Implementing active surveillance for TB—The views of managers in a resource limited setting, South Africa

Abstract

Background The achievement of the World Health Organization's END TB goals will depend on the successful implementation of strategies for early diagnosis and retention of patients on effective therapy until cure. An estimated 150,000 cases are missed annually in South Africa. It is necessary to look at means for identifying these missed cases. This requires the implementation of active surveillance for TB, a policy adopted by the National Department of Health. Aim To explore the views of managers of the TB program on the implementation of active surveillance for TB in the resource constrained setting of the Eastern Cape, South Africa. Methods A descriptive, explorative, thematically analysed qualitative study based on 10 semi-structured interviews of managers of the TB program. Interviews were transcribed verbatim and analysed using the framework method and Atlas-ti. Results Active case finding of people attending health facilities was the dominant approach, although screening by community health workers (CHWs) was available. Both government and non-government organisations employed CHWs to screen door to door and sometimes as part of campaigns or community events. Some CHWs focused only on contact tracing or people that were non-adherent to TB treatment. Challenges for CHWs included poor coordination and duplication of services, failure to investigate those identified in the community, lack of transport and supportive supervision as well as security issues. Successes included expanding coverage by government CHW teams, innovations to improve screening, strategies to improve CHW capability and attention to social determinants.

Public health surveillance through community health workers: a scoping review of evidence from 25 low-income and middle-income countries

“… 11 12 Studies were from 25 LMICs across the world including Africa, 11–26 Asia, 27–36 Latin America 37 38 and the Caribbean. 39 Although most studies focused on specific infectious diseases including HIV/AIDS, 20 malaria, 15 18 37–39 tuberculosis (TB), 16 19 Ebola, 12 neglected tropical diseases (NTDs) 13 24 26 and COVID-19, 34 others focused on maternal and child health, 14 25 29–32 35 general health/overall mortality 17 21 23 33 and specific outcomes such a suicide. 28 Once data charting was completed, we synthesised results by identifying the most commonly described roles, challenges and impacts and categorised these based on similarity.…”

“…In some cases, the data collected are not restricted to mortality and morbidity data but may also include samples in the case of surveillance for patients with TB in South Africa. 16 Additionally, in the case of surveillance of NTDs, Timothy et al, 13 based on a survey of CHWs in Liberia, describe the data gathering role of CHWs to include the taking of photographs of skin-related NTDs. In places where vital registration systems have been historically ill-equipped/insufficient, CHWs have played an important role in obtaining vital registration data to be forwarded to health facilities.…”

“…In Panama, 37 Zambia, 18 the Dominican Republic 39 and Honduras and Laos, 38 an identified role of CHWs as part of surveillance work has been the administration of rapid diagnostic testing for malaria, particularly among marginalised populations and those in so-called ‘hard-to-reach places’. In other contexts, such screenings have been done for other conditions, such as TB in South Africa, 16 19 skin-related NTDs in Liberia 13 and even pregnancy testing in Zimbabwe. 25 In most cases, where CHWs play a role in identifying and testing for conditions, they also often play a role in providing treatment for patients and community members.…”

Implementing active surveillance for tuberculosis: The experiences of healthcare workers at four sites in two provinces in South Africa

“…Questions were based on findings from an earlier study looking at views expressed by managers of TB programmes in the resource-limited setting of the Eastern Cape province. 23 The researchers sought to understand the views of interviewees on active surveillance for TB in COPC and more specifically on factors that influenced implementation of active surveillance for TB in the community. All interviews were conducted in English by the principal researcher.…”

Development of Gold-Nanoparticle-Based Lateral Flow Immunoassays for Rapid Detection of TB ESAT-6 and CFP-10

“…The global representation of this crisis is massive, as 3.6 million of TB cases can go undiagnosed or unreported in low–middle income countries. In sub-Saharan Africa, 5 out of 10 active TB cases go undiagnosed, and in South Africa (SA) alone, an estimated 150,000 of cases are not diagnosed, which poses a risk for increasing the rates of transmission, morbidity and mortality [ 1 ]. The lack of rapid, accurate diagnostic tools at a point of care (PoC), including the inaccessibility of easily collectible samples, is central to the missed diagnosis and subsequent spread of the disease.…”