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Partnership between USAID TB South Africa Project and Next2People successfully pilots a collaboration intervention with general practitioners to increase TB diagnosis in OR Tambo district

09 Jul 2019
Almost all-women General Practitioner Consortium launch in Mthatha, O.R. Tambo, Eastern Cape province, South Africa.
Almost all-women General Practitioner Consortium launch in Mthatha, O.R. Tambo,
Eastern Cape province, South Africa

USAID TB South Africa Project, in partnership with the organisation Next2People, is implementing an intervention to increase capacities of general practitioners (GPs) in OR Tambo district, Eastern Cape province, to identify symptoms of tuberculosis (TB) and increase rates of diagnosis and treatment among people who seek their services. The intervention was launched in December 2018 and Eastern Cape was selected in part because it has the second highest burden of TB by province in South Africa.

While South Africa has made significant progress in TB control over the years, the disease remains a significant public health problem. The country reported 244,053 incident cases in 2016. This figure is, however, significantly lower than the 438,000 patients estimated by the World Health Organization (WHO) the same year. The gap between the two figures suggests that a large number of people with TB are not diagnosed and are potentially missing from care, with grave implications for public health nationally.  

Based on understanding of TB data and trends in the country, USAID TB South Africa Project staff surmised that a proportion of the ‘missing TB patients’ implied by the WHO estimates seek health services from private and other care providers, and not those in the public healthcare sector where the majority of patients access services nationally. The approach shows promise in high TB burden countries where TB is generally considered ‘a disease of the poor’, which mainly afflicts people who use the public healthcare system.

Partnerships with GPs were considered important for diagnosing all people with TB who might not fit the profile of the ‘typical’ TB patient and might be missed in terms of being diagnosed with TB and initiated on appropriate treatment because they seek care in the private sector.

The USAID TB South Africa Project and Next2People public-private partnership intervention is implemented with ten GPs in private practice, twenty-eight community healthcare workers (CHWs) and three professional nurses.

Implementation primarily aims to enhance capacities of private healthcare providers in basic TB management through training and mentorship. Trained GPs are encouraged to screen all patients who visit their practices for TB symptoms. Capacity building is also availed to CHWs so they can better conduct active case-finding, sputum collection and systematic screening of household contacts of TB patients in communities, as well as provide TB treatment supervision support to patients at home.

Public healthcare facilities close to participating GPs’ practices were mapped to make it easier for doctors to link patients they diagnosed with TB to public healthcare facilities near them, which are better equipped to treat TB patients. This is also strategic as national monitoring of TB incidence, data and trends is informed by public healthcare figures.

From December 2018 to March 2019, this innovative partnership reached 31,977 people, all of whom were screened for TB. Of those, 4,599 (14 per cent) TB presumptive patients were identified, 210 (9 per cent) tested positive for TB and 166 (79 per cent) were initiated on appropriate treatment by general practitioners and linked to further care.

The intervention is continuing and will be scaled-up, as the USAID TB South Africa Project and Next2People have realised that public-private partnerships, including this one between GPs and non-governmental organisations, increase TB patient detection at community level and demonstrate potential to significantly contribute to South Africa’s efforts to find missing TB patients.