1. TB Contact Tracing in Motheo District, Free State Province South Africa IAS Community Satellite 17 th July 2011 Dr Ima P. Chima

2. Acknowledgement  Mr. Thomas Sihlangu – Community Linkages Officer, EGPAF  Ms Daphne Mpofu – Community Linkages Manager, EGPAF  Ms Maggie Kwatala – HIV TB Coordinator Department of Health Free State  Ms Keneilwe Nkoana, – TB Tracing Team from Department of Health Free State  Ms Joyce Ramakau – TB-Free, Free State

3. Background  Motheo District, in Free State Province has the highest TB case load.  In 2009 - case load of 24,940, of which 7, 747 (31.1 %) was in Motheo District only.  Department of Health (DoH) in Free State noted ↑ number of new MDR-TB patients based on quarterly data assessments, thus likelihood of  Defaulting from TB treatment  TB contacts being infected and not seeking treatment  Gupta et al (2010) Maternal TB associated with 2.51 fold ↑ in MTCT of HIV  Prevention of TB among HIV-infected mothers should be high priority for communities with significant HIV/TB burden.

4. Intervention  TB defaulter tracing in Motheo district  Find patients who default or lost to follow-up  Screen contacts for TB and refer them to the local facilities for further management.  EGPAF in partnership with DOH and TB Free (NGO) started the TB defaulter tracing exercise on 19 th January 2011.

5. Intervention (2)  2468 households were identified from a 2009 register of diagnosed TB patients.  Most patients resided in informal settlements  Contacts were traced using a number of ways:  Post office staff greatly assisted in locating the actual houses based on addresses from the register.  Team members asked community members for contacts surnames instead of first names  Teams also used municipality maps to locate house numbers

6. Intervention (3)  Community members were involved through the participation of Community Health Workers (CHW).  CHW are community members working with CBOs or attached to health facilities.  These CHW together with Lay Counsellors provided HCT.  Community members helped distribute IEC materials and were engaged to assist with mobilization.

7. Intervention (4)  The three partners formed 24 teams that were allocated different areas to cover in Motheo District.  The teams provided HIV counselling and testing and TB screening, door to door.  Household members gave verbal consent for screening and testing.  Community awareness and mobilisation of the exercise was achieved using road show techniques around “hot spots”.

8. Intervention (5)  Screening for TB was done with a screening tool (4 questions) and sputum testing.  HIV testing was done using Rapid HIV testing kits  Those HIV +ve were referred to health facilities for CD4 counts  Infants and children below 5 years were excluded from TB screening because of their inability to produce sputum

9. TB Screening tool

10. Results IndicatorNumber Number of households visited2470 Number of defaulters traced145 Number of TB patients lost to follow up73 Number of contacts screened for both HIV and TB4865 Number of adults sputum positive for TB12 Number of children sputum positive for TB24 Number of adults who tested HIV positive (>15 years)133 Females102 Males31 Number of children who tested HIV positive (5 to 15 years) 5

11. Recommendations  Involving post office workers was an effective means of identifying defaulters and patients lost to follow-up especially in informal settlements  The partnership created between EGPAF, DOH and TB-Free was effective and efficient:  Combined resources  Coordination  Ownership by DOH  Community mobilisation and awareness

12. Further research  Further research would assist in evaluating  Effectiveness of various community level interventions in promoting adherence and decreasing default among patients on HIV and TB treatment  Adherence and outcomes of traced defaulters identified through the tracing exercise  Outcomes of contacts identified post tracing

13. Rea Lebogha! Siyabonga! Dankie! Thank you!