Tanzania: AIGHD evaluates implementing TB screening in universal HIV test and treat model of care

Since 2015, the World Health Organization (WHO) recommends a Universal Test & Treat (UTT) approach in the fight against HIV/AIDS. All individuals tested positive for HIV should start antiretroviral treatment immediately, irrespective of CD4 count or clinical stage. Tanzania adopted this approach in 2016.

As the barriers to seeking TB diagnosis and care coincide with those for testing for, and enrolling into HIV care, the Amsterdam Institute for Global Health and Development (AIGHD), the National Institute for Medical Research Muhimbili Centre in Tanzania and CUAMM Doctors with Africa, in collaboration with the National TB and Leprosy Programme, set up a project in Shinyanga DC to investigate the feasibility and effectiveness of implementing TB screening in a universal HIV test and treat model of care in rural Tanzania.

The project is meant to serve as proof of successful implementation of TB screening as an add-on to the UTT approach, which can serve as an example for other Tanzanian regions. It also helps to assess the feasibility of implementing this model on a larger scale in the country.

The specific target population for this intervention can be divided into 3 subgroups within the rural key population: those approached for HIV testing in the HIV Test and Treat Programme; those who are found to be HIV positive; and the household contacts of the newly identified TB patients.

The project implementation includes 3 main activities:

TB screening is linked to an HIV testing campaign, in which HIV and TB testing teams travel to different communities to do community-based testing. All people aged 5 years and above who undergo HIV testing during these campaigns are also tested for TB.

When people are suspected of TB, a sputum sample is collected and transported to a laboratory. In the laboratory, highly sensitive GeneXpert Ultra cartridges are used for TB diagnosis.

If TB is confirmed, members living in the same household as the newly confirmed TB patient are screened for TB using mHealth technology. If a household member is suspected of TB, a Community Health Worker collects a sputum sample for GeneXpert testing.

All confirmed TB cases are linked to care and started on treatment, as are all HIV positive patients.

The impact of the intervention is studied using embedded operational research.

Since initiation of the project, 15’103 people were screened at community and facility levels, as well as an additional 23 contacts of confirmed cases. 642 people were tested and 29 were diagnosed and started on treatment. TB notification in all 4 quarters of the project duration increased compared to the previous 2 years.

In the coming days, a large 3 day TB training will be held for all health staff in Bugisi and 3 other clinics in the Shinyanga and Simiyu region – which are part of the HIV Test & Treat project – during which the new approach on how to screen for TB will be discussed.

Moving forward, there will be additional focus on screening all outpatients in clinics for TB as well as during HIV outreach testing events.

The method used to screen household contacts using mHealth approach has been scaled-up to a national level by the National TB and Leprosy Programme. It is now available free of charge to anyone who has access to a mobile phone.

The GeneXpert machine remains at Bugisi clinic where Xpert Ultra cartridges are being used to continue TB diagnosis.