Tuberculosis (TB) is still a major public health challenge in Africa, spreading easily across borders where people move for trade and daily life. A recent presentation on Cross-Border TB Management in Western Kenya highlighted challenges such as patient follow-up across borders, differing national treatment protocols, and gaps in coordinated detection. It also showcased innovative responses, including joint contact tracing and shared surveillance between countries.
Why Cross-Border TB Matters
Kenya shares borders with Somalia, Ethiopia, South Sudan, Uganda, and Tanzania. Each presents distinct health challenges, but the “wet borders” with Uganda along Lake Victoria are particularly complex. Fishing and related trades drive high levels of human movement, which increases the risk of TB transmission. Unfortunately, access to early diagnosis and continuity of treatment for mobile populations remains inadequate. Many patients on TB treatment cross borders without proper referral mechanisms, thereby disrupting adherence. There is also limited information about facilities providing TB services across borders, and no formal platforms exist for consistent communication between health authorities.
The TIFA Wet Border Project
To address these gaps, the TIFA (Tuberculosis Implementation Framework Agreement) Wet Border Project was initiated. The project had three main goals. First, to strengthen cross-border collaboration using existing regional platforms. Second, to establish mechanisms for information sharing across counties and countries. Third, to build capacity among healthcare workers and community health teams to improve TB care in border areas. The project targeted five counties in Kenya—Busia, Siaya, Homabay, Kisumu, and Migori. These counties interact directly with Uganda across Lake Victoria.
Approaches and Interventions
Several strategies were implemented to enhance TB detection, referral, and treatment continuity:
- Mapping of TB diagnostic and treatment facilities across border counties.
- Sensitization of healthcare workers and community health volunteers on cross-border TB issues.
- Engagement of Beach Management Units (BMUs) to strengthen community outreach.
- Continuous medical education (CME) for facility-level staff.
- Integrated community outreaches in fishing communities to provide TB screening and linkage to treatment.
- Quarterly cross-border review meetings to align strategies with counterparts in Uganda.
- Development of inter-country referral directories and forms for smoother patient handover.
Results and Impact
The project achieved notable outcomes:
- TB case finding increased by 16–30% in supported counties.
- Community referrals improved by 5–35%, showing stronger community engagement.
- 282 Community Health Promoters were trained and supported in contact management.
- 1,109 bacteriologically confirmed TB cases were reported, with 75% of those screened initiated on preventive therapy.
- Outreach activities screened nearly 3,900 people, diagnosing 203 TB cases, all of whom were linked to treatment.
- A remarkable 88% of treatment interrupters and 76% of patients lost to follow-up were successfully brought back into care.
Challenges Identified
Despite progress, several hurdles remain:
- Informal and irregular movement patterns that evade formal health systems.
- Limited project scope (focused only on Kenya and Uganda).
- Lack of consistent TB services along fishing beaches.
- Leakages due to informal border crossings.
Lessons Learned
Key lessons emerged from the initiative:
- Community engagement is pivotal—CHWs and BMUs were essential in bridging gaps in TB detection and adherence.
- Cross-border collaboration improves outcomes by ensuring continuity of care.
- Understanding migration patterns helps design targeted interventions.
- Capacity building for health workers enhances diagnosis and management.
- The legal status of migrants can significantly affect access to TB care.
Opportunities Ahead
The presentation called for scaling up cross-border TB interventions and outlined future opportunities:
- Training health teams in harmonized cross-border health messaging.
- Leveraging digital and mobile health tools for surveillance and patient referrals.
- Engaging community-based organizations and networks already serving border communities.
- Establishing a regional TB stakeholder forum to advocate for more resources and political commitment.
- Ensuring cross-border TB is budgeted for within national health programs.
Conclusion
The experience from Western Kenya highlights that TB control in border areas requires partnerships, innovation, and sustained investment. By engaging communities, strengthening systems, and fostering cross-country collaboration, significant strides can be made in closing TB care gaps. As movement across borders continues to define life around Lake Victoria, so too must health interventions adapt—because diseases like TB recognize no borders.
