Active Case Finding: Innovation and tradition to fight TB in high burden low-income countries
Authors: Maria Vittoria De Vita1, Lucia Pincerato1, Alessandro Dadomo1, Gabriele Paone1, Pratap Kumar2, Mike Mulongo3, Gianfranco Morino1
Affiliations: 1Amici del Mondo - World Friends Onlus , 2Helath-E-Net, 3 Independent Health Finance Consultant
Background: In Kenya, Tuberculosis (TB) incidence is estimated between 348 (WHO) and 558/100.000 (TB Prevalence Survey 2015-16). WorldFriends’ projects are aligned with the 2019-2023 National Strategic Plan of Kenya and wish to address the following gaps: 74,401 TB patients per year are not diagnosed; half of the estimated TB cases are not notified and treated; 2/3 of people with symptomatic TB don’t access diagnostic and therapeutic pathways.
There are two projects on TB currently running: one based in Nairobi (Health Innovation for improving Private Sector TB screening and detection using a novel paper-based electronic system, HIPS-TB) , supporting vulnerable categories in the informal settlements, and one in the rural areas (Awareness Tradition and Innovation to fight TB, ATI-TB), targeting the Maasai communities.
Objective: The projects aim to reach the population that does not access diagnostic and treatments.
Methods: The methodology proposes to bridge the above-mentioned gaps by targeting TB risk populations and categories excluded from the health service with screenings and treatments.
HIPS-TB tests the public-private mixed approach, by empowering informal settlements’ private facilities in active case finding (ACF) with an innovative system, developed by the Kenyan social enterprise Health-E-Net. Healthcare providers in health centers and chemistries, through paper-based formats properly filled, collect the data that are, therefore, scanned and digitized through the PaperEMR system for analysis, diagnosis, monitoring and follow-up. The distribution of economic incentives, both for the patients and the health facilities, together with a referral system that involves two major hospitals, where GeneXpert provides certain microbiology diagnosis, complete the activities foreseen by the project. ATI-TB instead adopts an innovative approach in the union between tradition and innovation: the active involvement of traditional healers in ACF is matched with the use of an innovative technology, the portable GeneXpert. This approach allows TB on site tests. ATI-TB has a strong awareness raising component and aims at increasing the accessibility to health services.
Results: The project implemented in the informal settlements brings an improvement in the ACF and diagnosis of TB cases, followed by greater awareness for beneficiaries and improved access to quality care services. The project implemented in hard to reach areas, instead, gives a geo-local approach: TB is tackled by the introduction of an innovative TB screening machine while, at the same time, respecting and supporting the particularity and specificity of an ethnic group and its identity.
Conclusions: A model and a non-invasive approach for TB treatments that starts from the local and offers global answers. Our approach is replicable around the world, especially in developing countries, where the tradition is still strong and its reference figures are still extremely influential.