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USAID TB South Africa Project Interventions during the COVID-19 crisis

Publication date: 
May 2020

While South Africa continues with strict lockdown measures in an attempt to curb a potential unmanageable influx of COVID-19 patients, there is much concern about the spread, diagnosis and treatment of other diseases. Due to the rapid spread and acute onset of the SARS-CoV-2 virus (coronavirus), the response here and elsewhere has been dramatic, overshadowing among others the growing tuberculosis (TB) epidemic we face. TB is South Africa’s deadliest infection, killing on average 5,000 people per month according to the WHO Global Tuberculosis Report 2019. This is mainly due to the country’s high prevalence of HIV and diabetes, both immune deficient conditions that increase one’s susceptibility to the disease. Since the coronavirus can also cause severe illness in immunocompromised people and primarily attacks the respiratory system, it is imperative that health services for all co-morbidities especially TB, are not compromised. Locating and linking diagnosed TB patients to proper care is now more critical than ever to lower the risk of these patients succumbing to COVID-19.   

To ensure the continuous quality of TB management services, the USAID TB South Africa Project has been working closely with the National Department of Health towards an integrated approach to service delivery. The project has also been actively involved in supporting the Department’s rapid response teams in the infection prevention and control assessments conducted at facility level. These assessments were informed by the project’s best practices and lessons learnt from implementing IPC measures in health facilities across the country.

During the month of April, despite restrictions on movement and the high risk of infection, our project staff has been active in providing technical assistance to support both TB and COVID-19 efforts. Initiatives undertaken by the project include integrated COVID-19 and TB screenings in communities, COVID-19 training of health care workers, strengthening social distancing measures at health facilities and COVID-19 information sharing.

Community screening campaigns

Community-based screening campaigns in collaboration with the Department of Health have been critical in actively identifying COVID-19 patients at household-level. To support such collaborations, the USAID TB South Africa Project has ensured that community care workers from all funded NGOs as well as project staff are capacitated to safely perform COVID-19 screening services.       

In Cape Town, which has the highest number of coronavirus infections and deaths in the country, Dorothy Williams, the project’s district coordinator for the Metro District: Southern/Western Substructure, supported an integrated screening campaign in the informal settlement of Du Noon, an identified COVID-19 hotspot. In partnership with the Western Cape Provincial Health Department and a local NGO supported by the project, Kethimpilo, approximately 60 community members who were previously identified and traced as COVID-19 contacts were screened for both COVID-19 and TB. These contacts were all immediately tested for the coronavirus and six presumptive TB patients were referred to the clinic for TB testing. The set up at the campaign site encouraged social distancing among community members and health workers to curb the possible spread of the disease.

The Cederberg Matzikama Aids Network (CMAN), an NGO supported by the Project in the West Coast, conducted various screening activities in partnership with the Western Cape Provincial Health Department. These included stopping and screening for both TB and COVID-19; motorists on their way to perform essential work. They were also educated about the symptoms and prevention of the two diseases. Homeless people from Citrusdal and Clanwilliam towns were also screened, resulting in two patients being referred for TB testing. The massive screening campaigns conducted in the Bergrivier and Cederberg Sub Districts ensured that all farms workers, including seasonal workers were screened and educated during working hours at the farms whilst maintaining social distancing. Presumptive workers were all referred to the nearest clinic for testing. 

Figure 1: A community health worker from CMAN screens motorists in their community for symptoms of TB and COVID-19.
Figure 2: The HAST manager for the Southern/Western Substructure Metro Health District, Yolanda Cottee with Dorothy Williams, the project’s district coordinator at the COVID-19 testing station at Du Noon Community Hall.

In Nelson Madela Bay, the Provincial Department of Health initially did not permit health care workers to work in communities. But after the extension of the national lockdown, exemption was given to care workers who receive COVID-19 training. In partnership with the Department, the USAID TB South Africa Project trained 24 health care workers from the local NGO, Care Ministry. All trained workers were mobilized to support COVID-19 screening campaigns in the district, resulting in 44 referrals for testing.

Figure 3: The COVID-19 screening campaign conducted by Care Ministry in Nelson Mandela Bay followed strict guidelines for social distancing.​

The Premier for Limpopo, Mr. Stan Mathabatha launched a provincial COVID-19 door-to-door screening campaign in Waterberg that was supported by the project’s provincial manager Ms. Dolly Moleba. The campaign mobilized nine hundred community caregivers to conduct daily household screening in all five sub districts, targeting ten households per day. Visits were to include health education on infection prevention and presumptive community members were instructed to self-quarantine until test results were available.

Figure 4: Provincial manager, Ms. Dolly Moleba with the Limpopo premiere Mr Stan Mathabatha at the campaign launch in Waterberg

In Fezile Dabi in the Free State, the Tokoloho Foundation, a supported NGO, conducted door-to-door COVID-19 and TB screening campaigns in the Ngwathe Sub-district. The integrated approach resulted in 649 people being screened, 16 TB presumptive community members being tested and two linked to TB treatment at the Thabang and Schonkenville clinics.

Figure 5 & 6: The integrated screening campaign conducted by the Tokoloho foundation resulted in two TB patients being linked to care.

Capacity building for COVID-19 and infection prevention

Throughout the month of April, the USAID TB South Africa Project supported COVID-19 capacity building activities across the country, some in partnership with other District Support Partners such as matCH. Training sessions conducted by project staff capacitated almost 800 health care workers to enable them to contribute toward integrated case-finding initiatives. Focus areas of the training are COVID-19 symptoms and management, infection prevention measures, social distancing without discrimination, recording tools, communication of patients results and dealing with stigma during lockdown. Aspects of TB management and patient centered communication and counselling are also included to promote integrated and quality service delivery. All training sessions are planned to ensure social distancing and where possible, conducted outdoors.   

The project’s district coordinator for Sarah Baartman, Simphiwe Mayaphi, also conducted health education among farmers and their families at Sunlands farm in Addo to create awareness for COVID-19. The project’s long-standing TB in Farms initiative supports many farms in the Addo sub district and assist by ensuring that health screening and testing services also include COVID-19.

Figure 7: District coordinator, Zamani Dlamini demonstrating proper hand washing technique during training of community health care workers from Mpilonhle

Figure 8: District coordinator, Simphiwe Mayaphi educate farmers at Sunlands farm about COVID-19 and TB

Strengthening IPC measures at health facilities 

The USAD TB South Africa Project supported 425 facilities across six provinces on infection prevention and control (IPC) related activities which include implementation of IPC measures and mentoring, FAST Strategy implementation monitoring and IPC risk assessments. Best practices and lessons learnt, especially from the implementation of the FAST strategy has been very useful in the fight against COVID-19 and has assisted the rapid response teams in their IPC assessments. These include administrative actions (early detection of likely pulmonary TB, respiratory isolation, conducting screening and / or diagnostics), engineering measures (reorganizing air flows in the environment and use of exhaust fans) and individual measures (use of surgical masks for patients with TB symptoms, respirators for health professionals and visitors and respirators fit testing for health workers).

During April, the project also assisted IPC efforts for both COVID-19 and TB by donating specimen transport boxes to the Gauteng Health Department to ensure the cold chain of specimen is maintained. In uMkhanyakude, facilities were assisted with gazebos and tents for patient queuing outside while maintaining social distancing. Community health workers were capacitated to provide screening services outside of the facilities to assist in identifying presumptive patients prior to entering the facility.

Figure 9: Specimen transport boxes donated to the Gauteng Department of Health.
Figure 10: Community health workers screening patients at Hlabisa Gateway clinic.

Ina Cillie, the project’s district coordinator in the West Coast was interviewed on Radio Namakwaland that has a listenership of 74 000. She discussed both TB and COVID-19, focusing on general information such as symptoms and prevention. Practical information regarding the COVID-19 preparations undertaken by the District Department of Health was also shared with listeners.  The provincial manager for KwaZulu-Natal, Zamani Dlamini also conducted an interview at Rise FM Mtubatuba that has a listenership of 160 000. The special community education session was done with a representative of the Provincial Department of Health. The session focused on information about COVID-19 as well the similarities and differences between COVID-19 and TB. In Mangaung, Free state, the district coordinator, Carol Padi conducted three interviews at Motheo Community Radio Station with a daily listenership of 750 000. The radio sessions were interactive with listeners calling in with questions about TB, the differences between TB and COVID-19 and also the risk of a TB patient contracting the disease. Information about COVID-19 screening sites in Mangaung was also shared. The project also partnered with the department to distribute IEC materials on TB and COVID 19 at the Botshabelo shopping mall in MangaungInforming the public about COVID-19

During April, the USAID TB South Africa Project has also been very active in sharing information and knowledge about the coronavirus via media channels such as radio and social media. The communication opportunities for COVID-19 were utilized to also share TB messages to the various audiences. 

Figure 11: District coordinator, Ina Cillie on the air with Radio Namakwaland
Figure 12: Provincial manager, Zamani Dlamini during the education session interview at Rise FM Mtubatuba

The project’s website and social media platforms were utilized to share project initiatives and general information about COVID-19 and TB, reaching 17,434 people.  The government’s recommendation for the public to only use cloth face masks was shared in the form of visual banners and a webpage on guidelines to washing and caring for cloth masks. Publications highlighting COVID-19 information in relation to TB was also published on the project website and shared on Facebook and Twitter. Activities in the provinces to assist the government with COVID-19 interventions, such as the screening campaigns and capacity building sessions were also shared on social media, often re-shared by USAID Southern Africa.

Figure 13: Visual banner to promote the use of cloth masks by the public.

While the project continues to participate in COVID-19 activities and initiatives, it remains critical to highlight the impact on TB and how the project manages to support TB initiatives despite the challenges imposed by the lockdown. Our TB patients remain our biggest priority and should continue to receive quality service and support throughout these trying and uncertain times.

Together we can #FightCOVID19 and #BeatTB!