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Countries around the world continue to face a massive challenge in defeating the TB epidemic at the global, regional, national, and community levels. A curable disease, TB kills some 2 million people each year due to health system failures to reach those infected, especially those with weakened immune systems. Because TB is the single leading killer of people with AIDS, accounting for at least 13% of all AIDS deaths worldwide, special attention must be paid to detecting and treating TB among persons infected with HIV, particularly in Africa, where the majority of TB-HIV co-infected individuals live. As a STOP TB coalition partner, URC is proud to work in partnership with local and national governments, public and private providers, and community health workers in 10 countries to improve the quality of TB programs, increase case detection, and expand access to quality treatment. URC projects, funded by the United States Agency for International Development (USAID) and the Centers for Disease Control and Prevention , are helping National TB Programs to expand and strengthen the delivery of Directly Observed Treatment, Short Course (DOTS) strategy; improve the quality of microscopy; increase the impact of advocacy, communication, and social mobilization activities; strengthen and integrate TB and HIV/AIDS control activities; strengthen supervision, referral, and monitoring systems at the district level; and scale up best practices through collaboratives and knowledge sharing. Current URC country activities South Africa: Under a USAID-funded TASC2 tuberculosis task order, URC assists the National TB Control Program (NTCP) to strengthen information systems, supervision, and program management at the national level and is working with the provincial, district, municipal, and community levels to build local capacity to detect, treat, and prevent TB in eight provinces. Particular emphasis is placed on developing community-based strategies to identify undetected cases, ensure early referrals for screening and treatment, and support treatment adherence. In collaboration with the National Health Laboratory Service, URC’s TASC2 TB team is developing a national laboratory information system to strengthen quality monitoring and reduce turnaround time for sputum smear test results. These efforts are coordinated with those of the USAID Health Care Improvement Project (HCI), formerly QAP, which supports quality improvement activities focused on increasing TB screening for patients with HIV in some 150 health facilities. Read more about 2008 achievements in South Africa . Lesotho: HCI, in partnership with the Ministry of Health and Social Welfare (MOHSW) and other stakeholders is designing and implementing interventions to strengthen TB programs as well as to improve and better integrate TB and TB-HIV services. HCI is working to strengthen Lesotho’s TB program in ten districts. In partnership with the NTP and other stakeholders, the team is developing policies and guidelines, including a National TB Policy, TB-HIV Strategy, and National TB Training Guidelines. HCI supports the National TB Control Program to improve case management, reduce HIV among TB patients, and strengthen recording and reporting systems. The project team works to prevent the spread of MDR/XDR TB by training health facility staff in TB case management and follow-up procedures, including conducting sputum examinations and strengthening infection control, and dissemination of information, education and communication (IEC) materials. Read more about 2008 achievements in Lesotho . Swaziland: HCI works with the Ministry of Health and Social Welfare’s National Tuberculosis Control Program (NTCP) and the National AIDS Programme in Swaziland to improve systems for promoting cross referrals for TB and HIV screening, treatment, and follow-up, strengthen TB DOTS implementation and implementation of guidelines for Multi-Drug Resistance TB case management. The project's focus is on capacity development, policy and guideline development; increasing compliance with evidence-based guidelines; behavior change communication; and monitoring and evaluation. HCI provides technical assistance and training to all 19 TB diagnostic sites and 71 out of the 162 clinics in all four regions of the country and to the NTCP. We are assisting with development of a reporting and recording system for TB control; and MDR and XDR TB management guidelines, infection control guidelines and TB-HIV policy guidelines. In addition, the project team participates in strengthening lab capacity through training of laboratory personnel and establishment of quality assurance for sputum microscopy. We are also helping to develop advocacy and social mobilization activities. With funding from the Centers for Disease Control, URC is also seeking to increase the proportion of TB patients and suspects who get tested for HIV and vice versa and are referred for onward care and support services. Read more about 2008 achievements in Swaziland . Russia: HCI, in partnership with local health authorities, is implementing improvement collaboratives to scale up TB-HIV co-infection screening and treatment in all 18 districts of St. Petersburg, three districts in Leningrad Oblast, and four cities in Orenburg Oblast (Orenburg Cty, Gai, Novotroitsk, and Orsk). The project also continues to work with inter-disciplinary teams in Saratov Oblast to strengthen the continuum of care for TB-HIV co-infected patients. HCI collaborates with the Federal TB-HIV Center to disseminate innovations developed in the collaboratives with health authorities from other oblasts. Read more about achievements in Russia . Albania: URC works with the National TB Program (NTP) to improve community-based information and education programs in TB endemic areas. The USAID-funded Improving Primary Health Care in Albania II (Pro Shëndetit II) project, in partnership with the NTP developed a training manual and IEC materials for community-based educators and health promoters. Within the endemic regions where NTP and URC collaborate, the Pro Shëndetit team, in partnership with the Faculty of Medicine, is upgrading clinic-based doctors’ skills in TB case detection and case management. Cambodia: Under a USAID-funded project to strengthen health systems in Cambodia, URC is working to increase the quality of TB case management and lab services in public health centers and hospitals. The project team is strengthening public sector TB services as well as facilitating a Public-Private Mix approach to improve TB service delivery by reinforcing private provider skills in case detection, diagnosis, and follow-up, as well as referrals, recording cases and reporting to the National TB Program. URC supports activities to increase TB case detection among HIV-positive patients and to refer TB patients for HIV counseling and testing. Bolivia: HCI, in partnership with the Ministry of Health and the Gestión y Calidad en Salud Project, completed in December 2008 the demonstration phase of a TB Collaborative. The initiative engaged 114 health care facilities from 16 municipal networks in three departments in an intensified effort to improve TB case finding, sputum sample collection, diagnosis, directly observed treatment (DOTS), and patient follow-up. Laboratory personnel, the municipal networks' managerial teams, and the provincial offices of the MOH also participated in the collaborative. The demonstration sites in the collaborative improved cure rates, particularly in the La Paz region, which had the lowest performance prior to the collaborative. HCI and Gestión y Calidad en Salud, are spreading the improvement interventions developed in the demonstration phase to 12 additional municipalities (including 33 QI teams covering 82 facilities). We are currently working at the city of El Alto with nearly one million inhabitants, most disadvantaged, who migrated from the rural areas of the highlands of Bolivia. The spread phase of the collaborative in El Alto aims to improve TB activities in 36 facilities in the city, training near 450 health workers, improving DOTS, cure rates, abandonment rates and other impact indicators. Production of a revised Spanish version of the Tuberculosis Case Management CD-ROM , developed by the Bolivian Ministry of Health with support from QAP, is underway. Vietnam: HCI, in partnership with the National Tuberculosis Program, the Vietnam Administration of HIV/AIDS Control, Ministry of Health (MOH), and other stakeholders, is developing and implementing specific operational strategies to integrate TB-HIV prevention, treatment/care, and follow-up services in Thai Binh Province. Collaborative improvement activities are being implemented in TB clinics and selected hospitals in Thai Binh to operationalize guidelines and develop a model of care that can be extended to other provinces. Plans are already underway to expand this model to Hai Duong province. Since the launch of the collaborative in April 2007, a cross-referral system has been established between TB and HIV/AIDS programs and referral forms implemented in all TB-HIV facilities. Additionally, the cross-referral mechanism of suspected cases from private clinics to TB hospitals has been encouraged. As a result, the proportion of TB patients receiving HIV testing increased from 10–15% in 2006 to 80–90% by the end of 2008, and the percentage of TB-HIV patients receiving cotrimoxazole also increased. Philippines: Tuberculosis is the sixth most common cause of death in the Philippines. Under the

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