Community health volunteers’ contribution to tuberculosis patients notified to National Tuberculosis program through contact investigation in Kenya

Abstract

Background: Contact investigation is important in finding contacts of people who have Tuberculosis (TB) disease so that they can be given treatment and stop further transmission. The main objective of this study was to assess the contribution of community health volunteers (CHVs) to the number of TB patients notified to the National program in Kenya through household contact screening and referral of persons with TB signs and symptoms to the facilities for further investigation. Methods: This was a retrospective desk review of project reports submitted to Amref Health Africa in Kenya by the sub-recipients implementing activities in the 33 counties with Case Notification Rate (CNR) of less 175/100,000 and Treatment Success Rate (TRS) of less than 88% as per the National strategic plan 2015-2018. Data for this study covered a period between January and December 2016. Data on the notified TB patients was obtained from the National Tuberculosis Information Basic Unit (TIBU). The study population included all the TB index cases whose households were visited by CHVs for contact screening. Data was recorded into excel spreadsheets where the descriptive analysis was done, proportions calculated and summarized in a table. Results: Community health volunteers visited a total of 26,307 TB patients (index cases) in their households for contact screening. A total of 44,617 household members were screened for TB with 43,012 (96.40%) from households of bacteriologically confirmed TB patients and 1606 (3.60%) from households of children under 5 years. The proportion of the persons referred to the number screened was 19.6% for those over 5 years and 21.9% from under 5 years with almost the same percentages for males and females at 19.2% and 19.7% respectively. The percentage of (TB) cases identified through tracing of contacts in these counties improved to 10% (5456) of the 54, 913 cases notified to the National TB Program. Conclusions: This study showed that in the 33 counties of Global Fund TB project implementation, the percentage of TB cases identified through tracing of contacts improved from 6 to 10% while the percentage of notified TB cases; all forms contributed through community referrals improved from 4 to 8%. Community health volunteers can play an effective role in household contact screening and referrals for the identification of TB.

Accounting for health inequities in the design of contact tracing interventions: A rapid review

“…A total of 230 references were identified and 39 met the inclusion criteria ( Figure 1 ). The analysis of the full texts led to the final selection of seven relevant references ( Danquah et al (2019) ; Tom-Aba et al, 2015 ; Cherutich et al, 2017 ; Ho et al, 2020 ; Fox et al, 2018 ; Hamblion et al, 2018 ; Abongo et al, 2020 ) ( Annex 1 ).

Figure 1 PRISMA diagram.

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“…Three interventions prioritized the use of technological tools in contact tracing, such as smartphones equipped with an application ( Danquah et al, 2019 , Tom-Aba et al, 2015 , Cherutich et al, 2017 ) or real-time location systems ( Ho et al, 2020 ). Three interventions planned contact tracing based on telephone tracking and manual contact case entry ( Fox et al, 2018 , Hamblion et al, 2018 , Abongo et al, 2020 ).…”

“…For interventions based on manual data collection and telephone follow-up, the rationale for these approaches was the ease of implementation in an epidemic context ( Hamblion et al, 2018 ) and their ease of implementation during household contact tracing ( Fox et al, 2018 ). In Kenya, community health volunteers (CHVs) were chosen to perform contact tracing by telephone and manually, as they provided links between the community and the health system, which can improve healthcare access and community empowerment ( Abongo et al, 2020 ). None of the articles mentioned incorporating health inequities into their intervention.…”

“…The populations studied were direct contacts of laboratory-confirmed cases, whether household contacts or by occupation (healthcare workers) ( Danquah et al, 2019 , Tom-Aba et al, 2015 , Cherutich et al, 2017 , Ho et al, 2020 , Fox et al, 2018 , Hamblion et al, 2018 , Abongo et al, 2020 ). No intervention included a subgroup of the population, whether in terms of income, socio-professional category, gender, or geographic area.…”

“…Finally, for the tuberculosis intervention in Kenya, contact tracing in the household of a confirmed case was conducted by CHVs. Household contacts of tuberculosis cases were screened by CHVs by telephone or through household visits and these volunteers ensured that positive cases arrived at the health facility for healthcare ( Abongo et al, 2020 ). None of the interventions adapted their follow-up to the income, gender, or socio-professional profile of the target population.…”