Translation research into policy and practice: Scaling up Evidence Based Multiple focus Integrated Intensified TB Screening to End TB(EXIT-TB) in the East African region

Institutions: MLI/IDI/MoH(NTLP) Project

Funded by: EDCTP

Summary

Tuberculosis (TB) remains a major cause of morbidity and mortality especially in sub-Saharan Africa. This high burden is mainly attributed to low case detection and delayed diagnosis. Recently, country surveys have showed unacceptable high prevalence of confirmed TB even among those with a low duration cough and more than 50% of those with prevalent bacteriologically confirmed pulmonary TB do not report symptoms that correspond to presumptive TB. Furthermore, there is an increase in incidence of smear negative pulmonary TB patients who can serve as source of infection. In view of the foregoing, aggressive control measures are essential.

 

Project Objectives

 

To implement and evaluate EXIT-TB package in increasing TB case detection in the East African region.

Specific objectives:

  1. To determine effectiveness of scaling up EXIT-TB package in increasing TB case detection, reducing TB diagnostic and treatment delays and improving TB treatment outcomes when implemented on a large scale in the East African region.
  2. To determine feasibility of scaling up the implementation of EXIT-TB package in routine health system.
  3. To inform and refine guidelines on TB diagnosis in HIV/AIDS, RCH and diabetic management services.
  4. To describe, using simple auditing of procedures and observations, the challenges faced by health services in delivering EXIT-TB package.
  5. To determine the cost effectiveness of EXIT-TB package implementation in urban and rural settings.
  6. To determine barriers to scaling-up EXIT-TB package in urban and rural settings.

The EXIT-TB package consists of:

EXIT-TB intervention package will involve 1) Screening for TB all individuals who passively report a cough at OPD and RCH using CXR. Pregnant women with a cough attending RCH will be tested using GeneXpert. Those with abnormal CXR will be subjected to either GeneXpert or sputum smear microscopy depending on the availability of GeneXpert machine in the selected facilities; 2) testing for TB irrespective of symptoms among HIV clinics attendees with advanced diseases and diabetic clinics using GeneXpert; 3) conducting household contact tracing of children with a household member with TB and perform symptoms screening followed by CXR and those with symptoms and/or abnormal CXR will be further subjected to diagnostic test using TB score chart, GeneXpert or smear microscopy depending on the availability of the GeneXpert machine

Outcomes

Primary outcome: TB notification rates

Secondary outcomes:  Number of TB suspects registered, Number of TB patients put into TB care, Number of hospital attendances and admissions, Number of death, Time from symptoms to diagnosis, Time from diagnosis to treatment, TB treatment outcome Proportion of healthcare workers, policy makers and clients who accepted the model, pattern of re-organization of staff roles, Enabling and barrier factors including patients and health system cost