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Innovations in Community-Based Care and Strengthening Public-Private Partnerships

Innovations in Community-Based Care and Strengthening Public-Private Partnerships
Publication date: 
Aug 2019

Since 2016, the United States Agency for International Development (USAID) Tuberculosis South Africa Project has provided technical support to the South African TB Program at national, provincial and district levels. Working closely with the National Department of Health (NDoH), the USAID TB South Africa Project currently supports 14 districts in six provinces, works directly with more than 30 local non-governmental organizations (NGOs), civil society organizations and faith-based organizations and engages private providers and other private sector partners for important programmatic gains. 

The project’s main priorities include reducing TB infections, ensuring the sustainability of an effective TB response system, and improving TB care and treatment among vulnerable populations. Within these priorities, the project implements strategies to align with global and national goals of ending TB by 2030, combatting multidrug-resistant TB and finding missing TB patients, all while leading the country toward self-reliance.

Engaging Local Organizations for Improved Patient Care

The USAID TB South Africa Project’s Small Grants program engages local NGOs at the grassroots level to find missing TB patients, to engage patients in supportive care and to improve overall patient outcomes. As the graph shows, the supportive NGO model, which works to provide patients with daily treatment supporters who further engage patients in care, improved outcomes among DR-TB patients in Nelson Mandela Bay Metro district in the Eastern Cape Province. Treatment success rate was uniformly higher in the project sample compared to the district patients. Further, as the model continued to be implemented in 2016, treatment success rates strengthened accordingly within the project. Overall, the small grants component has screened 215,293 people through Advocacy, Communications and Social Mobilization (ACSM) activities, 50,311 adult contacts and 4,867 child contacts to date. Additionally, the grants program alone has started 1,014 patients on treatment through ACSM activities, 827 adult contacts and 160 child contacts. Additionally, the grants component has led to 688 children under five years of age being initiated on isoniazid preventive therapy (IPT). 

Curbing TB in Farms and Farming Communities

Farmers and those living in farming communities suffer disproportionately from TB in South Africa due to numerous factors, including access to care and frequent close contact in an occupational setting. The USAID TB South Africa Project works to find missing TB patients within this key population through improved screening, testing and treatment initiation activities. The project also works to improve TB care and treatment among farmers through TB screening, HIV testing and counseling, TB treatment initiation and adherence support. The project has reached 23,313 farmers and people in farming communities with ACSM materials from April 2017 to April 2019, has screened 21,607 and has initiated 286 farmers and people in farming communities on appropriate TB treatment. The project has engaged farmers effectively, having an above 90% screening, testing and treatment initiation rate.

mHealth Innovations for Improved Outcomes

The USAID TB South Africa Project implements multiple mHealth solutions to improve patient care and infection prevention and control. The ConnecTB system helps treatment supporters to keep track of patients at their homes, to record daily medication dosage and side effects from medications.  A geo-mapping module allows for identification of high burden TB areas or hotspots for efficient and rapid management. The IPConnect suite of applications is focused on improving Infection Prevention Control (IPC) in the facility setting, serving as a job aid for health care workers, and working as a facility-based IPC risk assessment tool. The suite of applications is used widely in South Africa and places IPC at the forefront of TB management at the facility level. 

Engaging Public Agencies and Private Providers in South Africa to Strengthen a Collaborative TB/HIV Response

The USAID TB South Africa project engages the South African Medical Association (SAMA), National Institute for Communicable Diseases (NICD) and South African National AIDS Council (SANAC) to strengthen collaboration within the TB and TB/HIV response. The project engages SAMA to more closely collaborate with private practitioners for enhanced case finding and linkage to care and works to share TB information with the over 17,000 health care workers in the SAMA network. The project engages NICD to study the feasibility of using interferon-gamma release assay (IGRA) to test health care workers for latent TB infection (LTBI). Finally, the project engages SANAC to better synchronize collaborative TB/HIV efforts, ensuring mutual awareness and increasing the number of missing patients identified in South Africa.

The USAID TB South Africa Project also coordinates closely with NEXT2People Foundation, an organization which works to collaborate with private General Practitioners (GPs) to improve TB case finding in partnership with the NDoH. In partnership with the National Health Laboratory Services (NHLS), patients who are identified through GPs are linked to public facilities for TB treatment and management. Since the start of activities in December 2018 – January 2019 over 8, 000 people have been screened through this program, and among 1, 159 presumptive TB patients, 45 people tested positive for TB. Forty of these people have been initiated on appropriate TB treatment.