Experiences in Tanzania: Community Based Efforts to Support HIV/TB Integration

1. Experiences in Tanzania: Community Based Efforts to Support HIV/TB Integration Jackson Mugyabuso Dr. Charlotte Colvin PATH 25 July 2012

2. Outline • Background • Methods • Results • Conclusions and lessons learned • Next steps and the way forward • Questions

3. Background • PATH/Tanzania received USAID funding to pilot community based interventions in Kisarawe District in 2009 • In collaboration with National TB & Leprosy Program, PATH implemented an innovative package of interventions to improve TB case detection • PATH supported an in-depth evaluation to determine effectiveness

4. Setting – Kisarawe District, Tanzania • Mostly rural area bordering Dar es Salaam, population about 100,00 • High burden of communicable disease (43% of total disease burden) • Malaria and maternal death are persistent challenges, along with high HIV prevalence • DOTS scaled up since 2004 to reach most facilities

5. Innovative “package” of community based interventions • Sensitization of district health and education officials • Establishment of private provider referral network • Pharmacists and traditional healers • Training Community’s Own Resource Persons on TB/HIV • Sputum fixers • School-based TB and TB/HIV curriculum • Development of IEC materials

6. CORPs sharing information in the community Traditional healer School based TB/HIV curriculum

7. Multi-method approach to evaluation • Analysis of routine case detection data • Key program output data • Collection and analysis of short term case detection outcomes • Referrals made/received through PPM network • TB cases diagnosed with assistance of sputum fixer • Collection/analysis of medium term outcomes • Results of PPM referral – how many TB cases diagnosed? How many started treatment? • Survey of all SS+ TB patients diagnosed from October 2010 through April 2011

8. Data Collection & Analysis • Ongoing analysis of trends in case detection • Routine monitoring of output and outcome data • Univariate/bivariate analysis of survey data

9. RESULTS – Routine TB case detection data

10. RESULTS – PPM referral network

11. RESULTS – Survey of new SS+ TB patients (n = 150) • ~ 30% visited a pharmacy when symptomatic • ~ 30% visited a traditional healer when symptomatic • Almost 60% did NOT initially seek care at a public sector DOTS facility • About half reported seeking care on the advice of a family or household member • > 80% reported hearing about TB through street theater • > 90% reported seeing some type of TB message through print media

12. Limitations • No comparison site for survey results • No way to isolate specific interventions • Ex, print materials, street theatre • Still need to estimate contribution of PPM network by time period to determine overall utility • Very difficult to determine “exposure” to school based intervention • Cost effectiveness not analyzed • Intensive collection of program data may not be sustainable over time

13. Conclusions & Lessons Learned • Results help us to identify where people go to seek care and how communities access messages and information about TB and HIV, so that interventions for TB/HIV can be targeted accordingly. • A variety of community based interventions can be used to improve TB case detection and help target interventions where people seek care

14. Next Steps and the Way Forward • Continue analysis of PPM referral network data by quarter • Look at “positive deviants” among pharmacists and traditional healers – who performed best and why? • Implement in three more districts and collect and analyze program data • Work with NTLP, CBOs, other stakeholders to identify the most promising approaches among the possible activities • Find ways to more fully integrate with HIV program • TB/HIV integration relative strong at facility level, need to strengthen at community level

15. ASANTE SANA! • USAID • National TB and Leprosy Program • Kisarawe District Health Management Team • Kisarawe District Education officials • Participating pharmacists, traditional healers, CORPs, teachers, DOTS nurses • Survey participants • Dr. Eyal Oren • PATH/Tanzania