15 Apr DRC: National TB Program implements intensified TB case-finding approach in Kinshasa
[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=”2644,2642″ img_size=”full”][vc_column_text]In the context of World Day against Tuberculosis 2019, the National TB Program (NTP) in the Democratic Republic of Congo (DRC) held a 4-day intensified case-finding intervention to find missing people with TB. From 21st to 24th March, a “TB Village” was set up in Kinshasa, in a site called Place Saint-Thèrése which is surrounded by 7 health districts: Matete, Ndjili, Masina I, Masina II, Kimbanseke, Kingasani and Biyela.
These 7 districts together have an estimated population of 2,5 million out of which nearly 70% earn less than $1 every day. The area is characterized by overcrowded slums with no electricity or water connections and where malnutrition is widespread.
10 days before the intervention, 87 community health workers conducted community mobilization and compaigning on the main avenues and in several public sites in the area. In parallel 32 medical doctors, nurses and lab technicians were trained.
The “TB Village” was set up in an area equivalent to the size of 3 football pitches. TB screening and testing were conducted with the help of 3 mobile clinics – each one equipped with digital X-rays, 4 GeneXpert MTB/RIF modules and a lab. The clinics also offered HIV, blood sugar and blood pressure tests. All services at the site were offered for free.
Each patient was registered, screened and tested for TB by chest X-ray. Patients with abnormal results were further tested using GeneXpert. If TB positive, the patient was immediately referred to the nearest TB clinic for treatment.
During the 4 days of activities, 50’000 people visited the “TB Village” out of which 1’352 registered and 1’240 were screened for TB. 654 chest X-rays were performed with 246 having abnormal readings. 196 GeneXpert tests were done and 80 patients were diagnosed with all forms TB, out of which 68 have been reported to date to have started treatment. 2 cases of Rifampicin-resistant TB were detected and put on treatment. The number of notified cases in 4 days was 10 times higher than the usual notification rate.
“…I have been coughing for a long time, but I do not have the money to visit a hospital.”
The “TB Village”, as an advanced health post, provides care to people within walking distance of their houses, which eliminates transportation fees that the inhabitants of the area cannot afford. Likewise, all TB services including screening, testing and treatment are offered for free to eliminate the financial barrier.
Most of the time people are afraid to visit TB clinics due to stigmatization and discrimination. The setting of the “TB Village” has helped to ease people to get tested without experiencing the social and cultural stigma linked to this disease.
The NTP in DRC has usually adopted a passive approach to retrieve TB cases among people visiting TB clinics. However, economic and cultural barriers limit the access to quality care and leave many TB cases unidentified and untreated. By using an intensified case-finding strategy – with a mobile clinic close to the population and free services – they were able to achieve better results and find more of the missing people with TB.
In the next quarter, the NTP plans to a) review and check TB status of all cases of abnormal chest X-rays who tested negative on GeneXpert; b) monitor all patients who were put on TB treatment; c) investigate close contacts of index TB patients; and d) conduct advocacy with stakeholders to allocate more funding for future activities to maximize the intervention’s impact within the community.
At the request of the population, the Global Fund and the MOH, the NTP is designing an optimal plan to use its mobile units in Kinshasa in the following sites during the next months: Camp Luka, Kinkole, Kisenso, Mbanza, Lemba, Bordal communal land, Lufungula police camp, Kokolo military camp, Central prison of Makala, Ndolo military prison and Camp Kabila.[/vc_column_text][/vc_column][/vc_row]