07 Aug Pakistan: Mercy Corps implements Enhanced Case Finding approach in Punjab province to find missing people with TB
[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=”1608,1607,1606″ img_size=”full”][/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_column_text]Tuberculosis (TB) is one of the major public health issues in Pakistan; the country ranks 5th among the 30 high burden TB countries. As part of its TB Control activities, Mercy Corps is implementing Enhanced Case Finding (ECF) component since July 2016, under the New Funding Model grant of the Global Fund. The objective of the ECF component is to find the missing people with TB and ensure their treatment to avoid spread of the disease among others.
The key activities under ECF include (1) training of identified doctors, lab technicians and paramedics in the selected small to large private hospitals on national TB DOTS Guidelines; (2) microscopic sputum analysis; (3) chest camps outside hospitals and in community outreach; (4) verbal screening of all patients presenting at Outpatient Departments (OPDs) of the selected hospitals; and (5) GeneXpert testing of bacteriologically positive patients from 15 selected hospitals, chest camps and public sector health facilities.
The target population for this intervention is the catchment population of the Tehsils (or sub-districts) in which 15 private hospitals are present. These private hospitals are located in the 6 districts of Punjab province: Gujranwala, Hafizabad, Mandi Bahauddin, Multan, Khanewal and Vehari. Any presumptive TB patient identified through the outreach chest camps in these districts is referred to these hospitals for diagnosis and treatment.
The ECF intervention specifically focuses on the identification of missing people with TB reporting to the different outpatient departments of the selected hospitals. The TB screeners placed in the hospitals, symptomatically screen all the patients reporting to the OPD of different specialties. Those found to have any TB symptom are referred to the doctor trained on TB DOTS for further investigation and confirmation of diagnosis.
Among the 15 private hospitals, 6 are equipped with GeneXpert machines. Here, all identified presumptive people with TB undergo GeneXpert testing for MTB and detection of rifampicin resistance. In the remaining 9 hospitals the presumptive TB patients undergo sputum smear microscopy. Those found bacteriologically positive are further tested on GeneXpert for detection of rifampicin resistance.
The TB screeners in the different OPDs have helped in early diagnosis and improved TB case notification, since many patients do not present typical TB symptoms and are unaware of their disease. TB screeners also do regular follow up of the diagnosed TB patients, thus improving adherence to treatment. To reduce stigma and raise awareness about TB among the community, people with TB and their attendants receive adequate counseling.
This Enhanced Case Finding intervention itself is innovative in its design since it addresses some of the important issues faced by the TB control program such as finding missing people with TB, failure to follow up and social isolation of TB patients due to the stigma attached with the disease. Furthermore, identification of rifampicin resistant TB patients through GeneXpert testing in small to large private hospitals is a novel approach that was never tried before in this region.
During the time period between January 2017 to December 2017, 5,678 GeneXpert tests of patients from chest camps, private hospitals and public sector health facilities were performed. A total of 1,322 MTB cases were detected, out of which 94 were rifampicin resistant. Mercy Corps plans to continue the same activities in the 15 selected hospitals to find many more of the missing people with TB.[/vc_column_text][/vc_column][/vc_row]