Africa: WHO Supports Government to Integrate Covid-19 Case Finding Into TB Surveillance Activities

Globally, the TB incidence rate is falling, but not fast enough to reach the 2020 milestone of a 20% reduction between 2015 and 2020.

Abuja — "During a tuberculosis outreach in my community, one of the team members insisted I take a test as he said I already have symptoms. As I was about to undergo the test, the DSNOs suggested I also undergo a COVID-19 test because I was also displaying some of the symptoms," says 32 year old Janet Ishaya, reached through the TB intervention in Kaduna State.

Speaking further, Ms Ishaya adds that, "After a few days, I was contacted and told my COVID-19 test turned out positive and had to be taken to the isolation centre to commence treatment. I am glad I took the test and have been treated. If not for the DSNO at the outreach, I wouldn't have been diagnosed at an early stage."

Ms Janet Ishaya is one of the beneficiaries of renewed efforts to curb COVID-19 in Nigeria, whereby World Health Organization (WHO) supports the government in an initiative to improve contact tracing, active case search and testing with support of the already existing Tuberculosis (TB) infrastructure in the country.

The outbreak of COVID-19 in February 2020 and the presence of public health response measures put in place to curtail the spread of the global pandemic in the country had led to palpable fear in the TB community that the virus might impact on the active TB case finding activities.

However that took a different turn as the structure is being effectively utilized to combine TB and COVID-19. Presently, all the 36 + 1 S Nigerian States are currently including COVID-19 in their TB response to ensure that no case is missed and every positive case is handled accordingly.

In States like Niger for instance, 18 WHO TB supervisors and Disease Surveillance and Notification Officers (DSNO) have already been trained on the modified community engagement approaches and the principles of COVID-19 infection prevention and control (IPC) who are referred to as super-trainers. The super-trainers were engaged at the diagnostics sites closest to communities in addition to staff of the nearest primary healthcare (PHC) for outreach. Over a three-month period, in Q2 2020 (April to June 2020), 30 rural communities were visited across nine Local Governments (LGA) in the State, 3 072 households were screened with 2 235 presumptive TB patients identified out of which 277 TB patients were notified through the Niger state TB & Leprosy control program, with all being tested of COVID-19.

Also in Imo State, the TB Surveillance Officer collaborated with the State TB Program to develop a house to house active TB and COVID-19 case search that lasted for one month. With support of five community volunteers from each LGA, active house to house TB and COVID-19 case search was conducted in the highest burden communities whereas Lagos trained over 500 heath workers on COVID-19 IPC.

For Benue State, 56 health personnel including five DSNOs and 37 TB Case officers /community informants from 14 LGAs were trained on advocacy, community/House to House sensitization, social mobilization for Tuberculosis and COVID 19 including training on IPC, facilitation of GeneXpert sites engagement/Chest X-ray sites for children and engagement of key community stakeholders.

During contact tracing, the WHO Bauchi state TB Focal Point Dr. Babayi Aminu stated that "we sensitized the surveillance team members to always consider TB as a possible diagnosis of all coughing patients, especially if associated with fever; both cough and fever were common presentations of COVID-19. Though without appropriate documentation, a number of presumptive TB patients were identified by the COVID-19 surveillance team and linked to TB diagnostic services and vice versa."

WHO continues to support Governments at all levels to ensure that the Covid-19 management programme takes the advantage of the extensive structures and human resource capacity available in the TB control programme to increase detection, diagnosis and management of cases at the community level.

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