20 Nov South Africa: University Research Co./USAID diagnose over 3 thousand patients with TB using facility-based screening strategy
[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=”2896,2895″ img_size=”full”][vc_column_text]University Research Co., LLC (URC – SA), together with USAID (under the Tuberculosis South Africa Project), have developed and implemented a hospital-based TB screening method to identify and treat TB patients across 5 provinces in the country: Limpopo, Free State, Gauteng, Eastern Cape and KwaZulu-Natal.
The FAST approach (Finding TB cases Actively, Separating safely, and Treating effectively) is a case-finding intervention primarily implemented in hospitals to strengthen TB services and reduce the spread of TB in congregate settings. Through FAST, all hospital patients and visitors are screened for TB at all entry points. The FAST approach also aims to reduce diagnosis timeframe by using appropriate tests, and to accelerate initiation of treatment for patients with TB.
The target population for this intervention is anyone who accesses the hospital; patients, visitors or facility workers, including key populations such as children, pregnant women, health care workers and people living with HIV.
The strategy has been implemented in all hospitals in 11 of the project’s 14 directly supported districts: OR Tambo, Sarah Baartman, Nelson Mandela Health Metro, Waterberg, Sekhukhune, Mangaung, Fezile Dabi, Johannesburg Health Metro, Tshwane Health Metro, eThekwini and uMkhanyakude.
In partnership with the National Department of Health and the Eastern Cape provincial TB programme, the project conducted a peer learning visit to Vietnam to learn about the FAST Approach. Vietnam has been one of the pilot countries to test this approach and has been able to share lessons learned and assist others in successfully implementing the strategy.
This was followed by orientation sessions in the Eastern Cape, where the pilot plan was developed. Key activities included selection of pilot hospitals, capacity building of the facility-based teams, formation of FAST teams, implementation of monitoring and evaluation strategies, development of the national FAST implementation guideline, training material and reporting tools.
By August 2019, project implementation had been scaled up from 15 pilot sites to 153 facilities, which represents 81% of the targeted 188 facilities in the 14 project supported districts.
The project also facilitated adoption of the FAST approach to the South African National TB Programme (NTP) for scale-up and sustainability. This led to the introduction and implementation of FAST training-of-trainers (ToT) for national roll-out. The NTP has continued to scale-up the approach for institutionalization of active TB case-finding in hospitals through FAST in other districts not supported by the project.
The USAID TB South Africa Project achieved remarkable progress in TB screening, from a 44% baseline in 2017 to 71% in January-March 2019 to 76% in April-June 2019. From January through June 2019, the FAST strategy has resulted in 1,198,734 people screened for TB, 39,988 identified people with presumptive TB and 23,377 tested for TB using GeneXpert technology. 3,079 TB patients were diagnosed, with 138 having DR-TB. 2,679 were started on treatment.
In the next quarter, TB case finding will be enhanced through the implementation of urinary lipoarabinomannan (U-LAM) for HIV positive people with a low CD4 count (less than or equal to 100 cells/ul) and for those who are considered to be seriously ill (determined based on 4 signs respiratory rate > 30/min; temperature > 39C; heart rate > 120/min; unable to walk unaided) regardless of CD4 count. Implementation of the Continuous Quality Improvement (CQI) methodology to address identified gaps along the TB care cascade will contribute toward maintaining the impact of the FAST Approach.[/vc_column_text][/vc_column][/vc_row]