Tuberculosis (TB)

TB & OTHER LUNG DISEASES Introduction:

 Respiratory (including TB) diseases account for more than 10% of all DALYs and make up five of the thirty most common causes of death globally. They also contribute to a minimum of 25% of outpatient morbidity and rank among the top five causes of mortality. The most common lower respiratory tract diseases that result in significant morbidity and mortality are asthma, lower respiratory tract infection including TB, and Chronic Obstructive Pulmonary Disease (COPD) all of which have similar presentations, most notably a cough.

Kenya is one of the 30 high TB burden countries globally with an incidence of 319/100,000 population with estimated deaths of 17,000 in 2022. In Kenya, COPD accounts for 1.2% of all deaths and is ranked as the 17th cause of mortality1. Kenya has an estimated asthma prevalence of 10%, or approximately 4 million people.

 2023 review

1. COVID Test and treat model: Updating M&E tools to capture the data required to track Paxlovid roll out and uptake in 25 facilities.

a. Status: 1000 doses received; 51 facilities supplied with Paxlovid in 23 counties, 490 Positives reported in 2023 out 34,968 Ag tests with an average positivity rate of 1.4%.

b. Comments: Lack of a house for Covid 19 response a challenge, Integration of Covid 19 into lung health program being pursued.

2. Screening of COVID in collaboration with the NCD program.

a. Status: Currently only the TB program has started bidirectional screening for TB and Covid 19. Through TIBU lite 4624 screened to TB and Covid, 197 Covid 19 cases identified, indicating positivity rate of 4.3%

b. Comments: There is reduced traction of covid 19 response due to WHO advisory declassifying COVID 19 as global health emergency.

c.   Yet to have a patient initiated on Paxlovid

3. Sustaining 95% of patients on 3HP:

a. Status: Uptake was 68,557 for newly enrolled PLHIVs and 32% of Household contacts

b. Comments: Adoption of 3HP among adults’ population PLHIVS and HIV-ve population,but children still using IPT the long regimen.

Into 2024

The Problem:

1. Covid 19:

  • Low coverage of covid 19 therapeutics
  • Reduced traction for covid 19 after WHO advisory
  • Covid 19 response not streamlined after emergency

2. TB

  • Missed cases; In 2022, only 60% of the TB presumptive cases identified were investigated for TB with 41% receiving clinical diagnosis along the cascade.
  • DR TB treatment – Long duration 18-24 months, No TPT for DR TB contacts, long TAT for DST
  • TB prevention: Low coverage of TPT among TB patient contacts, CALHIVs using long duration regimens

3. Management of lung health:

  • Suboptimal knowledge and skills for managing lung health conditions at all levels •      Deferential diagnosis of lung health
  • Data insufficiency
  •  Medications and consumables for lung health are in short supply, especially in the public facilities, and some are not included in the essential drug list
  • Poor mapping and linkages/collaboration

Root cause:

1. Covid 19:

  • Transition from emergency • Low testing
  • Evolving epidemiology

2. TB

  • Diagnosis-Long TAT for diagnosis- Coverage of diagnostics low
  • Supply chain issues including optimal treatment access

3. Other Lung diseases COPD, Asthma, Covid 19

  • Lack of systematic screening and diagnosis to provide deferential diagnosis
  • Siloed programing for TB only
  • Supply chain for health products not well streamlined
  • Lack of data for COPD Asthma

 

Expected process outcomes

Integrating tuberculosis (TB), asthma, and chronic obstructive pulmonary disease (COPD) COVID 19, detection in Kenya will bring about several significant changes in healthcare and disease management:

  • Early Detection
  • Improved Differential Diagnosis for lung diseases
  • Streamlined Patient Management and holistic management o Enhanced Resources Utilization
  • Comprehensive Training and Education o Public Health Impact
  • Policy and Program Improvement
  • Integration of Covid 19 test and treat

IMPACT

  1. Reduced TB incidence rate by 80% by 2030
  2. To reduced TB deaths by 90% by 2030
  3. Reduce the burden of chronic lung health by 20%
  4. Integration of

© CHAI Kenya Repository.
CHAI Kenya Repository