Amref Health Africa calls for greater synergy and investment to find ‘missed’ TB cases

Over 7,000 people have been referred by the healers to clinics for HIV and TB screening.

Despite major progress made towards the global Millennium Development Goals in recent years the Tuberculosis burden remains enormous. In 2012, an estimated 8.6 million cases of TB infection were recorded and 1.3 million people died from the disease. At the same time, however, three million TB cases are missed by national notification systems every year, accelerating the spread of the disease.

Many of these three million people live in the world’s poorest, most vulnerable communities, including in Africa, underlining the need for innovative action both at health system and community levels to identify all cases of TB infection, illness and ensure that they get the right treatment and care.

As Africa’s leading health development organisation working with vulnerable and underserved communities, Amref Health Africa joins the global TB Partnership in calling for increased efforts to reach the three million missed cases.

Amref Health Africa is implementing several projects that contribute to this aim. In Tanzania, Amref Health Africa has been actively engaged in establishment of the ENGAGE-TB network and in developing National Operational Guidelines for engaging Civil Society Organisations in TB control activities. The network was launched by the Deputy Minister for Health on World TB Day 2013. In South Africa, Amref Health Africa's Traditional Healers Project has successfully linked trained healers with local health facilities for collaboration in referral and treatment support of TB and HIV/AIDS patients. Over 7,000 people have been referred by the healers to clinics for HIV and TB screening.

Through its role as Principal Recipient for the Global Fund’s Round 9 tuberculosis grant in Kenya, Amref Health Africa recorded a reduction in TB treatment interruption and defaulter rate from seven per cent in 2008 to 4.1 per cent in June 2013. This is partly associated with intensified community-based sensitisation by implementing partners, formation of patient support groups and improved patient awareness of the importance of treatment adherence. The project has also supported Kenya’s National TB Programme to ensure that screening for TB is done across health facilities in Kenya as a standard practice for all People Living with HIV. A total of 1,568,323 clients have since been screened, surpassing the target of 99,440. Furthermore in the informal Kibera settlement in Nairobi, a screening tool is used to screen all HIV-positive clients for TB on every health facility visit, while all newly diagnosed TB patients are tested for HIV. The screening tool has been incorporated into the patient visit review forms. Patients suspected to have TB from the symptom screening questions are sent for further investigations and started on treatment if confirmed to be infected.

Amref Health Africa and the World Health Organisation have built a partnership to reinforce community-based interventions for TB control. The collaboration involves training of NGOs and other Civil Society Organisations on how to integrate TB control activities into their work. In this regard, Amref Health Africa has begun implementation of Community-Based TB Prevention and Treatment Initiatives among pastoralist populations in Ethiopia. An integrated approach is used to include TB screening in existing malaria, HIV and maternal and child health programmes, thus increasing case detection.

Amref Health Africa strongly advocates for more resources to accelerate TB interventions and to create synergy with existing programmes. It is also important to invest in operational research whose findings can translate into policy and practice for improved case detection. In this way, Amref Health Africa believes that we will be able to drastically decrease the numbers of missed TB cases and lighten the burden of the disease in Africa.