none annually TBD TBD N/A

8.2.1. Global Fund grant rating

none annually B1 A1 A1

48

Sub-objective: 9. Drug and commodity management systems




9.1.1. Number of stock outs of anti-TB drugs, by type (first and second line) and level (ex, national,

provincial, district)

none annually "Not Applicable (CTB is not working on this area)"


N/A

9.2.2. Number of patients (eligibility based on WHO/NTP criteria) started on bedaquiline

National and 20 CTB sites

quarterly BL = 0 as First patient was started on BDQ in June 2016.

1,600 (end of 2017)

Total (Oct, 2016-Mar, 2017)=377 Q1 (Oct-Dec, 2016)=226 Q2 (Jan-Mar, 2017)= 151

Sub-objective: 10. Quality data, surveillance and M&E




10.1.4. Status of electronic recording and reporting system

None annually Indicator value=3, In India it is known as 'Nikshay'. Source: RNTCP Report 2016


N/A

10.2.1. Standards

and benchmarks to certify surveillance systems and vital registration for direct measurement of TB burden have been implemented

None annually No (RNTCP has no

plans for certifications of Surveillance system)

Not Applicable

(CTB is not working on this area)

N/A

10.2.6. % of

operations research

project funding provided to local partner (provide % for each OR project)

None annually 0 (no OR funding

provided to local partners)

Not Applicable

(CTB is not

working on this area)

N/A

49

Sub-objective: 10. Quality data, surveillance and M&E




10.2.7. Operational research findings are used to change policy or practices

(ex, change guidelines or

implementation approach)

None annually Not Applicable (no OR done)


N/A

Sub-objective: 11. Human resource development




11.1.3. Number of

healthcare workers trained, by gender and technical area

Gender &

Technical Area

annually 20 25 0

11.1.5. % of USAID TB funding directed to local partners

None annually 22% 40% N/A

Documents

Challenge TB - India Year 3 Quarterly Monitoring Report ...pdf.usaid.gov/pdf_docs/PA00MPX6.pdf · Quarterly Monitoring Report January – March 2017 Submission date: ... Cover photo: