The primary target for the long-term TB control should be to reduce the high force of TB infection, particularly in densely populated sub-urban areas. This is because the effectual contact numbers and the population prevalence of the infectious TB cases are the drivers of the high force of infection for the TB epidemic. Using of antiretroviral therapy (ART) as prevention has a strategy of controlling the HIV epidemic will have a supplementary effect in the control of the TB that is HIV-associated. A full implementation of the available ART guidelines, among the HIV- infected patients, will decrease the pre-ART TB infection burden. There is a need to target high-risk communities, and accompanying a shift in priority concentration from case management to the reduction in TB transmission with the incorporation of new result measures, which reflect continuing TB transmission at the sentinel and national sites.

Section 4: The Impact

There are a number of benefits that the high-density township areas, particularly in South Africa, will receive in case they implement the above intervention strategies. The major impact of the intervention is a decrease in the number of TB cases among children and adolescents in this community. In addition, a reduction of the number of TB admissions at the hospital, and the decrease of TB transmission within and without the community will be a result that will arise from the implementation of the intervention plan. Other health outcomes to expect from the implementation of this program include an acceptance of TB treatment and prevention, patients receiving appropriate treatment for the TB, patients adhering to treatment and completing treatment in time, an increase in patients' knowledge about the disease, and an enhancement in the overall health of the population. On the other hand, the social outcomes of the program include building trust within the community, a reduction of stigma about TB, an overall improvement of the community's quality of life and patients being able to identify all of their close associates.

Section 5: Evaluation

Below is the evaluation plan that the researcher shall use to assess the effectiveness of the intervention suggestions above in achieving the expected outcomes of the program:

Introduction

The major goals of this evaluation shall be:

To establish the efficacy of the program

To appraise the success and advancement toward the realization of program objectives

To examine segments of the program that are functioning optimally so as to replicate them

To help in the equitable redistribution of resources

The aim of this assessment plan is to offer the researcher, and other stakeholders in the implementation of the intervention strategies, with the necessary information that will be helpful in assessing the effectiveness and progress of the program.

Evaluation Team

The evaluation team shall comprise 10 members and a team leader. The roles of the team leader shall be:

Supervision of all evaluation activities

Coordinator of all meetings of the evaluation team

Chief analyst of the evaluation data

Principal author of the evaluation plan and reports

Top person in the distribution of evaluation materials and reports

The rest of the members of the team shall carry out the following roles:

Data collection

Data analysis

Dissemination of findings

Use of the findings

Members of the evaluation planning committee

These people will include the program manager, epidemiologists, nurses, epidemiologists, and representatives from partner agencies.

Stakeholder Assessment

The table below gives the list of stakeholders who will be included in the program, their perspective, or interest in the program, the function they will have in the evaluation, and how and when they will participate in the evaluation:

Stakeholders

Perspective on or Interest in the TB program and the evaluation function in the evaluation

How and when will they be occupied in the evaluation

Program Managers

Interest in self-improvements and the perfection of the program

Define program processes

Formal Interview

Program staff

See program evaluation as a personal judgment

Define the problem in the program from a staff perspective

Formal Interview

Outreach workers evidence of effects for funding and program development purposes broadcast results to agency leaders and financial support agencies

External reviewer

Nurses

They fear an increase in workload

Collect data

Formal interview

Clinicians

Fear program alteration & job loss

Identify data sources

Formal interview

Program administrators

Interest in self-improvements and the improvements of the program

Providing administrative and funding context

External reviewer

Health department administrators

Concerns about the HIV status of the community

Define health problem

Data collector

Patients

Need for services

Define the problem in program from a client perspective

Participant

Adolescents and children

Fear or reject health system

Participate in providing their view of the program

Participant

Community members

Community image

Identify data sources

Meeting

Community-based organizations

Partnership capacity

Disseminate findings to community audiences

Community planning board

Community health among underserved population

Identify stakeholders

Meeting

Business community

Partnership capacity

Provide funding

Informal interview

Policy makers

Defensive of current system

Provide operational context

Focus group

Health care providers

Proof of effects for funding and program expansion purposes

Define health problem

Formal interview

Schools

They fear an increase in workload

Collect data

Data collector

The roles of the stakeholders...

In addition, children in this area have not been vaccinated against TB through the BCG vaccine. This problem could be arising because there are only a few health care centers to serve the densely populated community thereby making the vaccines inaccessible. The consequences of this problem include ill health among children and adolescents, high morbidity rates, rise in the treatment costs and backlash against the community's population. This poses potential for a bigger problem, but acting may lessen the problem. In this area, there are a number of trends that are occurring, which have worsened the situation including an increase in the TB incidence and change in the demographic patterns.
Context

The factors that affect this program include:

This TB program will cooperate and coordinate with other social and health services in the community including HIV service programs, housing and food support programs, schools and hospitals among others.

The program is competing for resources with other health programs within the community.

Organization's structural factors

The program will be operating within the context of policy and political environment who may influence the effectiveness of the program

The community does not consider TB as a serious health problem

Target Population

This TB program targets the following groups of people in addressing the TB concerns:

Children and adolescents

People who are infected with HIV

People living in congregate settings

Stage of Program Development

In evaluating the program, one will consider the stages of the following activities:

Needs assessment

Design and planning

Implementation

Well-established implementation

This will be useful in deciding on outcome evaluation, process evaluation, or both.

Resources/Inputs

The resources for implementing the program are:

The TB program staff

Continuing education and Training staff

Financial support

Structural components

Infrastructure resources that are part of the health department

Partner organizations

Outputs

The following are the outputs that the evaluation shall take into account:

A strategic plan for the program

Conducting of TB Tests

Educating of providers about TB

Presenting of education sessions to community groups

Outcomes

The following are the probable expectations of the program, which evaluation will consider:

An increase in patient's knowledge

Acceptance by patients for TB treatment

More children receive BCG vaccine

Patients receive appropriate treatment

Patients stick to the TB treatment

A reduction in hospital admissions for TB

A reduction in the transmission of TB

Trust developed within the community

Patients name all of their close associates

Reduction of stigma about TB

Improved quality of patient's life

Patients are in good health overall

Evaluation Questions, indicators, benchmarks

Process questions:

1. Are there adequate resources to perform the activities of this program?

Indicators:

Availability of funding

Availability of personnel

Availability of physical space

Benchmarks:

Availability of enough funding for all activities

100% availability of personnel to execute the program's activities

100% availability of space for running the affairs of the program

2. Are associates named in the timeframe set by the procedures?

Indicator:

Patients naming of close contact between January and April 2014

Benchmark:

An increase in the number of patients identifying their close associates

3. Have community associates been taken on to work in partnership with us to thwart TB in the high-risk populace?

Indicator:

Associates are already working with the implementation team

Benchmarks:

An increase in the number of associates working with the implementation team

Outcome questions:

1. How did the plan play a part in the decline of TB transmission rate among children and adolescents?

Indicator:

The number of children and adolescents tested with TB between Jan and December 2014

Benchmark:

Reduction in the number of children and adolescents with TB

2. To what extent was the plan able to lessen the incidence of TB among adults?

Indicator:

The number of adults suffering from TB

Benchmark:

A reduction in the number of adults suffering from TB

Evaluation Design

Use of a control group

Measurements will be before and after

Data collection will be retrospective

Qualitative information

Data Collection

The sources

The data sources for evaluation include:

TB Records or charts

TB registry and databases

Interviews and focus groups

Participant observations

Other relevant documents

The tools

The tools for collecting the evaluation data will be:

1. Focus groups

2. Interviews

3. Personal interviews, both formal and informal

4. Self-administered surveys

There will be pilot testing of the tool before using them in the collection of evaluation data to ensure that users can effectively use them to achieve the intended purpose. Based on the pilot test, there shall be appropriate changes in the tools.

Analysis and Interpretation

Below is the plan for analyzing and interpreting the evaluation data:

Analysis

The evaluation team will use STATA data analysis software to analyze the evaluation results. The findings shall be presented…