Background:
The Urban Health Initiative (UHI) is a five-year cooperative agreement (October 14, 2020–October 13, 2025) funded by the United States Agency for International Development (USAID) and implemented by a consortium led by Jhpiego, with Management Sciences for Health (MSH), CARE, Intellecap, Agency for Assistance and Development of Afghanistan, Afghan Social Marketing Association, Afghan Midwives Association, Terre des Hommes, BAO Systems, Project ECHO, and Viamo. UHI is implementing an integrated package of health services in five cities—Kabul, Mazar-e-Sharif, Herat, Kandahar, and Jalalabad – that consists of community and facility-based interventions for reproductive, maternal, newborn, child, and adolescent health, family planning, immunization, nutrition, COVID-19, and tuberculosis (TB) through an integrated and phased Nahia (sub-district) approach.
Project objectives:
- Objective 1 (Governance): Strengthen the health service delivery ecosystem in urban areas to deliver high-quality services to the most vulnerable
- Objective 2 (Access): To improve access for vulnerable populations to critical primary and lifesaving secondary and referral care health services in urban areas through the public and private sectors
- Objective 3 (Quality): To improve the quality of public and private critical primary and lifesaving secondary and referral health services in urban areas
- Objective 4 (Demand To improve awareness, demand, and care-seeking for key services and referral
UHI has supported 75 health facilities (HFs), including four Programmatic Management of Drug-Resistant TB (PMDT) sites, 51 diagnostic, and 24 referral (49 public and 26 private) HFs to strengthen service delivery for TB, including drug-resistant (DR) case detection and treatment. According to the PY5 work plan, UHI will implement 11 main TB activities in the five target cities with additions to five crosscutting activities.
During the PY4 of the project, the UHI project introduced and piloted artificial intelligence in TB diagnosis implementing Computerized Aided Detection (box system) for Tuberculosis (CAD4TB) for digital X-ray machines. In five tertiary hospitals of five UHI-supported cities Kabul (Afghan Japan Hospital), Herat (Shaidayee Hospital), Kandahar (Mirwais Regional Hospital), Jalalabad (Regional Hospital) and Mazar (Regional Hospital). The five CAD4TB box systems were installed for early screening of presumptive pulmonary TB cases in the mentioned hospitals to increase case detection and use GeneXpert cartridges sufficiently.
The UHI team developed an algorithm for screening and referring presumptive pulmonary TB cases to X-ray machines connected to CAD4TB boxes (operating offline) based on a score above 60. So far, 3,341 presumptive TB patients have been screened by CAD4TB, and those identified have been referred for GeneXpert testing. A total of 467 patients who had a high score were referred for GeneXpert testing, resulting in 136 (29%) bacteriologically confirmed TB cases.
Overview of the STTA:
The main purpose of the CAD4TB STTA is to assist UHI and partners in improving the CAD4TB implementation and utilization as a screening tool for early TB case detection, with technical support on its use and a clear algorithm to enhance TB case detection. This will take place in UHI targeted health facilities and also include on-site visits to two CAD4TB sites in Kabul and Herat.
The consultant will review the current algorithm used by CAD4TB and provide feedback to enhance and optimize the system for improving TB case detection in urban settings. In addition, the consultant will offer recommendations on how to strengthen the referral system between the CAD4TB sites and other health facilities.
The consultant will also discuss strategies and interventions to scale up the use of CAD4TB with the TB program, UHI, and partners and how to sustain the system after the UHI project closes.
Expected results:
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With this training health care providers in CAD4TB sites will be equipped to implement the new technology as a screening tool for presumptive TB cases
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Review the current CAD4TB algorithm and provide recommendations that will support the utilization of the CAD4TB system
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Oversee the data collection process using CAD4TB software to ensure systematic and standardized data gathering for the project
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Share lessons learned from other countries in implementing the CAD4TB technology for TB screening and case detection
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Provide recommendation to the UHI project and partners on the use and expansion of CAD4TB in Afghanistan for the next two years
Activities/Deliverables:
Before visit
-Conduct a preparatory/desk review of the current screening and case detection tools in Afghanistan and the experience of other countries using the CAD4TB system
-Prepare a technical presentation on the use and implementation of CAD4TB worldwide and in the region with a focus on scale up and sustainability
-Review the existing approach of using CAD4TB and its algorithm in Afghanistan
During the visit – Kabul
-Conduct coordination meetings with UHI technical team, TB program and partners which will also include an orientation on the use and implementation of CAD4TB
-Conduct visits and assess the two CAD4TB sites in Kabul and Herat. During the visit the consultant will evaluate the current use of the CAD4TB in the two hospitals
-Review the UHI project’s CAD4TB reporting system
-Based on the assessment findings (from the activities outlined above), make concrete recommendations and actions that are needed to address the identified gaps to accelerate the implementation of CAD4TB
- Meet with TB Program, UHI, AFIAT, UNDP, WHO, MSF, Afghan-Japan and other stakeholders who are involved in the TB program and share the recommendation on the use of CAD4TB for closing the gap of case finding in Afghanistan and scale up and sustainably of the system in the future. with the TB program, UHI, and partners and provide recommendations to scale up and sustainably of the system in the future.
- Meet with TB Program, UHI, AFIAT, UNDP, WHO, MSF, Afghan-Japan and relevant stakeholders, involved in the TB program, to disseminate findings and provide recommendations for scaling up and sustaining the system for the future in Afghanistan
-Provide concrete recommendations to sustain the system in Afghanistan after the UHI project closes
- Debriefing with USAID mission, if requested
Post visit
- A final technical report highlighting main findings, conclusions, recommendations (short and long term), and next steps within 30 calendar days of completion of the mission
QUALIFICATIONS
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MD, MPH, or similar academic degree
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Experience in the programmatic use of CAD4TB technology for TB screening and sustainability of CAD4TB system in TB program
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Extensive experience in TB service implementation in urban settings in the region
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Willingness and ability to travel to Afghanistan
Experience in the region or South Asian countries like Pakistan, India, Uzbekistan or Afghanistan
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