New Tide to Strengthen Client Centered Tuberculosis Care

Speeches Shim

Tuesday, January 25, 2022
The USAID Afya Endelevu (“Sustainable Health”) activity works with the government of Tanzania to address human resources for health gaps at the national, regional, and local government levels.

Identification and notification of multi-drug resistant tuberculosis (MDR-TB) patients in rural areas need much more than high-technology machines for screening. Tanzania's Kilimanjaro region has been on the frontline to strengthen the provision of TB services including identification and treatment of MDR-TB patients. Unfortunately, without a comprehensive strategy and ample effort, it was difficult for the Regional Health Team to identify and notify MDR-TB patients.

“At regional level, we had our health priorities and among them, combatting TB is one of our top priorities; especially identification of MDR-TB patients. But we had a very low MDR-TB case detection rate.” Narrates Dr. Peter Nigwa, the Regional TB and Leprosy Coordinator.

In Tanzania, the burden of TB and drug-resistant TB is a major cause of illness and death. In 2019, an estimated 32,000 people died from TB, and from the estimated  1,700 MDR-TB patients, only 567 (33%) were diagnosed and treated. Timely identification, notification, and treatment of MDR-TB patient is paramount to reduction of transmission and deaths resulting from drug resistance. For Kilimanjaro region, the identification and notification of MDR-TB patients have been low due to low screening rates at health facilities, underutilization of GeneXpert machines for sample testing, and inadequate documentation.

“We were struggling to identify and report cases of MDR-TB from health facilities. However, thanks to USAID Afya Endelevu (“Sustainable Health”), in close collaboration with the Ministry of Health (MOH) and the President’s Office for Regional Administration and Local Government (PORALG), we were allocated a Zonal MDR – TB Officer Dr. Mzee Hussein. He coordinates and provides technical support in TB and MDR-TB management.”  added Dr. Nigwa

For Dr. Nigwa, his aspiration to strengthen the provision of TB services is becoming a reality. Dr. Mzee arrived in Kilimanjaro early last year and his presence has been a game changer. The doctor’s work has enhanced TB screening and strengthened the use of GeneXpert through TB coordinators’ facilitated specimen collection and transportation network.

“When he arrived, we jointly reviewed regional TB reports and facilitated the development of a comprehensive TB case identification plan in line with national programmatic management of drug-resistant TB guidelines. Then we embarked on empowering all council TB coordinators to utilize the plan and encouraged utilization of GeneXpert machine to enhance active case finding through targeted supportive supervision and mentorship in councils and health facilities, says Dr. Nigwa.

With the implementation of the new strategy , the team managed to strengthen TB Screening at facility entry points, and collected and sent samples to the laboratory for testing in a timely manner. As a result, the region was able to improve active case finding at the facility and community level, strengthening screening and utilization of GeneXpert testing.

“We are grateful that with the revitalized strategy we have registered promising improvements. For example, our data shows that we have increased general TB case identification from 613 cases in quarter one of last year,  to 621 cases in quarter two (April - June), and 706 cases in  the quarter three (July -September). Also, we were able to record 7 MDR-TB patients during the quarter of July -September. This is up from 1 case identified in January to March” narrates Dr. Nigwa

Salehe Rashid, a warden Guard at Kaloleni, Arusha who lives in Kilimanjaro narrates the struggle he went through when he was infected with TB. For him things were normal until he started experiencing long standing cough and chest pain which prompted him to go for checkup.

“I went to Mawenzi Regional Referral Hospital last year for a checkup, the result came positive that I had been infected with TB. They gave me medicine which I used for almost two months without improvement. At the facility, I was requested to give another saliva sample and was informed  that I had MDR-TB. They decided to change medication which I have now used for five months , and I feel fully recovered,” said Mr. Rashid

As of September 2021, USAID Afya Endelevu managed a total of 1,063 healthcare workers across 16 regions, 107 Councils and 499 health facilities. 12 of the over 1,000 healthcare workers were supporting client centered TB care at national and sub-national levels.







Last updated: May 13, 2022

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