TB Contact Tracing in Motheo District, Free State Province

South Africa

IAS Community Satellite17th July 2011

Dr Ima P. Chima

Acknowledgement Mr. Thomas Sihlangu

– Community Linkages Officer, EGPAF Ms Daphne Mpofu

– Community Linkages Manager, EGPAF Ms Maggie Kwatala

– HIV TB Coordinator Department of Health Free State Ms Keneilwe Nkoana,

– TB Tracing Team from Department of Health Free State Ms Joyce Ramakau

– TB-Free, Free State

Background Motheo District, in Free State Province has the

highest TB case load. In 2009 - case load of 24,940, of which 7, 747

(31.1 %) was in Motheo District only. Department of Health (DoH) in Free State noted ↑

number of new MDR-TB patients based on quarterly data assessments, thus likelihood of Defaulting from TB treatment TB contacts being infected and not seeking treatment

Gupta et al (2010) Maternal TB associated with 2.51 fold ↑ in MTCT of HIV

Prevention of TB among HIV-infected mothers should be high priority for communities with significant HIV/TB burden.

Intervention TB defaulter tracing in Motheo district

Find patients who default or lost to follow-up

Screen contacts for TB and refer them to the local facilities for further management.

EGPAF in partnership with DOH and TB Free (NGO) started the TB defaulter tracing exercise on 19th January 2011.

Intervention (2) 2468 households were identified from a 2009

register of diagnosed TB patients. Most patients resided in informal settlements Contacts were traced using a number of

ways: Post office staff greatly assisted in locating the

actual houses based on addresses from the register.

Team members asked community members for contacts surnames instead of first names

Teams also used municipality maps to locate house numbers

Intervention (3) Community members were involved

through the participation of Community Health Workers (CHW).

CHW are community members working with CBOs or attached to health facilities.

These CHW together with Lay Counsellors provided HCT.

Community members helped distribute IEC materials and were engaged to assist with mobilization.

Intervention (4) The three partners formed 24 teams

that were allocated different areas to cover in Motheo District.

The teams provided HIV counselling and testing and TB screening, door to door.

Household members gave verbal consent for screening and testing.

Community awareness and mobilisation of the exercise was achieved using road show techniques around “hot spots”.

Intervention (5) Screening for TB was done with a

screening tool (4 questions) and sputum testing .

HIV testing was done using Rapid HIV testing kits

Those HIV +ve were referred to health facilities for CD4 counts

Infants and children below 5 years were excluded from TB screening because of their inability to produce sputum

TB Screening tool

ResultsIndicator Number

Number of households visited 2470

Number of defaulters traced 145

Number of TB patients lost to follow up 73

Number of contacts screened for both HIV and TB 4865

Number of adults sputum positive for TB 12

Number of children sputum positive for TB 24

Number of adults who tested HIV positive (>15 years) 133

• Females 102

• Males 31

Number of children who tested HIV positive (5 to 15 years)

5

Recommendations Involving post office workers was an

effective means of identifying defaulters and patients lost to follow-up especially in informal settlements

The partnership created between EGPAF, DOH and TB-Free was effective and efficient: Combined resources Coordination Ownership by DOH Community mobilisation and awareness

Further research Further research would assist in

evaluating Effectiveness of various community level

interventions in promoting adherence and decreasing default among patients on HIV and TB treatment

Adherence and outcomes of traced defaulters identified through the tracing exercise

Outcomes of contacts identified post tracing

Rea Lebogha!Siyabonga!

Dankie!Thank you!