WHO ranks Kenya among the high burden Tuberculosis (TB) countries in the World, with TB being the leading cause of death among infectious diseases in Kenya. Since 2013, Centre for Health Solutions-Kenya with funding from the United States Agency for International Development (USAID) has been working with the National TB, Leprosy and Lung Disease Program (NTLD-P) to change this narrative. This is through the Tuberculosis Accelerated Response and Care II (TB ARC II ) activity, and its predecessor Tuberculosis Accelerated Response and Care (TB ARC ) activity, 2013-2018.
In March this year, Kenya reported the first case of Coronavirus disease (COVID-19), an infectious disease that presents with cough and fever which are also the key symptoms of TB disease. According to NTLD-P, there is limited data on the exact effects of co-infection with COVID-19 of persons with TB. TB disease usually occurs due to a lowered immune response, and in itself lowers the immunity. COVID-19 has a higher likelihood of being severe in persons with lowered immunity and in persons with other co-morbidities. Therefore, it is also likely that TB patients who get infected with COVID-19 may have a higher likelihood of severe lower respiratory tract infection and/ or death.
In the view of the above, NTLD-P recommends that in the duration of the COVID-19 pandemic: persons with suspected, probable or confirmed COVID-19 should also be evaluated for TB disease; a reduction in the frequency of the scheduled follow-up visits for stable TB patients who have completed at least one month of treatment; and scheduled visits as per the current standard of care, or more frequently as the need arises for the unstable patients in the intensive and continuation phase of treatment.
NTLD-P in collaboration with TB ARC II and other partners are also exploring community drug delivery as an additional measure to ensure continuity of TB treatment services in the community.
It is crucial to prevent persons with TB disease from being infected with COVID-19 and also those with COVID-19 from infection with TB. For continued support to NTLD-P in offering TB services while at the same time preventing its staff from COVID-19, TB ARC II has taken the following measures;
Sensitisation on COVID-19
All TB ARC II staff have been sensitised on how to prevent themselves from COVID-19, the symptoms of the disease and what to do in case one falls ill.
Additionally, TB ARC II has sensitised courier service providers from G4S on infection, prevention and control when handling samples as well as provided technical support in institutionalisation of infection prevention measures at the courier hubs. TB ARC II in partnership with G4S offers sample referral of all TB patients culture samples to the National TB Reference Laboratory and KEMRI – Kisian Laboratory.
Provision of Personal Protective Equipment
To ensure the safety of the regional staff providing technical support and on job mentorship in high volume facilities in the counties, TB ARC II has purchased surgical masks, N95 masks, latex gloves, sanitisers and disinfectants for these staff.
Work from home methodology adoption
To ensure less exposure of its staff to the virus on their way to work and congestion in the office, TB ARC II has adopted a work from home approach since March 16, 2020. However, those staff who are required to work from the office have been supported with adequate information on prevention of infection transmission as well as adequate personal protective equipment.
Adoption of e-meetings
TB ARC II has reviewed its Year 2 work plan to accommodate the different delivery modes that have been adopted due COVID-19. Some trainings and meetings (both internal and with external stakeholders) have been suspended while others have been converted to e-meetings. All activities that previously required congregation of health care workers for capacity building sessions, sensitisation on revised guidelines, technical working groups and development of various reports and outputs are now online. These activities are being conducted via Extension for Community Healthcare Outcomes (ECHO) and other online platforms.
To effectively deliver e-training content, TB ARC II is working within 5 regional hubs that are overseen by technical experts derived from the NTLD-P and TB ARC II.
Support of Differentiated Care Model for TB
TB ARC II supported the development of a Differentiated Care Model for TB in the January to March 2020 quarter. With support from TB ARC II, this model is currently being rolled out by the National TB Program country wide to reduce hospital visits and free up human resource to support COVID-19 response.
