07 Nov Kenya: Population Services Kenya implements PPM strategy for early TB diagnosis
[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=”2878,2879″ img_size=”full”][vc_column_text]A patient pathway analysis indicates that 15% of patients with TB in Kenya first seek care in the informal private sector, while another 10% seek care in private clinics, many of which are disengaged from TB response. Due to limited availability of TB diagnostics at initial point of care, opportunity for early TB diagnosis and prompt treatment is missed.
Population Services Kenya (PS Kenya) – as the interface agency of the Global Fund grant through Amref PR2 – has implemented a PPM project to engage and build the capacity of health providers to participate in TB case-detection through screening and linkage to diagnosis and treatment.
The project targets patients seeking healthcare in 8 urban sub-counties: Embakasi in Nairobi County, Changamwe/Jomvu in Mombasa, Thika Town in Kiambu, Kisumu East in Kisumu, Ngong in Kajiado, Malindi Town in Kilifi, Naivasha Town in Nakuru and Garissa Township in Garissa.
Private facilities targeted under the project interventions include chemists and pharmacies, drug stores, private clinics, radiology units, NGO clinics, parastatal/company clinics, mission dispensaries, nursing homes and stand-alone laboratories.
The intervention focuses on reaching the unreached populations who did not benefit from an early diagnosis because their primary point of contact with the health system was not involved in TB response. Many of the targeted sub-counties have large urban informal settlements with a high TB burden and whose residents do not systematically seek care in the formal health system. Many buy over-the-counter medicines to manage cough and other symptoms, thus delaying TB diagnosis.
Additionally, many of them are unable to access public health facilities which are either very far from their settlements or over-crowded. Others cannot afford time off work to seek care and hence opt for readily available over-the-counter medicines for symptom relief.
Soon after project kick-off in May, mapping tools were developed and applied in all 8 target urban centers. Approximately 1’168 health facilities were mapped, out of which 499 (280 clinics and 219 chemists/medicine outlets) were selected for engagement. The engaged healthcare providers were linked to 10 GeneXpert diagnostic and treatment facilities, provided with M&E tools and supported to report to the NTLDP as appropriate.
Of the 315 providers trained to carry out routine TB screening, 124 have signed memorandums of understanding (MoU) to guide engagement between the facilities and PS Kenya.
Eight motorcycle riders – one per urban center – have been contracted and trained to carry out sample referral. The riders have also been sensitized on sample handling and infection control and provided with cooler boxes and ice packs for sample transportation.
Screening and linkage services have fully started in 99 facilities beginning August 2019 and since then, 3’686 people have been screened for TB, 389 presumptive patients were identified, and 21 people diagnosed with TB and initiated on treatment. These private facilities are given monetary incentives for every person with TB identified.
Over the next quarter, special focus will be put on engaging the providers that have not signed MoUs yet, so they can receive support to start screening for TB. All engaged providers will be given technical assistance to screen, document and optimize linkages to minimize losses and leaks along the diagnostic cascade.
In the coming months, Kenya will be having an active case-finding rapid results initiative to target poorly performing counties. Senior county leaders will be engaged to garner political support for TB active case finding as there is sub-optimal buy-in at various levels.[/vc_column_text][/vc_column][/vc_row]