28 May Mozambique: Health Alliance International engages community health workers to conduct TB screening at health facilities
[vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_separator type=”normal” thickness=”2″ up=”20″ down=”20″][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_gallery type=”nivo” interval=”3″ images=”2755,2757″ img_size=”full”][vc_column_text]The Mozambican National TB Control Programme (NTP) and Health Alliance International, with funding from the Stop TB Partnership’s TB REACH Initiative Wave 5, received support of 30 Community Health Workers (CHW) across 5 districts in the province of Manica to conduct active case finding activities.
The CHWs led short TB education sessions for patients in waiting rooms at health facilities, carried out active TB screening for all patients at all clinical sites in the all health facilities across the 5 districts and were responsible for contact tracing in households. The CHWs also traced patients who were diagnosed with TB by the laboratory but who did not return to collect their results, or who abandoned anti-TB therapy.
Over the first 12 months of intervention (Q4 2017 – Q3 2018), the 30 CHWs gave brief presentations on TB to over 337,000 people at health facilities, in schools, at community gatherings, and in patients’ homes. Out of those individuals that participated in the TB sensitization/education program, 9,192 reported symptoms and were referred for additional testing including Xpert (if available), smear microscopy, and clinical evaluation. In total, 979 were bacteriologically confirmed (approx. 75% by Xpert and 25% by smear), and 812 were clinically diagnosed. CHWs were directly responsible for a total of 1,791 new all forms TB notifications, out of which 1,782 were started on treatment.
In the year before this intervention started (Q4 2016 – Q3 2017) these 5 districts in Manica notified 5’219 cases of all forms of TB.
In the first year of this project (Q4 2017 – Q3 2018) the same 5 districts notified 5’982 cases of all forms of TB, which represents an increase of 14.6% over the prior year.
The increase in TB case notifications is believed to be attributed to the efforts of the CHWs who focused on screening for TB at health facilities and who conducted targeted contact tracing and case-finding in communities.
Following the project’s success, the strategy and daily registries for CHWs developed for this project were adopted as part of a standardized package of tools and strategies for all CHWs and TB partners in Mozambique and are currently being scaled up nationally.
Addressing loss to follow up
During this period, CHWs actively tracked down 163 patients who had abandoned TB treatment and were able to reconnect 137 to treatment. At the health facilities that they served, CHWs reported that there were 185 patients with a new bacteriologically confirmed TB result that either hadn’t formally returned for their results or got their results and weren’t started on treatment. They tried to track down 172 of these individuals and were able to enroll 164 in treatment.
Another part of this project involved scaling up GxAlert to 95% of all GeneXpert machines in Mozambique, creating better standardized reporting of notified TB cases and reducing the large pre-treatment loss to follow-up of patients diagnosed with Rifampicin-resistance.
A new monthly review of data from GxAlert, provincial aggregate data on RR/MDR TB cases notified and the excel based patient list has helped to substantially reduce the pre-treatment loss to follow-up and improve data quality and concordance across these three data sources.[/vc_column_text][/vc_column][/vc_row]