TUBERCULOSIS CONTROL MATRIX 2014-2016 STRA- S1 S1 S1 S2 1.1. 80% of provinces and highly urbanized cities (HUC) include TB based on a set criteria within PIPH/ AIPH/ CIPH 1.3. Ninety percent (90%) of provinces and HUCs given performance grants (PBGs) have achieved and sustained program targets (CDR and cure rate) 1.5. All PP coordinating bodies - national, regional and provincial levels - have established and sustained to include CUP mechanisms 2.1. Trend of TB burden tracked TOPIC/ Evaluation of Investment Plan for Health and AOP as one of the sustainable financing models for TB Control An Analysis of the Impact of PBGs on Local TB Program Implementation Assessment of Functionality of PP Coordinating Bodies (NCC, RCC, PCC) 2015 National TB Prevalence Survey How effective and sustainable have the IHP and AOP been as financing models for TB Control? How has the implementation of PBGs on local TB Programs affected the delivery of local health services and its contribution to the NTP performance? How efficient and effective are PP Coordinating Bodies in fulfilling their mandate in the areas where they have been established? What is the national prevalence of TB? This will be the first study on the IHP and AOP as sustainable financing models for TB Control. This study will determine and analyze the impacts of implementing PBGs on local TB Programs and how it contributed to the NTP performance. This research will determine and analyze the efficiency and effectiveness of PP Coordinating Bodies. The results of the survey will guide the national program and other implementers in developing and planning TB Control initiatives at various levels. 1 IMPACT USG sites 2016 part of scope of work (STTA) IMPACT 2016 Evaluation Research; IMPACT along with HPDP2 is holding this depending on the final arrangement with DOH HPDPB on HRT IMPACT 2016 GOP National 2015 (prepa- ratory- 2014) Dr. Edgardo Gonzaga Component 5, IMPACT mobile no.: 0998-9729178 email: emg_impact@yahoo.com Dr. Edgardo Gonzaga Component 5, IMPACT mobile no.: 0998-9729178 email: emg_impact@yahoo.com
S2 2.1. Trend of TB burden tracked TOPIC/ 2016 Drug Resistance Survey What is the drug resistance TB burden in the country? study will help the national program and other implementers plan appropriate responses to address drug resistance in TB treatment. NTRL 2016 (prepa- ratory- 2015) S2 S2 S2 S3 2.1. Trend of TB burden tracked 2.1. Trend of TB burden tracked 2.1. Trend of TB burden tracked 3.1. At least 50% of all provinces and HUCs have functional province/ city-wide Subnational TB mortality study DALY of TB External Evaluation of IT IS Pilot Results Drug resistance among patients on self-administered treatment (JPR) What is the mortality of TB in certain areas of the Philippines? What is the DALY value of TB in the Philippines? What is the incidence of drug resistance among patients on self- The results of the survey will guide the national program and other implementers in developing and planning TB Control initiatives. The results of the survey will guide the national program and other implementers in developing and planning TB Control initiatives at various levels. study will contribute to the body of knowledge on the burden of TB in the Philippines. This will increase the body of knowledge on the effects of self- WHO TBD 2014 DOH-HPDPB National 2014 HPDP to coordinate with University of Melbourne SIAPS 2014 2015 Include analysis of private sector 2
S3 S4 S4 referral system 3.2. 90% of public hospitals and 65% of private hospitals are participating in TB control either as DOTS provider or referring center 4.1. Proportion of TB symptomatics who are self-medicating and not consulting health care providers reduced by 30% 4.1. Proportion of TB symptomatics who are self-medicating and not consulting health care providers reduced by 30% TOPIC/ Study of factors contributing to PPMD sustainability (JPR) Effectiveness of behavior change strategies Assessment of various approaches to DOT administered treatment? What are the factors affecting PPMD sustainability? How can we make PPMD more sustainable? How have the current behavior change strategies affected the demand for TB services? Which strategy was most effective and why? Which approach to DOT is most effective? administered TB treatments. This study will help national planners and stakeholders in making PPMD more sustainable. This study will assist national planners and partners in designing and developing Behavior Change strategies and messages to increase demand for TB services. assessment will help the national program in determining which DOT approach is best in terms of effectiveness, costefficiency, and coverage. 2015 2014 IMPACT 2015 contribution S4 4.3. Percentage contribution on referral of TB cases by CBOs/ CHTs at least 10% of total TB cases notified 5.1. A total of 19, 500 MDR-TB cases have Effectiveness of enablers to CHTs / BHWs Analysis of risk factors for drug How effective are enablers for CHTs/ BHWs in contributing to the improvement of case finding and case holding? Which risk factor most likely To improve the contribution of CHT/ BHW referrals to the total TB cases notified. To establish a means of identifying 2015 WHO* 2016 *WHO will not be the 3
been detected and provided with quality-assured second-line anti-tb drugs. 5.1. A total of 19, 500 MDR-TB cases have been detected and provided with quality-assured second-line anti-tb drugs. 5.1. A total of 19, 500 MDR-TB cases have been detected and provided with quality-assured second-line anti-tb drugs. TOPIC/ resistance in new TB cases Analysis of reasons for delays of time and initial loss between TB diagnosis and detection of drugresistance and time to initiating appropriate treatment. (JPR) Evaluation of decentralization of MDR-TB patients and communitybased PMDT implementation. (JPR) predisposes a TB patient to drug resistance? What are the reasons for delays and initial loss in the diagnosis and treatment of TB and DRTB and how can these be addressed? How has decentralization contributed to improved treatment outcomes? priority groups for rapid testing for new cases of drug resistance thus contributing to case notification. This will help shorten the time between TB diagnoses, detection of DRTB, and treatment, which will lead to a better treatment outcome. This study will contribute to the body of knowledge on how decentralization affects TB treatment outcomes. lead agency but it can provide TA in developing the research design. This study can be done by reviewing & analyzing current DRS data. WHO* 2014 *WHO will not be the lead agency but it can provide TA in developing the research design. TASC, CF, LCP, WHO* 2015 Include microbiologic al and clinical monitoring of treatment and KAP surveys of patients and DOT providers/ treatment partners * WHO will not be the lead agency but it can 4
TOPIC/ An analysis of the links between sociodemographic and behavior characteristics and clinical data to endof-treatment outcomes among MDR-TB patients (JPR) Evaluation of the Enhanced Transportation Allowance Package (ETAP) for MDR-TB patients Evaluation of Community-Based What are the reasons for default among MDR-TB patients based on the Sociological Model? How do patients perceived enablers? How effective and efficient is the Enhanced Transportation Allowance Package (ETAP) in improving the treatment adherence of MDR- TB patients? How effective and efficient is the This will provide the means to decrease the default rate (36%) among MDR- TB patients and thus contribute to the performance target on case holding. This will guide GF in its investments for addressing the high default rate of MDR- TB patients. This is one of the commitments made under the GF-NFM made during the grant making process last November, 2013. This will determine how effective and TASC, IMPACT 3 Regions 2014 GF, TASC 18 Treatment facilities TASC, GF selected PMDT provide TA in developing the research design. This study can be done by reviewing & analyzing data routinely collected during PMDT implementation. 2014 Marl Mantala 2014 TASC will help develop Marl Mantala 5
TOPIC/ PMDT Care Initiative (COMPCARE) A Feasibility Study of the Effectiveness and Safety of the 9- Month Treatment Regimen for MDRTB in the Philippines Evaluation of a standardized treatment regimen of anti-tb drugs for patients with MDR- TB (STREAM Trial) community based MDR-TB care in improving the treatment adherence of MDR- TB patients? How effective and suitable is the 9- month treatment regimen for MDR-TB patients in the Philippines? How effective and efficient is the standardized treatment regimen of anti-tb drugs for MDR-TB patients? efficient the community-based MDR-TB Care initiative has been in improving treatment outcomes of MDR- TB patients which will help replicate the strategy. If found suitable and effective, the current 18-month treatment regimen which long and expensive will be shortened to the 9-month treatment regimen. This will help reduce the default rate of MDR- TB patients (at 36%), which will contribute to reaching the performance target of 75%. study will add to the body of knowledge on the treatment of MDR-TB and will validate its continued use among the patients. This will also prove the effectiveness and safety of the shorter treatment regimen for MDR-TB. LCP, TASC, GF STREAM/ IUATLD/ MRC facilities 9 treatment centers selected PMDT facilities the protocol/ guidelines for pilot testing, including the M&E to track the progress of the intervention 2014 TASC will support in terms of participating in the development of the protocol and analysis of data 2014 Dr. Marl Mantala Dr. Vivian Lofranco 6
TOPIC/ An Analysis of the Strategies for Improving Treatment Adherence of Patients with DR/ MDR-TB An assessment of risk factors for poor treatment outcomes (death, failure, default) among patients with drugsusceptible and drug-resistant TB. (JPR) What strategies, whether individual or in combination, can significantly improve adherence to treatment? What social support services (food assistance, nutritional support) are preferred by most patients? What are the impacts of social support services to adherence to treatment? How effective are enablers and incentive models in improving treatment adherence especially among MDR-TB patients? What are the risk factors for poor treatment outcomes among patients with TB and DRTB? Analysis of the 2010 cohort showed high default rate at 36%. This will improve treatment outcomes among MDR-TB patients, thus contributing to achieving the performance target. The results can also guide program managers in designing community-based approaches to TB service delivery. The results will help TB treatment professionals in planning & monitoring the treatment of TB/ DR-TB patients who are vulnerable to poor treatment outcomes. 2014 WHO* 2015 * WHO will not be the lead agency but it can provide TA in developing the research design. This study can be done by 7
5.3. At least 80% of enrolled TB cases in Category A and B areas and 80% MDR-TB cases are provided with HIV counseling and testing 5.3. At least 80% of enrolled TB cases in Category A and B areas and 80% MDR-TB cases are TOPIC/ An assessment of the frequency and risk factors for adverse events in patients on first and second-line TB treatment. Evaluation of Non- Medical Technologists who do Rapid HIV testing Evaluation of the strengthened TB- HIV Service Delivery Mechanism What are the frequent ADRs during TB treatment and the associated risk factors for their incidence? How do non-medical technologists (doctors, nurses, etc.) who do rapid HIV Testing perform based on the following areas & standards (competencies, laboratory performance, infection control and quality assurance)? How effective was the implementation of the strengthened TB-HIV service delivery The results will help TB treatment professionals in planning & monitoring the treatment of TB/ DR-TB patients who are at-risk for ADRs to first and secondline TB treatment. study will help improve the capacity of non-medical technologists in doing rapid HIV testing, which in turn will address the lack of available personnel who can administer the test in clinics, which was revealed in the performance review of 2010-2012. evaluation will contribute to the further improvement of the 2015 TASC, GF 2014 GF 2014 reviewing & analyzing data routinely collected during PMDT implementation. 8
STRA- provided with HIV counseling and testing 5.4. At least 730,000 children were provided with anti- TB drugs or INH preventive therapy 5.5. Jails, prisons at all levels provide access to DOTS services to all inmates 5.5. Jails, prisons at all levels provide TOPIC/ Evaluation of the Implementation of the TB in Children Program Utilization of CXR and GX in Active Case Finding (TB Mass Screening) among inmates Analysis of MDR-TB screening among mechanism? What are the reasons for the high rate of diagnosed TB in children among all diagnosed TB and the very low of rate of Extrapulmonary TB (ETB) cases? What factors led to the low implementation of IPT among children? What are the sensitivity/ specificity/ PPV/ NPV of the current diagnostic algorithm for children? What is the prevalence of DR- TB in prison and jails? Will GX be more cost effective in screening TB compared to DSSM? How effective and efficient is MDR-TB strengthened TB- HIV service delivery mechanism. Analysis of data showed high variation in the proportion of children with TB among notified TB cases across regions that indicates overdiagnosis or underdiagnosis. study will provide the means to address the gaps in the implementation of the TB in children program, e.g. the weak reporting of the number of children receiving treatment in the DOTS facilities. This will address the missing cases in prisons and jails and will help develop a model on the most cost effective way of identifying active cases in prison, therefore preventing further transmission. analysis will help WHO* 2015 This is an integration of various evaluation researches that are related/ relevant to children with TB. *WHO will not be the lead agency but it can provide TA in developing the research design. ICRC 2014 IMPACT, ICRC 2014 9
S6 S6 S6 access to DOTS services to all inmates 6.2. TB laboratory network managed by the National TB Reference Laboratory to ensure that 90% of all participating laboratory diagnostic services are within EQA standards 6.3. Culture, DST and Rapid Diagnostics centers are scaled up. 6.3. Culture, DST and Rapid Diagnostics centers are scaled up. TOPIC/ inmates External Evaluation of EQA implementation or Evaluation of the Quality Assurance for DSSM implementation in the Philippines. (JPR) Assessment of the implementation of Xpert MTB/Rif Evaluation of the impact and costeffectiveness of using Xpert for diagnosing TB, especially for smear- screening in determining the prevalence of MDR- TB among inmates? How has the EQA standards helped in improving the quality and efficiency of TB microscopy laboratories? How has QA for DSSM improved the quality of microscopy laboratory services? What are the factors that facilitate or hinder the implementation of Xpert MTB/Rif? How effective and efficient is the use of Xpert in diagnosing TB among smearnegative, pediatric, and EP cases? improve and strengthen MDR-TB screening activities among inmates to generate more accurate data/ information on MDR-TB among inmates. study will help in maintaining compliance to EQA standards in laboratories nationwide. This study will support the achievement of performance targets 6.2 and 6.3, in particular, the findings will help in the diagnosis of smear negative TB cases and MDR-TB. study will validate the use of Xpert in diagnosing TB among smearnegative, pediatric, GF/NTRL and TASC 2015 2014 Data collection is on-going. Data analysis expected in Q1 2014 WHO* 2014 *WHO will not be the lead agency but it can provide TA in developing Noel Macalalad Marl Mantala 10
S6 S6 6.4. No stock-outs of anti-tb drugs (both FLD and SLD) and lab supplies in 90% of DOTS/lab facilities in the last 6 months 6.4. No stock-outs of anti-tb drugs (both FLD and SLD) and lab supplies in 90% of DOTS/lab facilities in the last 6 months TOPIC/ negative, pediatric and EP cases. (JPR) Feasibility study and pilot testing of procurement with drug distribution by private manufacturers Feasibility study on restricting private market access to anti-tb drugs Given government rules and regulations, is it feasible for the NTP to include in its procurement of TB drugs the storage and delivery costs to service points? How much will it cost to "bundle" these services in drug procurement? What is the feasibility and effectiveness of restricting private market access to anti-tb drugs in terms of increasing availability in DOTS facilities? and EP cases, thus, providing local evidence to the current policy. Drug distribution is a recurring problem, particularly from PHO to RHU. Utilizing the existing distribution system of private companies (i.e., pharmaceutical companies) may improve efficiency of this process. A 2013 study by WHO WPRO office into market characteristics for TB drugs in the Philippines found that while publicly procured TB drugs were sufficient to treat all reported new TB cases from 2007 to 2011 the volume of TB drugs procured through the private market suffices to treat an additional 250,000 TB patients annually. The findings of this study IMPACT selected Xpert centers 2014 Pilot testing by 2015 2015 the research design. If this is integrated within the planned DSM Assessment, the lead agency will either be USAID or GF. Dr. Allan Fabella Component 2, IMPACT mobile no.: 09285596844 email: allanfabella@yahoo.com 11
S7 S7 7.2. At least 70% of DOTS facilities are DOH certified and PhilHealth accredited 7.3. Infection control measures in place in all treatment centers/ sites and DOTS centers TOPIC/ Identifying and analyzing the factors/ reasons for high and low rates of accreditation and certification of DOTS facilities Assessment of the rates and risk factors for LTBI and active TB among healthcare workers (JPR) What are the factors influencing certification and accreditation of TB health facilities? What are the incidence and prevalence rates of LTBI and TB disease among health workers? will help develop the national policy. study will help in understanding why certain regions have a higher rate of certification and accreditation compared to others and come up with ways to help the low performing regions improve. There is no information on the number of health workers who developed TB. This is a critical indicator in the effectiveness of infection control. The results will measure the effectiveness of the current infection control measures and contribute to the formulation of necessary policies and guidelines. study will create an impetus for the accelerated implementation of infection control measures in all 2015 WHO* 2015 *WHO will not be the lead agency but it can provide TA in developing the research design. 12
8.1. Reduced redundancies and gaps by harmonizing financing of TB prevention and control 8.1. Reduced redundancies and gaps by harmonizing financing of TB prevention and control 8.3. PhilHealth s role expanded through greater availability of accredited providers and increased utilization of TB-DOTS package 8.3. PhilHealth s role expanded through TOPIC/ Assessment and analysis of the barriers to the optimal use of the NTP sub-allotment. (JPR) Determine potential resource, capacities, gaps of private sector to beef-up support for implementation according to strategic instruments or goals Analysis of the Effects of TB/DOTS Benefit Package as Provider Incentive in Improving Local Financing and TB Control Program Performance Actuarial analysis for socialized What are the barriers to the full utilization of the NTP sub-allotment? How can the private sector be better engaged in support of achieving the performance targets? In what ways has the TB DOTS benefit package been effective in improving local TB Control Program performance? Is the reimbursement of 4 thousand pesos enough? Why or why not? How much DRTBrelated claims do DOTS facilities. The NTP suballotment is underutilized. The results of this study will guide the national program in addressing the barriers to and in promoting the optimal use of the NTP sub-allotment among LGUs. study will guide the national program in establishing a more productive relationship with the private sector in achieving the performance targets. study will demonstrate the degree of use of the TB-specific reimbursements and its effects on improving local TB Control Program performance among LGUs Currently, funding of MDR-TB is IMPACT nationallevel study 2014 2016 IMPACT USG sites 2015 2014 part of the STTA work Dr. Edgardo Gonzaga Component 5, IMPACT mobile no.: 0998-9729178 email: emg_impact@yahoo.com 13
greater availability of accredited providers and increased utilization of TB-DOTS package 8.3. PhilHealth s role expanded through greater availability of accredited providers and increased utilization of TB-DOTS package 8.4. Alternative funding models developed TOPIC/ insurance schemes for DRTB An analysis of the economic costs of TB (susceptible and DRTB) at the individual, household, community, and country level An Analysis of the Effects of DOTS Benefit Package at Patient, Provider, LGU, NTP Levels we expect to pay out in the next 5 years? How much premium can we charge to maintain a profit margin? What is the economic cost of TB at the individual, household, community, and country level? In what ways has the TB DOTS benefit package been effective in improving local TB Control Program performance? Is the reimbursement of supported by external partners. Part of reducing this dependency is for PhilHealth to support part of MDR-TB expenses. study will help PhilHealth in predicting with a reasonable degree of accuracy the amount of DRTB-related claims it will pay, which will help in determining the amount of premiums it must charge to remain profitable. The last time a study on this topic was done was back in 2003. It is time for an update. study will demonstrate the degree of use of the TB-specific reimbursements and its effects on the scale-up of TB support and expansion of TB IMPACT 2014 IMPACT 2015 part of the STTA work; IMPACT to expand research question. Dr. Edgardo Gonzaga Component 5, IMPACT mobile no.: 0998-9729178 email: emg_impact@yahoo.com 14
8.4. Alternative funding models developed 8.4. Alternative funding models developed TOPIC/ Evaluation Study of Bottom-Up Budgeting on Improving Local TB Control Program Performance Pilot testing of alternative financing models/strategies 4 thousand pesos enough? Why or why not? What is the effectiveness and impact of PhilHealth benefit package for TB support scale up or expansion of TB services? Is BUB effective and sustainable in improving local TB program performance? Which of these financing models/ strategies will be most effective and efficient in ensuring the financial sustainability of TB services? services. This will be the first study on BUB and its impact on improving Local TB Control Program performance. Based on costing there is a funding gap in implementing the plan. study will guide the national program in selecting the most effective and efficient financing model/ strategy to ensure the financial sustainability of TB services and to decrease funding gap. IMPACT USG sites 2015 part of the STTA work GF 2015 Dr. Edgardo Gonzaga Component 5, IMPACT mobile no.: 0998-9729178 email: emg_impact@yahoo.com 15