17.5 Programme assessment

Access to care

• Accessibility of treatment facilities, decentralization, etc.
• Home-based treatment available when appropriate.

Easy access to care during the intensive/continuation phases

Patient comfort

• Patient welcome
• Condition of the facility, heating (or cooling), overall organization and cleanliness.
• Food during hospitalization and/or for outpatients (supplemental rations, quantities, organization in charge).
• Bed occupancy rate of the TB ward.

• According to needs
• Bed occupancy rate ≤ 100%

Information and therapeutic education

Patient interviews conducted.

Patient understanding of treatment

Hospital hygiene

• Equipment (respirators, masks, gloves, gowns, autoclaves, cleaning supplies, etc.)
• Waste management (sorting, incinerator, etc.)

All necessary equipment is available and used.

Constant supply of lab materials

• Supplied by (government, agency or facility, other)
• Buffer stock
• Number and duration of shortages

• 3-month buffer stock
• No shortages

Constant supply of quality-assured
anti-TB drugs

• Stock card maintenance
• Order frequency, delivery time, buffer stock
• Shortage(s)
• Drug sources
• Institution in charge of supply
• Use of FDCs first-line drugs
• Storage conditions
• Organization of supply for peripheral facilities

• Stock cards up-to-dated
• One person in charge of the pharmacy
• All adequate
• No shortages
• WHO-prequalified sources (or equivalent)
• Use of FDCs
• Appropriate storage conditions
• Regular supply

Case detection

• Type of case detection (active or passive)
• Contacts screening
• Detection rate of new smear-positive cases
• Percentage of smear-positive patients out of the total number of patients who had a sputum smear.
• Detection rate of MDR-TB

Know the type, in order to interpret the quantitative results of case detection

• 100%
• Depends on the context
• < 20%
• Depends on the context

Diagnosis of smear-negative PTB and EP forms

• Automated molecular test
• Culture or molecular techniques
• X-rays
• Others (e.g. ADA, Pandy, Rivalta, FNAC)
• Algorithms used

• Yes
• Yes
• Yes
• Yes
• Yes

DST

DST possible (methods, quality control)

Detection of DR-TB

Treatment support

Number of patients receiving treatment support/month

100% of those eligible for support

• System for identifying and looking for non- adherent patients
• Percentage of patients who resumed treatment among those missing for less than 2 months who had to be looked for

• Yes
• > 90%

• Access to voluntary counselling and testing (VCT)
• Access to ART
• Access to cotrimoxazole prophylaxis
• HIV treatment integrated in the TB service (or TB treatment in the HIV service)

• Yes
• Yes
• Yes
• Yes

Registers/records

Description of the documents

• Consistency between TB registers and treatment cards
• Consistency between TB register and lab registers

Records reliable

• 100%
• 100%

Standard case definitions

Percentage of patients with exact case definition out of a randomized sample of patients

100%

Adequate standard treatment regimens and follow-up

• Percentage of new cases correctly treated (combinations, dosage, duration) out of a randomized sample of patients
• Percentage of patients who did not have bacteriological follow-up according to schedule out of a randomized sample of patients
• Percentage of MDR-TB patients who did not have biochemistry tests according to schedule out of a randomized sample of patients

• > 95%
• < 10%
• < 10%

HIV testing

Percentage of new cases tested for HIV

100%

ART

Percentage of HIV-positive TB cases started on ART
ART started within:
< 2 weeks; 2 weeks-< 2 months; ≥ 2 months

100%

Criteria for cure

Percentage of confirmed cases declared cured who actually met the definition of cure out of a randomized sample of patients

> 90%

Regular monitoring of drug-susceptible TB and DR-TB

• Quarterly report and cohort analysis for drug-susceptible TB
• Bi-annual report and cohort analysis for DR-TB

• Quantitative data on inclusions and results collected
• Rapid detection of potential problems

Adherence monitoring

• Percentage of patients coming in for their appointment out of number of patients expected
• Percentage of doses given under DOT for DR-TB treatment in a randomized sample of patients

• > 90% in both the intensive and continuation phases
• 100%

• Isolation
• Building ventilation, lights, UV lamps (hospital wards, outpatient clinics, laboratory); respirators for staff and visitors in contact with contagious patients; masks for contagious patients (if they move about)
• Written prevention plan?
• Person in charge identified?

• Isolation of smear positive patients
• Isolation of DR smear positive patients
• Appropriate use of means
• Yes
• Yes

• Regular evaluation of laboratory functioning
• Quarterly EQA of smear microscopy
• Annual EQA of DST

• Ensure the quality of laboratory analyses for bacteriological diagnosis
• Results according to standards
• Results according to standards

Staff

• Job descriptions (doctors, nurses, lab technicians, cleaning staff, etc.)
• Medical staff-to-patient ratio

On average:

• One nurse for 10-15 patients
• One doctor for 40-50 patients

Training

Refer to training programme evaluation criteria

Competent staff

Other contributors

Description: other NGOs, local associations, etc.