2
Mozambique TB Country Profile
• Population: 29 million (2016)
• TB incidence: 551 per 100,000 (2016)
• TB cases estimated:159,000
• TB cases Notified: 73,470
• 85,530 (54%)TB cases are
missing
• Estimated MDR/RR-TB cases among
notified pulmonary TB cases: 3,400
• MDR-TB cases notified:868
• 2,532 (72%) MDR/RR-TB are
missing
• HIV prevalence: 13.2%
• HIV prevalence among TB: 44%
3
High Uptake of HIV Testing and ART Initiation
76763 73011
31511 28538
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
Total
Nu
mb
er
of
TB
Cas
es
TB/HIV Cascade, 2017 (APR)
Sum of TB STAT (Den) Sum of TB STAT (Num)
Sum of TB_ART (Den) Sum of TB_ART (Num)
91%
95%
39%
4
TB/HIV Achievements Driven by Case Detection
85876
76763
85876
73011
44773
31511
44773
28538
Sum of TB STATCOPTarget
(Den)
Sum of TB STAT(Den)
Sum of TB STATCOPTarget
(Num)
Sum of TB STAT(Num)
Sum of TB_ARTCOPTarget
(Den)
Sum of TB_ART(Den)
Sum of TB_ARTCOPTarget
(Num)
Sum of TB_ART(Num)
TB/HIV Cascade Target vs Results, APR17
89% 85% 70% 64%
6
COP Planning Decision Tree: TB Case Detection
Problem
Diagnosis
Strategic
Objective
Approach
Low TB
case
detection
Increase
TB case
detection
Problem
Statement/Indi
cator
Poor screening
in all entry
points
Delay seeking
health care
Low TB
suspicion
among priority
population (PP)
Under
utilization of
GeneXpert
Deficient
contact tracing
Monitoring
and Partner
Management
TB
cascade
monitoring
GeneXpert
utilization
rate
Expansion of
Cough officers to
improve HF TB
Screening
Strengthening TB
diagnosis Capacity
(including
optimization of
Xpert)
Improve active
case finding
among TB contacts
& PP
7
PEPFAR Support to Improve TB Case Detection
Site-level support
• Setting ambitious targets jointly
with ministry
• Monthly partner’s meetings
• Semi-annual review of APR and
SAPR results IPs representatives
• TB/HIV focal points at the central,
provincial and in some provinces
regional/district levels
• Support for increased utilization of
GeneXpert
• Strengthening integrated sample
transport
• Trainings and intensive supportive
supervision
• Implementation of FAST strategy and
expansion of cough officers: Find TB patients
Actively identify patients with current
cough, fast track them to be screened
for other symptoms suggestive of TB
Separating safely
Treatment
• Household TB contact tracing (Gaza)
• Incorporating TB education/screening
into community interventions
• Targeted outreach to miners and their
families
Central support
8
Activities to Support Gene Xpert Expansion & Utilization
• Provider & laboratory trainings
• Gene Xpert maintenance and connection to GX Alert
• Support integrated sample transport and results return
• Monthly review of TB cascade data with partners to improve support
9
Targets for Aggressive Achievements in COP18
Indicator
COP16
(APR17)
Achievement
COP17
(FY18)
Target
COP18
(FY19)
Target
TB_STAT 73,011 77,909 99,269
TB_ART 28,538 40,155 28,631
TX_TB
(Den) 817,421 333,471 1,586,904
• Targeting for 27%
increase in TB cases
detected from FY17
• 100% HIV testing
among TB Patients
• 100% ART initiation
among TB/HIV
patients
• 100% of persons on
ART to be screened
for TB
10
COP Planning Decision Tree: IPT
Problem
Diagnosis
Strategic
Objective Approach
Inadequate
uptake and
completion
of IPT
Increase IPT,
initiation,
completion and
documentation
Problem
Statement/
Indicator
Inadequate TB screening Health workers lack confidence to prescribe IPT Limited availavility of IPT registers & inadequate documentation Availability of a continuous supply of INH and B6
Monitoring
and Partner
Management
TB_PREV
(Den and
Num)
Provide
enhanced
support for IPT
uptake and
completion
Increase
availability &
use of M&E
tools to monitor
IPT completion
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TB Diagnostic Cascade and IPT Initiation & Completion
FY17 Current on Treatment
995,547
FY17 New on Treatment:
317,171
Screened for TB:
817,432
(82% of TX_Curr)
Started on TB TX:
23,601
(2% of TX_CURR)
Started IPT :
300,970
(30% of TX_Curr)
(95% of TX_NEW)
Completed IPT:
179,013
(59%)
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COP18 Activities to Improve IPT Completion
Improving IPT cohort monitoring/M&E
• Dissemenate revised TB/HIV Guidelines
• Health care worker refresher trainings
• Revitalize job-aids/checklist for TB screening & IPT prescription
• Improve patient education and literacy through patient and family center approach
• Assure availability of IPT at site-level
• Improve the availability of appropriate IPT registers and M&E tools at all necessary sectors
• Close monitoring of IPT completion, adverse events
• Establish mechanism for monthly reporting of IPT
• Close follow-up of IPT initiation and TB PREV during TB HIV TWG and TB partner meetings
Increasing IPT Uptake & Completion
13
Targets for Aggressive Achievements in COP18
Indicator
COP16
(APR17)
Achievement
COP17
(FY18)
Target
COP18
(FY19)
Target
TB_PREV
(DEN) 190,022 335,501 352,849
TB_PREV
(NUM) -- 226,768 299,922
• Assumes 85% of new
on treatment to
receive IPT
• 85% IPT Completion
rate
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COP Planning Decision Tree: TB Infection Control (TBIC)
Problem
Diagnosis
Strategic
Objective Approach
Lack of
systematic
implement-
ation of
TBIC
measures
Improve
implementation
of IC measures
in HF and
congregate
settings
Problem
Statement/
Indicator
Insufficient
implementation
of core IC
measures
Lack of routine
monitoring/over
sight of IC
Facility
design&
infrastructure
challenges
Monitoring
and Partner
Management
TBIC
dashboard;
HCW
surveillance
data
(partners)
Support
broader uptake
of IC at
HF/congregate
settings
Expand HCW
surveillance as
core TB IC
activity
Support the
use of IC dash
board in large-
volume HFs
15
Monitoring ICTB using simplified dashboard
• Ministry TB Infection Control Policy and Plan (2010)
• Direct support to HF to implement TBIC (2012)
• Routine HCW Surveillance for TB at select sites (2012)
Core Activities to Improve TB-IC Supported by JHPIEGO
HCWs attended
Workplace Clinic: 39,097
Screened for TB: 39,097
(100%)
No TB Symptoms:
28,619 (73.2%)
TB symptoms/ tested for TB:
10,478(26.8%)
Diagnosed with TB: 218 (2%)
Started on TB treatment: 218
(100%)
Counselled for HIV: 12,595
(32.2%)
Tested for HIV: 9,208 (73%)
HCW diagnosed HIV positive: 355
(3.9%)
Started on ART: 355 (100%)
Not tested for HIV: 3387
(27%)
JHPEIGO HCW Surveillance
Data (2017):
16
Monitoring ICTB using simplified dashboard
• Routine monitoring using standardized dashboard/checklist (2014)
• Development of abbreviated TBIC monitoring jointly with CDC (2017)
• Direct support to 44 health facilities (2017)
• Performed the internal evaluation using simplified dashboard;
• Action plans were prepared together with managers of HF
• At least 25 HF achieved a performance ≥ 80% using dashboard;
Core Activities to Improve TB-IC Supported by JHPIEGO
17
COP 18 Plans for Improving TBIC Implementation
Clinical Partners:
• Support to IC focal point to
implement IC plan
• Routine monitoring with TBIC
dashboard
• Support implementation of
HCW surveillance
• Support for minor renovations
to improve IC
JHPIEGO:
• Development and
dissemination of IC materials
• Training & Coordination
• Intensive support in 1-2 high
burden provinces
18
1940 2330 2160 2800 3400 266 444 544 646 911 213 313 482 646 897
14% 19%
25% 23% 27%
80%
70%
89%
100% 98%
0%
20%
40%
60%
80%
100%
120%
0
500
1000
1500
2000
2500
3000
3500
4000
2012 2013 2014 2015 2016
MDR-TB Notification and Treatment Trend, 2012 - 2016
Estimated Lab confirmed MDR-TB
Patients started MDR-TB Tx % Diagnosed
% of those diagnosed who initiated treatment
MDR Case Notification is Extremely Low
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Problem
Diagnosis
Strategic
Objective Approach
Low MDR
Case
Detection
and
Treatment
Completion
Strengthening
Program
Management of
MDR-TB
(PMDT) at all
levels
Problem
Statement/
Indicator
Inadequate
screening/
suspicion for
MDR-TB
Under-
utilization of
GeneXpert in
targeted
population
Patients not
retained on
treatment/Low
treatment
sucess rate
Monitoring
and Partner
Management
MDR
Cases
Detected,
Treatment
Outcomes
(Non-
PEPFAR)
Strengthening
MDR-TB
Mentorship
Implementation
of MDR TB
short course
Enhanced
MDR-TB
retention/
psychosocial
support
COP Planning Decision Tree: MDR-TB
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Progress Towards Improving MDR-TB Management
Core Ministry of Health Activities
to Improve PMDT
• Participation in GLC auditing and
supervision
• National training and supportive
supervisions (On-going)
• Long Term DR-TB plan including in
National TB Plan (2014-2018)
• National DR-TB TWG and Provincial
MDR Focal Points (2015)
• Updated National DR-TB Guidelines
(PMDT) (2017)
• Introduction of MDR Short Course
Regimen and New Drugs (Bedaquilin)
(Starting 2017)
PEPFAR-Support to PMDT:
• Support training and supervision at
provincial and district level
• Support increased utilization of
Gene Xpert
• Follow-up return of results and
confirm MDR patients initiated on
treatment
• Implementation of retention/
psychosocial package for MDR-TB
patients
• Support provincial management of
commodities to ensure availability of
drugs & materials
• Support implementation of quality
assurance programs
21
TB/HIV Activities for Miners
IOM:
• Providing comprehensive
TB/HIV screening services at
annual recertification
• Work with clinical partners to
ensure linkage to treatment
• Follow-up on miners on return
to S. Africa to ensure
treatment continuation
Clinical Partners:
• Ensuring linkage to treatment
for patients identified with TB
• Household TB contact tracing
for identified TB Miners
22
Core Package of Services for TB/HIV Care in Prisons
HIV
Systematic HTS at
entrance
Linkage to C&T
services
Psychosocial support
Transport of samples
to LAB (VL, CD4 and
return of results for
clinical decision)
Ensure continuum of
treatment before
incarceration and after
release
Tuberculosis
Screening for TB at
entrance and
periodically
Ensure GeneXpert
for all TB suspect
Ensure DOT during
period of
incarceration and
after release
IPT for HIV-positive
persons
Human Resources
and Infrastructures
Trainings of Prison
staff
Technical
assistance
Rehabilitation of
existing prison
infrastructures
Peer educators:
HIV sessions in
prison
Follow up after
release to ensure
linkage to care
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Coordination
Using various Task Working Groups, partners meetings and other mechanisms, the NTP coordinates activities from various sources: