SURVEY FINDINGS April 28, 2017

Transcription

1 SURVEY FINDINGS April 28, 2017 Brenda Mungai Centre for Health Solutions-Kenya, TB ARC

2 Outline Background Survey Rationale Methods Key Findings Conclusions Call to Action KENYA TUBERCULOSIS PREVALENCE SURVEY Assessing Kenya s TB Burden REACH, TREAT, CURE EVERYONE

3 Tuberculosis in Kenya 4th leading cause of death Among the 30 high TB burden countries globally TB epidemic affects the young (15-34yrs) the economically productive age groups In ,518 cases were identified and treated Estimated prevalence of TB was 233/100,000 Kenya detected about 80% of all TB cases KENYA TUBERCULOSIS PREVALENCE SURVEY Assessing Kenya s TB Burden REACH, TREAT, CURE EVERYONE

4 TB Case Notification by Year Number Is this true? Year

5 Survey Rationale First national TB prevalence survey done in (646 per 100,000) Provide a better estimate of the burden of TB Assess the associated health seeking behaviour of TB patients and those reporting TB symptoms Inform country planning and policy formulation to end TB KENYA TUBERCULOSIS PREVALENCE SURVEY Assessing Kenya s TB Burden REACH, TREAT, CURE EVERYONE

6 Methods All participants were: asked a series of questions to assess for TB symptoms were subjected to a chest x-ray submitted sputum for laboratory analysis through microscopy, GeneXpert and culture

7 National Population against Survey Population Proportions ,00-40,00 Census-male -20,00 Survey-male 0,00 20,00 Census-female 40,00 Survey-female 60,00

8 TB Prevalence Survey Summary 126,389 Total Census 31,955 Households Visited 76,291 Eligible (60%) Ineligible Individuals 47,428 (38%) children (<15yrs) 2,670 (2%) non-resident & adult 63,050 Enrolled (83%) Chest X-ray Screening 62,484 (99%) Symptom Screening 63,050 (100%) Participants eligible for Sputum Examination 9,715 (15%) Eligible by both screening methods: 1,241 Eligible by symptom screening only: 2,861 Eligible by CXR screening only: 5,184 Eligible by declining X-ray and no symptoms: 394 Smear Microscopy done (94%) GeneXpert done 8,954 (92%) Bacteriology Confirmed TB 305 Participants Culture done 9,121 (94%)%)

9 KEY FINDINGS Of The TB Prevalence Survey 2016

10 There s More TB in Kenya than we Thought 2015 WHO estimate 2016 Prevalence survey estimate 233 per 100,000 population 558 per 100,000 population Translates to approximately 138,105 TB incident cases per year KENYA TUBERCULOSIS PREVALENCE SURVEY Assessing Kenya s TB Burden REACH, TREAT, CURE EVERYONE

11 Prevalence / 100,000 Prevalence among Men is Twice as High as Women Age Males have a higher disease burden (809 vs 359 per 100,000) and are more likely to be missed Prevalence among women age group 65 years and above was high

12 TB Prevalence is Highest in Urban Areas KENYA TUBERCULOSIS PREVALENCE SURVEY Assessing Kenya s TB Burden REACH, TREAT, CURE EVERYONE

13 Majority of TB Cases were HIV Negative 83% of TB cases were HIV negative. This suggests that interventions to control TB among People Living with HIV have been successful and a large burden of TB now exists among people not infected with HIV KENYA TUBERCULOSIS PREVALENCE SURVEY Assessing Kenya s TB Burden REACH, TREAT, CURE EVERYONE

14 Symptom Profile of Prevalent Cases Symptom Cases Proportion Cough two weeks only Night sweats only Fever only Weight loss only % 28% 20% 13% Weight loss or fever or night sweats or cough more than two weeks % Any coughing or fever or weight loss or night sweats or fatigue or other symptoms or breathe shortness or chest pains (At least one symptom) Total % If other TB related symptoms are included in the sputum eligibility criteria, the prevalent cases missed by symptom screening would be reduced

15 Chest X-ray is a Good Screening Tool Among the TB cases, 88% had abnormal chest x-rays However, 52% of the TB cases did not have the usual cough of two weeks or more These cases were only identified because of an abnormal chest x-ray KENYA TUBERCULOSIS PREVALENCE SURVEY Assessing Kenya s TB Burden REACH, TREAT, CURE EVERYONE

16 Overview of Prevalence by Diagnostic Method Type of Test All bacteriologically confirmed cases (culture and Xpert) Number of Cases (n) Prevalence per 100,000 population (N=63,050) Smear Microscopy 123 (40%) 230 Gene Xpert Positive 237 (78%) 431 Culture positive 215 (71%) 341

17 Testing for Tuberculosis Use of microscopy for diagnosis misses cases As a solo test, the commonly used microscopy test would have missed more than 50% of the TB cases GeneXpert (innovative technology for the diagnosis of TB) detected 78% of the TB cases making it a more reliable and efficient test KENYA TUBERCULOSIS PREVALENCE SURVEY Assessing Kenya s TB Burden REACH, TREAT, CURE EVERYONE

18 Health Seeking Behaviour and Missing Cases TB Patients (305) No Symptom(s) 26% Symptom(s) 74% Symptoms not severe; no care 25% Missing Seek care 33% Diagnosed (15) Did not seek care; other reasons 42% Missing Missing 40% of TB patients are missing

19 Where are the Missing Cases? People are in the community with non-severe symptoms, and are therefore not seeking care People at work, school, home or clinics are presumed not to have TB and hence not screened People are seeking care for TB symptoms, but do not get diagnosed

20 CONCLUSION Of The TB Survey Findings

21 Key TB Survey Findings 1 The Burden of TB in Kenya is Higher Than Previously Thought 2 People Most Affected by TB 809 males per 100,000 people 3 Testing for Tuberculosis 4 Health Seeking Behaviour Current practice of TB symptom screening misses cases Individuals with symptoms of TB in the community are not seeking care Chest x-ray emerged to be a good screening tool for TB People with TB symptoms first seek health care at either public or private health facilities Use of microscopy for diagnosis misses cases Three quarters of the people with TB symptoms who seek care do not get diagnosed/are missed GeneXpert is a more reliable and efficient test A quarter of those found to have TB did not report any TB symptoms

22 Call to Action: Find the missing cases

23 TB Screening and Diagnosis 1. Expand symptom list for TB screening beyond the 4 cardinal symptoms, Include any TB related symptom as follows cough of any duration, night sweats, weight loss, fatigue, fever, and shortness of breath 2. Screen all persons with respiratory symptoms seeking care in health facilities for TB 3. Make diagnostics accessible where patients seek care Expand use of Chest X-ray to screen all persons presumed to have TB Make GeneXpert the first diagnostic test for all presumed TB cases KENYA TUBERCULOSIS PREVALENCE SURVEY Assessing Kenya s TB Burden REACH, TREAT, CURE EVERYONE

24 Public-Private Sector Partnership 1. Engage the private sector in TB screening, diagnosis and treatment including private pharmacies KENYA TUBERCULOSIS PREVALENCE SURVEY Assessing Kenya s TB Burden REACH, TREAT, CURE EVERYONE

25 Community Based Action 1. Develop and implement targeted approaches for TB screening and active case finding among young men and the elderly (employment institutions, informal labour sector, schools/colleges) 2. Enhance focus on urban TB care and prevention to address the high burden of TB in cities and towns by the Ministry of Health, County Governments and civil society partners 3. Expansion of social protection and food subsidies to include men KENYA TUBERCULOSIS PREVALENCE SURVEY Assessing Kenya s TB Burden REACH, TREAT, CURE EVERYONE

26 Improve Community Awareness of TB Symptoms 1. Develop targeted messages and health education on TB to key affected populations encouraging people to seek early intervention for any symptom 2. Expand school health programs to include TB and target children as change agents to reach young families KENYA TUBERCULOSIS PREVALENCE SURVEY Assessing Kenya s TB Burden REACH, TREAT, CURE EVERYONE

27 TB Prevalence Survey Partners

28 TB REACH 1 year grant April 2017-June 2018 Increase case finding peadiatric TB and IPT for under 5 contacts 10 facilities per county, Staff-3 field coordinators, Trainer, M&E, Project Manager Trainings-NPA, GA, ECHO, You Tube Videos Target counties Nairobi Mombasa Machakos Homabay Garissa Siaya Makueni Kericho Meru Kirinyaga