When 27 year old Brian Wekesa, a groceries trader at Soko Posta market in Busia town closed his business and accompanied his elder brother who had been ailing with complains of a persistent cough, night sweats, loss of appetite and unintentional weight loss to the Busia County Referral Hospital, he did not expect to be requested to test for TB as well.
“After examination which included production of a sputum that was examined in the laboratory, it was confirmed he had TB. The health workers explained to me that since we had been staying together and TB is an infectious disease that is spread when a person with active TB disease coughs, laughs, and or sings that I get tested. I obliged and the tests confirmed that I also had TB,” Brian shares.
He continues, “When we were told we both have the disease, it really worried me. I thought we were going to die but the reassurance from the doctor that the disease is curable redeemed my lost hope.” Before being initiated on treatment, Brian and his brother were informed about the causes of the disease, how to not spread it to others and the importance of adhering to treatment to get cured.
“Immediately after the counselling, we were put on treatment and requested to come for clinical reviews as a well as drug refills as indicated in the patient card. This was last year December, 2022,” Brian shares.
Brian was also requested to bring his wife and child whom they stay with for testing but none of them had active disease. They were put on TB preventive therapy to prevent them from developing active TB disease.
“Since we began treatment, we are all progressing on well. The symptoms my brother had are gone. Treatment is free of charge and we are truly thankful because were it not for the support gotten, we would have lost our lives as well as the burden of treatment costs would be too much on us,” Brian says.
Brian and his household are among thousands of patients who access quality TB services as a result of the collaborative work between the Ministry of Health’s National TB Program, all the 47 counties and its partners including Centre for Health Solutions – Kenya (CHS) through the United States Agency for International Development (USAID) supported Tuberculosis Accelerated Response and Care II (USAID TB ARC II) in TB control in Kenya, one of the high burden countries in the world.
According to Mary Asoyong, Busia County, TB, Leprosy and Lung Disease Coordinator, the county is one of the high burden counties in Kenya with a TB case notification rate of around 130/100000 population in 2022, arise from 90/100000 population in 2021.
“With the support from the National TB Program and USAID TB ARC II, we have accelerated TB active case finding across the facilities. We have been able to increase this over time. We feel there is more TB in Busia than what we are managing with 2016 TB prevalence survey that we were part of showing that we could be missing 40% of all cases,” she explains.
Busia which is a boarder county with five of its seven sub counties being along the Kenya-Uganda wet and dry borders. The county gate way to east Africa serves a lot of TB vulnerable populations including the fisherfolk community, truck drivers, refugees, and slum dwellers
“We serve a big population including international population. We also have slums both in Busia and Malaba. The poverty levels are around 60% with malnutrition being one of our big challenges,” Mary says.
The National TB Program and CHS – USAID TB ARC II have been supporting TB control intervention in the county. Support supervision for both the County, TB, Leprosy and Lung Disease Coordinator( CTLC) and Sub-County, TB, Leprosy and Lung Disease Coordinators (STLCs) has been provided as it has for the other counties in Kenya.
“This has been one of our biggest pillars in provision of services. We have been able to reach thousands of health workers during the support supervision visits where we have been able to mentor them on TB. We know the training in school on TB was not intense as well as we have new guidelines and treatment regimens . During the support supervision we have been able to mentor them on one on one, including mentorship on active case finding, tools, management of TB and many other factors relating to care and treatment,” Mary says.
During the support supervision visit, the CTLC and the STLCs, are also able to engage health workers on matters quality of care improvement where they discuss with facility staff on how to consume their own data and utilise it to make decisions. Once mentored, the coordinator visits the facility the following month to draw solutions from the last visit based on data and improved service delivery. With the county being very vast and with a catchment population of around one million as of 2022 estimates, the terrain in most part of the county is difficult . The county has facilities in its islands where access is a challenge with only one boat connecting the mainland and island. If one has to access the island facilities to provide mentorship and come back to the mainland the same day, they need to have completed their work by noon otherwise they will miss the boat.
“We appreciate that the SCTLC serving there is supported with a monthly overnight perdiem of Kshs. 8000 to support the Island facilities adequately. With that, he doesn’t have to rush through the visit so as not to miss the boat.,” Mary says.
The County has 192 health facilities, 88 TB treatment sites and 35 diagnostics sites. The CTLC and the STLCs are supported with transport reimbursement to provide technical support in these sites with each visiting at least 12 facilities per month to provide technical assistance/ mentorship. The county is also provided with sampling networking support to scale up drug sensitive testing. With this support, they are able to network their samples to National TB Reference Lab and or Kisian for patients to access culture and drug sensitivity testing.
“We have been able to link samples of all bacteriologically TB confirmed cases by collecting culture and this has scaled up the number of DRTB cases we diagnose. In 2019 we had only 4 DRTB cases, increased to 13 in 2020, 14 in 2021, 15 in 2022 and in the January -March 2023 quarter we had six clients with four being first time TB clients,” Mary says.
Through the National TB Program, CHS – USAID TB ARC II and other partners, a multi-disciplinary team from the county and the health workers managing DRTB patients are supported to conduct clinical review meeting for the patients on monthly bases to monitor their response to treatment and address any challenges arising. The four geneXpert sites are supported with bundling on monthly basis as well as maintenance by a super user so that they are able to relay results on real time to clinicians for early treatment initiation and reduction in disease spread in the community.
“Previously before the support, we had a turnaround time of two weeks but this has reduced to 24 hours. Now we are able to test, diagnose and initiate patients on treatment the same day. With this support, the results are shared out among the CTLC, STLC,s the testing laboratory, and the clinician hence there is networking to ensure the patient is initiated on treatment in time as well as managing them properly,” Mary says.
Overly the quality of care for patients in the county has improved. There has been timely diagnosis based on these interventions and early diagnosis leading to improved TB outcomes.
“Our treatment success rate has improved from 80% in 2018 to 88% currently after the interventions. The death rate has decreased 12% in 2019 to 7% in 2021 and we are working to reducing it to less than 5% through various strategies including clinical reviews,” Mary says.
Gertrude Mwanya, the SCTLC Matayos Sub County notes that the continuous support they continue to receive through various interventions including timely reimbursement has made their work easy, and smooth despite working in the periphery areas. “We are utilising the support gotten to strengthen TB control. Personally, I am giving it my best and I am glad to share the sub county I support was ranked among the best improved sub counties in Kenya by the National TB Program performance review of 2022,” Gertrude shares. For sustainability they are engaging the county to support TB interventions.
“Aside from human resource, we have had no county government support on TB issues in the over ten years I have been in the program. After we began sharing TB reports with the leadership and updating them on the burden of TB and outcomes, we have gotten allocation for TB control by the county government within the current financial year allocation from the supplementary budget being one million. We are making some progress. We will continue to advocate for more resource allocation for TB control activities.” Mary concludes.
