TB is a major cause of death worldwide. Kenya is one of the 22 high burden TB countries that together account for more than 80 per cent of the world's TB cases.
The WHO estimates that there were 120,000 new cases of TB in Kenya in 2012. Additionally, TB,is the fourth leading cause of mortality in the country accounting for an estimated 9,500 (5,400-15,000) deaths.
The major factors responsible for the huge TB disease burden in Kenya include: TB/HIV co-infection, poverty and social deprivation leading to mushrooming of peri-urban slums, congestion in prisons and limited access to general health care services.
Community TB project in Machakos and Nyamira counties
This project is supported by Global fund through AMREF as principal recipient. The project implementation period was from October 1, 2015 to December 31, 2017.
CHAK supports and shares the Ministry of Health goal seeking to improve and sustain TB control gains in order to accelerate reduction of TB disease burden through provision of people-centred universally accessible, acceptable and affordable quality services in Kenya.
The objectives of the Global fund TB project are to:
a) Intensify efforts to find TB ‘missing” cases
b) Reduce TB transmission
c) Prevent TB active disease, morbidity and mortality
To achieve the above objectives the project carried out the following activities:
a) TB New Smear Positive Contacts (NSPC) tracing
The key intervention was identification of the TB new smear positive contacts of the TB index case at the health facility by health care workers or the facility based community health volunteer (CHV).
This information would then be passed on to the appropriate CHVs. The CHVs would then undertake a household visit to each of the contacts and screen all its household members.
This intensified active case finding strategy aimed to enhance early TB detection among undiagnosed TB patients, resulting in initiation of treatment hence arresting further transmission by these secondary cases. The CHVs particularly targeted children, the aged and those with HIV infection.
(b) TB treatment interrupters tracing
The aim of this activity was to stop these patients from reaching the status of lost to follow up. It improved adherence and treatment outcomes.
(c) Health education
This was done at the household level to provide individual and family education on TB infection control, counseling on nutrition and treatment adherence.
(d) TB screening for prison inmates
Screening upon entry to prison and within the prison helps detect TB and initiate treatment early, assisting to prevent transmission within the prison. This also helps to reach marginalized, high-risk and under-served populations with health education.
(e) Stake holder meetings
The meetings targeted TB stakeholders in the counties and sub-counties to discuss the disease burden in the regions, facility data reports, CHV activities and challenges encountered for the purpose of improving project outcomes.
Health facility-based interventions
A total of 57 CHAK health centers and hospitals provided TB diagnostic and treatment services in 2017 while 387 dispensaries supported TB treatment services.
Through the HIV/AIDS/TB projects, CHAK supported diagnostic and treatment services in 22 faith based health facilities under the AFYA KAMILI project.
Under the CHAP Uzima project, 54 facilities provided TB diagnostic and treatment services while theAFYA Jijini project supported 13 county and faith based facilities to offer comprehensive TB services.