1. HERD Team

2. Using Xpert to Reach the Unreached: Mobile Diagnostics Case Finding in NepalMay 2013 – April 2015

3. Aim : Contribute to NTPs aim of achieving case detection rate of 82% nationally Objectives: To identify over 2 years an Additional cases of MTB+ (3136). Ensure rapid diagnosis and treatment of all TB and MDR cases. To continually monitor and reflect on case finding and referral strategies.

4. Project Target Areas and Districts 22 districts and 29 municipalities & cities Kathmandu, Lalitpur, Bhaktapur, Kavre, Chitwan, Makwanpur, Parsa, Bara, Rautahat, Sarlahi, Mahottari, Dhanusha, Kaski, Rupandehi, Kapilbastu, Dang, Banke, Bardiya, Kailali, Accham, Doti and Kanchanpur

5. TB REACH Projects in Nepal

6. Major Activities by Target Population: Urban Slum: Door to Door Screening, Mobilization of urban health volunteers (UHV), Urban slum health camp, continual case finding activities PLHA: Strong communication and coordination with VCT and ARV centres, distribution of TB/HIV IEC materials, Screening of PLHAs Household Contacts: Identifying and recording and follow up of household contacts and screening and sputum collection Prisoners: Screening and sputum collection Factory Workers: Screening and sputum collection Refugees, Monks and Nuns:Screening and sputum collection Diabetics (In Kathmandu Valley Only): Coordination and communication with diabetic clinics, screening patients for symptoms and referring patients for microscopy

7. Strategies • Coordination with local RHD/DPHO/DHO and health institutions. • Coordination with respective target groups and populations. • Mobilization of outreach workers and volunteers • Mobilization of van. • Conduction of microscopic camps. • Case finding and referral strategies

8. Implementation Strategy Case findings with the help of mobile van Gene x-pert and Regular Microscopy • Coordination with respective stakeholders • NTP • Respective D(P)HOs • TB Reach Partners • Target groups Selection of outreach workers and volunteers Training of outreach workers and volunteers for active case findings

9. Data Monitoring Flow chart cont… Volunteer Screening Identification of Symptomatics Lab test (Microscopy and Gene X-pert Negative cases Positive cases Treatment and follow up Outreach workers

10. Location of GX Machines Four static units with 2 module Xpert machines in 1) HERD, Kathmandu 2) Manohara Clinic, Bhaktapur 3) Doti Hospital (FW) 4) Chitwan Hospital (Terai) Two mobile van with 4 module Xpert machines .

11. Tools / Guide Screenings register Monthly reporting form Sputum smear request form HH screening form. Xpert request form Xpert Register Xpert users guide Program guide for vulnerable population

12. Kit Box and supporting Materials for UHV

13. Gene xpert installation DHO Doti - 19 September 2013

14. Mobile TB Diagnostic service

15. Selection and Training of ORW/UHVs Urban slum Kathamandu - 21 November 2013 Field implementation Kathmandu and Nepalgunj - 3 December 2013 Mahendranagar - 20 Feb. 2014

16. External M & E Kathmandu and Nepalgunj - 1 December 2013 Revision of TBR indicators

17. TBR Project (Grant Period )15 February 2013 – 15 April 2015 Remaining grant period - 10 Months, No cost extension - 8 Months

18. Current Progress end of Baisakh 2071

19. District wise MTB+ cases at end of Baisakh 2071

20. District wise MTB+ cases at end of Baisakh 2071

21. Current Progress – end of Baisakh Assumption base on external M& E.

22. Indicators of GX end of Baisakh 2070

23. TB REACH on NEWS

24. What next ? • Analysis of progress at end of 3rd trimester. • Revise working modality and discussion with respective RHD and DHO/DPHO.

25. Thank You