COMMUNITY ENGAGEMENT AS A STRATEGIC FORCE TO TB

COMMUNITY ENGAGEMENT AS A STRATEGIC FORCE TO TB CASE FINDING: CASE STUDY OF KANO STATE. Owoyomi O. I. 1, , Ogbuji. 1, , Q. C, Osho J. A. 1, Hassan O. A. . 1, Ojo O. M. 1, Umar, I 2, Osinowo, K. A. 1, Ladipo, O. A. 1 Affiliations: 1 Association for Reproductive and Family Health, Abuja, Nigeria 2 Kano State Tuberculosis and Leprosy Control Program, Kano, Nigeria

Conflict of Interest • None of the authors has financial relationships or any form of conflict of interest to disclose.

Disclosure • Oladipo Owoyomi, Dr Ogbuji, Dr Hassan, Dr Osho, Ola Mathews, Osinowo and Prof Ladipo are all Staff of Association for Reproductive and Family Health that sponsored the study. • Dr Umar is an employee of Kano State Government that co-sponsored the study

Introduction • TB case notifications in Nigeria has stagnated over the past 5 years with detection of 25% of the estimated TB cases. • Kano State projected population - 13, 856, 080 million (from 2006 census). • Kano State DOTS expansion is estimated at 52% (based on the total number of health facilities in the state that stands at 1, 410) • CNR of 58%

Introduction – cont’d • Undetected cases tend to increase the risk of TB transmission. • Factors partly responsible for missing cases include low awareness about Tuberculosis (TB) and social stigma. • community engagement as in other health programs, has been identified as an effective means of improving case finding. • This community engagement involves engaging the key stakeholders (CBOs, WDC, FBOs, CTWs, CVs e. t. c).

Objectives • To assess the contribution of ACF to TB casefinding from Jan 2018 to Dec 2018 in all the intervention LGAs in Kano. • To examine the case-finding data in the intervention LGAs before and after the ACF intervention.

Methodology • This is a comparative descriptive study using retrospective data from the 13 LGAs where active case finding was implemented in slums. • Activities include house-to-house TB case search and Contact tracing of index TB cases. • Community outreaches – meeting, dialogues and sensitizations (Jingles in local languages).

Results • The outcome of intervention accounted for 78% contribution to total TB cases notified in the selected LGAs (i. e. 3686 TB against 4746) in 2018. • There was an increase of 47% of TB Case notified from 2014 to the period of intervention.

Percentage contribution of ACF to LGA data per LGAs in 2018 in Kano

Results LGA Albasu Bichi Dala DTF Fagge Gaya Gezawa KMC Rano Takai Ungogo Warawa Wudil 2015 9 82 646 145 814 66 83 628 127 77 153 9 147 2016 201 74 1340 177 987 58 160 772 187 80 197 76 194 2017 182 119 1054 231 639 23 218 804 164 99 213 189 174 Percentage Increase 2018 in Case Finding 210 144 616 204 735 147 75 632 135 197 178 159 160 2333% 176% 95% 141% 90% 223% 90% 101% 106% 256% 116% 1767% 109%

Lessons Learnt • The community leaders/gatekeepers were actively involved in the referral of presumptive clients to CTWs and linking them to CBOs. • Positive Impact: the CBOs integrated other project into the ACF project activities and using the medium to create awareness about TB. • Cured TB as Ambassadors invited to launch (Stakeholders) meetings made stakeholders own and support ACF intervention.

Recommendation Active case finding interventions remains effective in finding TB and therefore should be implemented in the context of a strengthened diagnostics system for optimal yield. Facilitate the airing of TB messages in local languages to address low level of awareness Engage and mobilize community structures in local TB programming, especially community mobilization and SBC activities. Expansion of diagnostic facilities (Xpert/RIF) in the intervention sites should be part of the preparatory processes.

Conclusion • The findings in the selected LGAs demonstrated the importance of community engagement to increase TB case notification • Just like the engine oil is the lifeblood of any vehicle, for any successful TB control program, community engagement remains critical.

References • Alemayehu, M. , et al (2014). Active tuberculosis case finding and detection of drug resistance among HIV-infected patients: International Journal of Mycobacteriology. • Community Systems Strengthening – Civil Society Consultation. International HIV/AIDS Alliance/ICASO; 2010. • Community System Strengthening Framework – The Global Fund 2014. • Kusimo et al (2017). Implementation of the Active TB Case Finding in Nigeria; Processes, Lessons Learnt and Recommendations