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Strengthening implementation of the U-LAM Strategy for TB Care and Treatment Services: The Limpopo Province in South Africa Experience

Publication date: 
Nov 2019
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Background and challenges to implementation

Tuberculosis is the leading cause of death among the 25 million people with HIV in sub-Saharan Africa. Early diagnosis and treatment of active tuberculosis (TB) in HIV-positive patients is challenging. Urinary lipoarabinomannan (U-LAM) is a point-of- care urine test for detecting LAM, a lipopolysaccharide present in mycobacterial cell walls, in people with active TB disease. South Africa has adopted use of U-LAM to improve TB diagnosis, allow treatment to start promptly and improve AIDS related mortality in HIV positive patients. U-LAM was introduced in Limpopo Province in October 2017.

Implementation 

Managers from different levels of service were trained on U-LAM implementation from 37 hospitals. Including hospital CEOs, nursing service managers and unit managers. The roadshows for the introduction of U-LAM were conducted in all 5 districts of Limpopo; Capricorn, Mopani, Sekhukhune, Waterberg and Vhembe. In January 2018, the implementers from all hospitals were trained on how to correctly perform the test, interpret, report and record results.

The test was used in adults living with HIV with signs and symptoms of TB (pulmonary or extra pulmonary) who have  CD4<100cells/ul or who are seriously ill. Those who tested positive were started on TB treatment using the national TB U-LAM algorithm.

Results

Hospitals started reporting in the second quarter of 2018. Of the 2,262 HIV positive patients that were tested by U-LAM, 595 (26%) were diagnosed with TB, 581 (97,6%) were initiated on treatment and fourteen died (2,4%). From January to March of 2018, before the implementation of U-LAM, 78 patients died whereas after implementation only 14 patients died from April to December 2018 showing a drastic decline in the TB death rate.

Conclusion

Overall, the U-LAM strategy has improved TB case detection and reduced TB mortality among HIV positive patients in the Limpopo province. Consistent political commitment and support from all levels (national, provincial, district and subdistrict) of healthcare is key in the implementation of the U-LAM strategy, coupled with adequate involvement of all health care workers at hospital level.