Introduction

KNCV’s overarching strategic direction focuses on assisting countries and national/local partners in accordance with their needs in the complementary areas of innovations and evidence generation, policy development and strategic planning, and supportive systems. Acknowledging the capacity which exisits in many countries to lead and implement TB programs, KNCV increasingly supports introduction, in-country evidence generation and scale-up of innovations, like new approaches, tools and treatments, while strengthening surveillance for data-driven program management and strategic planning. KNCV areas of work include the whole spectre of TB Elimination and the patient pathway, from prevention to diagnosis, treatment and care. In addition, KNCV collaborates with partner organizations like the TB Alliance and IAVI by providing complementary services, especially regarding introduction of innovations.

KNCV has over five decades of experience in technical assistance (TA) and project implementation in over 40 countries across four continents and understands the contexts and the complexities of different health systems. While being responsible to specific country TA requests, through its TA, KNCV’s work is guided by international standards and aims to contribute to achieving global objectives.
Drawing on lessons from its vast experience, KNCV adheres to the following best practices to ensure quality technical assistance and rapid capacity transfer.

ILLUSTRATIVE KNCV TECHNICAL ASSISTANCE PACKAGES

KNCV provides technical assistance at the request of governments, donor agencies and other stakeholders in TB Elimination. Depending on the expressed needs and locality, KNCV can provide short or medium term TA by local, regional or international consultants through country visits or longer term TA and/or managerial support for the duration of a project. Increasingly KNCV is using remote support, including e-workshops and e-learning as integral element of its technical assistance. This distance-based TA has been extremely useful during this time of COVID-19 pandemic.

Below is an illustrative list of KNCV TA packages:

1: National Strategic Plan (NSP) development or NSP updates

KNCV TA to NSP development would, depending on the request, consist of:
– Overall support and guidance to NSP development or partial contributions on request
– Implementation of novel Patient-Centered Framework approach or conventional data-driven planning as required
– Leading or participating in program reviews
– Epi assessments, comprehensive data consolidation along the care continuum, Patient Pathway Analysis,
– TIME Impact Modeling for prioritization
– Multidisciplinary consultants’ team “under one roof”

2: Support to success of Global Fund

KCNV TA to support Global Fund (GF) implementation and procedures could consist of:

– Development of GF funding requests (FR)
> Based on NSP or program review
> Overall support and guidance to GF FR development or partial support on specific topics as requested
> Multidisciplinary consultants’ team ‘under one roof’
> TIME Impact modelling for prioritization of interventions
> TA to NTPs and other prime recipients in the process of grant making

– Global Fund implementation support
> Periodic technical review and TA to development of remedial actions
> Flexible TA to principle recipient to GF (global fund) implementation (technical and/or managerial)
> TA for reprogramming of savings

3: Introduction and scale-up of innovations

KNCV supports development of evidence-based global and national policies and guidelines, as well as the development of generic technical tools, job aids and best practice documents; KNCV offers TA to countries to adapt global policies and generic tools to country-specific contexts. KNCV provides TA to introduction and scale-up of innovations, with a systematic approach to the introduction (at pilot or demonstration sites) and management of nation-wide access scale-up.

4: TA in specialized areas:

A: TA to epidemological studies, research and surveillance, including local capacity building

1. KCNV provides TA to population surveys, consisting of planning and costing, development of protocol, tools forms etc, TA to implementation, data collection and quality assurance, data management, analysis, reporting and utilization for decision making; international publication of important studies.

Examples include:
i. TB prevalence surveys; utilization of innovative techniques and methodologies
ii. Drug resistance surveys; assistance to innovative continuous surveillance of drug resistance
iii. LTBI surveys among populations of interest
iv. Risk group surveillance
v. Inventory studies
vi. Catastrophic cost studies
vii. Observational studies
viii. Diagnostic studies

2. Operational research: Effectiveness, safety, feasibility and costing studies, stigma measurement, patient and health worker surveys

B: TA to prevention: TB infection control (TB IC) and Tuberculosis Preventive Treatment (TPT)

1. Introduction and scale-up of contact investigation complemented by TB treatment and TPT
2. Introduction and scale-up of combined Active Case Finding and LTBI treatment approaches in high prevalence populations (key affected populations)
3. TA to programming of introduction and scale-up of TPT, including the introduction of new, more effective and shorter regimens for TPT
4. TA to planning and introduction of TB infection control in facilities and communities: the full specter of managerial, environmental and personal protection measures and development of the regulatory frameworks and M&E systems
5. TA to design and maintenance of TB infection control aspects of BSL2 laboratories and health facilities
6. Introduction of health care worker TB and LBTI surveillance.

C: TA to comprehensive diagnostic network strengthening

1. Conduct laboratory network assessments and development of laboratory strategic plans
2. Optimal placement and systematic introduction of new diagnostic tools within the laboratory network
3. Support to the planning, development and implementation of sample transportation network (see also Digital Health Solutions)
4. Supporting to optimal utilization of connectivity
5. Development of Access and Optimization strategy
for all laboratory services
6. Introduction of digital X-rays (CAD4TB) and mobile
diagnostic services
7. Introduction of multi-disease testing platforms

D: M/XDR-TB

1. Support systematic and programmatic implementation of new medicines and shorter, all
oral DR-TB treatment regimens, and operational research on modified shorter DR-TB regimens
2. Development of quality improvement systems, both for individual patient care and programmatic interventions
3. Introduction and/or strengthening of aDSM systems, and evaluation of implementation
4. Support to decentralization of PMDT
5. Surveillance, enhanced M&E and evidence generation

E: Health systems

1. Development and implementation of strategies for finding the missing TB patients including TB case finding among vulnerable groups
2. Capacity development and engagement in TB eliminiation for national and local NGOs including community based-organizations
3. Development of community systems for TB Elimination
4. Sub-national burden estimates, subnational TB Elimination planning, and TA to subnational resource mobilization for realization of NSPs
5. Assessments and planning for Human resources for Health for TB Elimination in the framework of integrated health systems approaches

F: Human resource capacity building

1. TA to development of country specific human resources capacity building strategies and
approaches, integrating pre–service and post graduate training, on the job support, supportive
supervision and feedback;

2. Development of accredited e-learning / blended learning packages in support of continuous professional development (CME points), with evaluation of results and health worker training
tracking system
3. TA to development of context-specific, targeted training packages (conventional – e-learning – blended learning), with job aids and tools for instance on
a. Contact investigation
b. Tuberculine testing
c. Infection control
d. DR-TB, aDSM, introduction of new drugs and regimens, QT interval measurement
e. Operational research
f. Stigma, stigma interventions and stigma measurement
g. For other examples please refer to all specific TA packages and see our website for generic and country-specific courses and materials)

 

G: Digital Health Solutions

1. TA to development of context-specific packages for digital adherence support
2. TA to development of Mobile and digital solutions for education, TB screening and support for health care workers and communities
3. Package approach to the use of connectivity and interoperability of eHealth systems
4. Surveillance system assessments and strengthening of surveillance system at all levels
5. Design, (further) development and strengthening of electronic health information
systems based on or interoperable with DHIS2 etc.
6. Design and implementation of e&m Health solutions for sample transportation networks

H: Stigma prevention & Reduction

1. TA to stigma measurement and development of stigma reduction strategy among health care
workers, patients, and communities-using an integrated approach including COVID-19
2. TA to Implementation of stigma reduction tools
for different users:
a. The Allies approach
b. TB Photovoices
c. From the inside out