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Reducing TB infections in South Africa

Reducing TB infections in South Africa
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.

Increasing Public Awareness of the TB Epidemic

The USAID TB South Africa project works extensively in advocacy, communication and social mobilization (ACSM) at all levels of implementation. These activities include infection prevention and control (IPC) screening campaigns – which have reached over 40,000 people and have identified 256 new TB cases, the My TB Survival Toolkit adherence support package, which has been delivered to over 200 patients, public service announcements in over 160 locations, and commemoration of major health days like World AIDS Day, World Diabetes Day and World TB Day, which have cumulatively led to the screening of nearly 23,000 people and diagnosis of 44 new TB cases.

Buddy Beat TB: Improving Treatment Experiences for Pediatric Patients

TB treatment often involves painful side effects and long treatment durations, which is especially difficult for pediatric TB patients. In response to this challenge, the USAID TB South Africa Project developed and implements a support program to help children cope with the treatment process in a way that is educational, empowering, and most importantly FUN! The Buddy Beat TB character was developed in consultation with pediatric patients to support children throughout their TB treatment journey. The blue cat-like character integrates elements of play education therapy to create a companion for patients and to teach them through play. Children have an opportunity to express their worries and feelings in a safe and comfortable space while also learning about health and the importance of taking treatment.

Testing Health Care Workers for Latent TB Infection

The USAID TB South Africa Project in collaboration with the Centre for Tuberculosis (CTB) at the National Institute of Communicable Diseases (NICD), QIAGEN and the South African National Department of Health (NDoH) has embarked on a project to understand and provide a baseline of the prevalence of latent tuberculosis infection (LTBI), active TB and progression from latent to active TB among Health Care Workers (HCWs). The study will be conducted to determine the role of QuantiFERON-Plus (QFT-Plus) in addressing LTBI in three hospitals. The study is ongoing and is expected to provide essential information on baseline LTBI prevalence and to inform HCW screening in South Africa.

FAST: Finding Missing Patients in a Hospital Setting

The USAID TB South Africa Project has been a pioneer in implementing the Finding patients Actively, Separating safely and Treating effectively (FAST) strategy in hospitals throughout supported districts. In wards with key populations (including antenatal care, maternity, ARV, diabetes and pediatric wards), the project has successfully screened 86% of all people presenting at supported facilities, has tested 82% of those and has started 79% of all people confirmed to have TB on treatment in 2018.

The Finding patients Actively, Separating safely and Treating effectively (FAST) strategy works to find missing TB patients in hospital settings through universal screening, prompt separation and molecular diagnosis, and rapid initiation on effective therapy. The USAID TB South Africa Project implements the FAST strategy in 81 facilities throughout the 14 supported districts and has identified nearly 6,000 new TB patients since the initiative began. Uniquely, the USAID TB South Africa Project implements FAST in all hospital wards, including antenatal care, labor and delivery, pediatric, staff clinic, outpatient departments, casualty and antiretroviral wards. Through universal screening in these high-priority wards, the project effectively targets patients who would otherwise be missed.

Targeting Key Populations with U-LAM Testing

The project also innovates in its use of the Urine-Lipoarabinomannan (U-LAM) diagnostic test in certain FAST-supported sites, meant to improve diagnosis of TB among HIV patients with a CD4 count of under 100. The project has identified an additional 629 TB cases with this strategy.

Using Carbon Dioxide (CO2) Monitors to Reduce TB Transmission in a Hospital Setting

The USAID TB South Africa Project uses carbon dioxide (CO2) monitors in supported facilities. As CO2 is expelled when people breathe, the CO2 concentration in the air serves as a proxy measure for understanding the ventilation in a given indoor space. If the CO2 concentration exceeds a certain level, facility managers receive an alert via SMS asking them to either ventilate the area through opening windows or to clear people from the area to allow the space to equilibrate with fresh air. Data on CO2 concentration, relative humidity and temperature are collected and are presented in an online dashboard through the IPConnect suite of applications. The project aims to further develop and scale up this approach to continue to provide the most actionable advice possible to facility managers.