Our Work

After many years of increasing numbers of people being notified to national TB control programs, TB notifications have remained stagnant since 2007 (with a slight increase in recent years due to improved case reporting in India). While other major global TB indicators like treatment success have improved and mortality rates have fallen, there is a persistent gap in the number of people who fail to receive adequate TB care each year. Although an entirely preventable and curable disease, 10.4 million people developed TB in 2016. Only 6.3 million were detected and officially notified, leaving a gap of 4.1 million people who were “missed” by health systems after failing to be diagnosed, treated or reported.

To achieve these milestones, Stop TB and WHO follow a joint 3-year long workplan which covers 4 broad areas of technical support to countries.

1. Addressing Barriers to the People with TB who are missed

Stop TB Partnership supports countries in developing their Funding Requests and Matching Funding plans for the Global Fund. Once approved by the Global Fund, Stop TB assists countries to operationalize their proposed TB case finding interventions, in ways that maximize the impact made on case detection and notification. In addition, Stop TB provides ad-hoc technical assistance to countries and taps into a roster of international TB experts and partner organizations that can be quickly deployed for in-country support, mentoring or problem-solving.

WHO produces country desk reviews, synthesizing key information that shall help countries and partners in improved decision-making. Countries are further being supported in conducting baseline assessments using existing assessment tools in areas relevant to TB case finding and setting targets. Analysis is also conducted for scaling up WHO’s ENGAGE-TB approach in countries, taking into account existing TB relevant community policies, strategies and programs.

WHO is also undertaking patient cost surveys and supports their subsequent translation into policy. Using the WHO standard methodology and survey instrument, countries are supported in identifying financial barriers which delay diagnosis and hamper access to care.

2. Development of Tools and Approaches for Reaching the People with TB who are missed

Stop TB has been developing a Series of TB Case Finding Guides that focus on the three areas where people with TB are missed most – 1) access to care 2) inadequate diagnosis 3) weak recording and reporting. Under these three rubrics, the Guides present 10 specific interventions that target people with TB and guide implementers through planning and executing these interventions, while discussing examples of successes and challenges from the field. Program implementers will be able to decide which interventions best fit their needs based on an introductory guide, which speaks to epidemic mapping, program management, evaluation and the key guiding principles for implementing programs. The Guide will soon be made available to countries as hard copy as well as through an online platform (currently under development).

Where there are opportunities for high-level advocacy on TB in Strategic Initiative countries, Stop TB is engaged through country visits or ministerial meetings to drive progress towards meeting national TB case notification targets.

WHO is developing a comprehensive checklist to help countries strengthen the operationalization of their TB case finding interventions. The tool covers a package of essential interventions on systematic screening, including standard operating procedures, strengthening of diagnostic networks, contact investigations and other case finding approaches, such as on childhood TB, public private mix (PPM), TB/HIV, and MDR-TB.

Based on WHO’s ENGAGE-TB guidance and tools, WHO is helping countries adapt their TB case finding approaches to different local contexts by developing and disseminating models and training materials to strengthen community-based TB activities. WHO has also set up a voluntary platform to share best practices on increased TB case finding through strengthening and scaling up integrated community-based TB activities.

3. Support Uptake and Scale-Up of Tools and Approaches for Reaching the People with TB who are Missed

Stop TB supports countries in conducting gender assessments for HIV and TB responses as well as legal environmental assessments. This work is done through in-country partners, community-based organizations (CBOs) and non-governmental organizations (NGOs) as well as through regional platforms and networks. The tools help NGOs and CBOs identify and propose solutions for providing health services to all those in need. The assessments are conducted by consultants trained by Stop TB for effectively implementing and interpretating their results.

Another tool offered by Stop TB is the Data for Action for Key Populations Framework. It sets out key principles and a process that countries can utilize and adapt to design and implement their TB programs for key populations. Primarily designed for governments, civil society and other stakeholders, the framework helps in prioritizing key populations and estimating their size at country level to optimally plan, operationalize and monitor impactful TB case finding interventions.

In order to strengthen community-based monitoring of acceptability, accessibility, accountability and affordability of TB services and care, Stop TB has developed the OneImpact platform. This platform of digital solutions includes four different apps to help improve access to quality, people-centered TB health care in community settings. A community monitoring framework is also provided to guide communities in adaptation, design and roll-out of OneImpact in countries.

Through the Challenge Facility for Civil Society (CFCS), a unique small grants mechanism, Stop TB supports innovative community responses to fight TB. CFCS invests in community responses that strengthen and expand access to quality TB prevention and care services beyond health facilities to settings that cannot be easily reached by public TB programs. The Strategic Initiative has enabled CFCS to provide another round of funding to community-based organizations, who will also implement the community-based OneImpact monitoring apps.

Finally, Stop TB Partnership, through a consortium of partners, is providing long-term technical support to countries in using their own locally collected data from routine work to analyze their progress and plan course corrections for the different TB case finding interventions. In addition, the MATCH approach, developed by KIT, Stop TB and the Global Fund, is implemented in countries. MATCH capitalizes on multiple readily available, yet underutilized data sources to develop locally differentiated action. Using Geographic Information Systems, factors associated with low TB case detection are identified. The analysis helps countries to develop more tailored approaches to TB control, by answering questions such as: Where are people with TB missed? Who are the missing people with TB? Why are people with TB missed? Which context-specific interventions are needed?

WHO provides technical remote and in-country support and guidance to National TB Control Programmes (NTPs) to ensure effective roll-out of TB case finding interventions. Countries are also assisted in strengthening their national standardized M&E of integrated community-based activities, including aligning M&E activities of implementing NGOs to the national recording system and DHIS2. Mentoring support is also provided through the Global Supranational TB Reference Laboratory Network, and annual DST proficiency testing is conducted in all Strategic Initiative countries to ensure high-quality case detection for MDR-TB.

Existing WHO training materials are further being updated to build national capacity at all health care delivery levels, including the private sector, maternal and child health clinics as well as HIV care services. WHO also provides country support in mapping optimizing diagnostic networks and access to TB services. Technical assistance is further provided in the areas of scale-up and decentralization of rapid diagnostics for improved TB case finding, optimizing contact investigation and improved public-private sector engagement along the TB cascade of care. WHO is also introducing a survey methodology for countries to rapidly review patient records to bridge case finding gaps along the TB/HIV diagnostic cascade and to assess strengths and weaknesses in the recording and reporting of the cascade.

4. Documentation, Learning and Experience Sharing

Global annual meetings are organized by Stop TB Partnership and WHO on an alternating basis. These events bring together global and national partners from the countries covered under the Strategic Initiative and beyond who are engaged in TB case finding activities. At these occasions, lessons learned and best practices are shared, and the next steps forward are discussed. On a more continuous basis, all such information is shared through this online information sharing platform. Stop TB and WHO newsletters disseminating information about latest progress around the implementation of the Strategic Initiative is in planning and will also be made available on this platform.

Stop TB is also developing a webpage to digitalize its Series of TB Case Finding Guides to further support implementers through planning and executing different types of case finding interventions while discussing examples of successes and challenges from the field.