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. Traditional healer CORPs sharing information in the community 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