Kenya Lung health Training Course

TUBERCULOSIS
 ACTIVE CASE FINDING:
Finding the missing cases of Tuberculosis
in Kenya
What is Active Case Finding?
 Trend of TB cases in Kenya

116723
115234

110251
110015
108400

106082
105818

103981
99159
93510

89332
89333
82114

81518
75898
73017
64159
54975
49413
40031
34980
28142
22600
20451
14599

1 9 9 21 9 9 31 9 9 41 9 9 51 9 9 61 9 9 71 9 9 81 9 9 92 0 0 02 0 0 12 0 0 22 0 0 32 0 0 42 0 0 52 0 0 62 0 0 72 0 0 82 0 0 92 0 1 02 0 1 12 0 1 22 0 1 32 0 1 42 0 1 52 0 1 6
Kenya National prevalence Survey
(2015-2016)
Missing Cases, Where are they?
 Rationale for ACF from the prevalence survey

• Individuals with TB symptoms in the community are not seeking care

early…(Kenya National TB prevalence survey, 2016)
• Reporting to facility when very sick-poorer outcomes
• Increased transmission in community

• Three quarters of people seeking care with TB symptoms not

diagnosed, are missed……(Kenya National TB prevalence survey,
2016)
• Our Health systems is not sensitive to TB even when patients
present

• A TB patient typically presents to a facility up to 5X before a diagnosis

of TB is made. (Defining and assessing the maximum number of
visits patients should make to a health facility to obtain a
diagnosis of pulmonary tuberculosis. Harries AD1, Nyirenda
TE, Godfrey-Faussett P, Salaniponi FM)
 What do Kenyan studies show?

• Contact Investigation, can work, but results are not great…

Results of Inmates screening at the remand prison in Nairobi, Mueni, et al
987 inmates 865 screened 487 suspects 400 tested - 4 positive (0.5%).

• Yield from Private health provider engagement

715 PP engaged 3273 suspects referred 1747 suspects arrived 328 TB patients dxd (10%)

• Yield from TB screening at HIV care centres

35,533 PLHIV screened 7037 investigated for TB 591 diagnosed with TB (1.6%)

• Yield from door-to-door community screening

23374 presumptive referred 15,391 arrived 1,487 diagnosed with TB (6.3%)

• TB REACH Hospital Initiative, Jane Carter, et al

3887 screened 3663 screened positive 2698 sputum done 339 sputum positive(8.7%) + 10%
clinically diagnosed. TB REACH experience, SS+PTB case notification increased by 36.9%
Increasing case detection….
KEMRI CDC experience
19.3% vs 2.5% vs 1.8%
Facility ACF
 Barriers to TB Diagnosis, Notification &
Treatment
• Inadequate leadership for TB control at hospital level.
• TB detection is mainly done in the TB clinic and Lab
• Low TB suspicion index among health workers
• Limited knowledge & use of TB diagnostic algorithms by
HCWs
• Low priority in sputum processing in the laboratory
• Weak referral & linkages between diagnostic and treatment
centers.
• Limited use of data at the Health facility levels for planning
and monitoring performance
• Limited capacity of HCWs to diagnose Childhood TB (under 5
yrs)
• Cost sharing fees limit access to CXR.
Facility Processes for ACF
TB screening (symptomatic) in all
facility entry points

All those found with

symptoms documented
in the departmental
Presumptive TB register

Symptomatic
patients sent to
lab/ Sample
collected on site

Those with
bacteriologically
diagnosed or clinically
diagnosed started on
treatment

TB
registration
care and
follow up
 Tools required
1. Screening tools
• ICF/IPT cards
• HTS screening tool
2. Presumptive TB registers
o To be located at every
facility entry point
3. Lab request forms;
o AFB/Xpert lab request
form

4. TB register
o Contact register
o IPT register
5. Monthly Data summary tool-
updated monthly
Tools required
Presumptive TB register
 ACF data Flow
Department:
Departmental head to fill monthly data summary tool.
To use summaries in Presumptive TB register
Send departmental summary to facility HRIO

Facility level:
Facility HRIO to collect all departmental monthly summary tools
Collate all ACF data in facility monthly summary tool, send a copy of summaries to SCHRIO

Sub county level:

SCHRIO and SCTLC to collect facility monthly summaries.
SCHRIO send to CHRIO and CDH
SCTLC to send to CTLC and through KOBO collect to NTLDP

County level:
County HMT to review ACF data monthly to ascertain progress and guide ACF supervisions.
 Target setting
• We are currently missing 40% of the TB cases in Kenya (Prevalence survey
2016)
• Estimated TB prevalence is 558/100,000
• Compare county prevalence 2016, and national prevalence to see how
many cases are expected in the county
• Every patient seeking care at the facility is eligible to be screened (work
load)
• Every patient in a department diagnosed with an RTI (respiratory illness), is
already a presumptive TB case and requires a TB test
Conclusion
Q&A