HERD Team

Using Xpert to Reach the Unreached: Mobile Diagnostics Case Finding in

NepalMay 2013 – April 2015

Objectives:

To identify over 2 years an Additional cases of MTB+ (3136).

Ensure rapid diagnosis and treatment of all TB and MDR cases.

To continually monitor and reflect on case finding and referral strategies.

Aim : Contribute to NTPs aim of achieving case detection rate of 82% nationally

Project Target Areas and Districts

22 districts and 29 municipalities & cities

Kathmandu, Lalitpur, Bhaktapur, Kavre, Chitwan, Makwanpur, Parsa, Bara, Rautahat, Sarlahi, Mahottari, Dhanusha, Kaski, Rupandehi, Kapilbastu, Dang, Banke, Bardiya, Kailali, Accham, Doti and Kanchanpur

TB REACH Projects in Nepal

Major Activities by Target Population:Urban Slum: Door to Door Screening, Mobilization of urban health volunteers (UHV), Urban slum health camp, continual case finding activities

PLHA: Strong communication and coordination with VCT and ARV centres, distribution of TB/HIV IEC materials, Screening of PLHAs

Household Contacts: Identifying and recording and follow up of household contacts and screening and sputum collection

Prisoners: Screening and sputum collection

Factory Workers: Screening and sputum collection

Refugees, Monks and Nuns: Screening and sputum collection

Diabetics (In Kathmandu Valley Only): Coordination and communication with diabetic clinics, screening patients for symptoms and referring patients for microscopy

Strategies• Coordination with local RHD/DPHO/DHO and health

institutions.• Coordination with respective target groups and

populations.• Mobilization of outreach workers and volunteers• Mobilization of van.• Conduction of microscopic camps.• Case finding and referral strategies

Implementation Strategy

Case findings with the help of mobile van Gene x-pert and Regular Microscopy

Coordination with respective stakeholders•NTP•Respective D(P)HOs •TB Reach Partners •Target groups

Selection of outreach workers and volunteers

Training of outreach workers and volunteers for active case findings

Data Monitoring Flow chart cont…

VolunteerVolunteer

Screening

Identification of Symptomatics

Lab test (Microscopy and Gene X-pert

Positive cases Negative cases

Treatment and follow up Outreach workers

Location of GX Machines

Four static units with 2 module Xpert machines in

1) HERD, Kathmandu 2) Manohara Clinic, Bhaktapur3) Doti Hospital (FW) 4) Chitwan Hospital (Terai)

Two mobile van with 4 module Xpert machines .

Tools / Guide1. Screenings register

2. Monthly reporting form

3. Sputum smear request form

4. HH screening form.

5. Xpert request form

6. Xpert Register

7. Xpert users guide

8. Program guide for vulnerable population

Kit Box and supporting Materials for UHV

Gene xpert installationDHO Doti - 19 September 2013

Mobile TB Diagnostic service

Selection and Training of ORW/UHVsUrban slum Kathamandu - 21 November 2013

Kathmandu and Nepalgunj - 3 December 2013

Mahendranagar - 20 Feb. 2014

Field implementation

External M & E

Revision of TBR indicators

Kathmandu and Nepalgunj - 1 December 2013

TBR Project (Grant Period )15 February 2013 – 15 April 2015

Details Date Gap

TBR Project Case detection start ( As per application )

May 2013

Xpert received 23 July 2013 3 Months

Xpert Installation 19 September 2013 2 Months

Field Implementation start 3 December 2013 2 Months

External M& E 1 December 2013

Remaining grant period - 10 Months, No cost extension - 8 Months

Current Progress end of Baisakh 2071

TARGET Total Screening

Total Symptoma

tic

Total Microscop

y Tests

Total Microscopy Positive

Cases

Total Gene Xpert Tests

Total Gene Xpert

Positive Cases

Total Positive

Cases

Slum 37700 1788 1416 36 643 25 61

PLHIV 369 184 184 2 137 24 26

Household contacts

1982 492 479 30 145 24 54

Prisoners 1600 778 774 6 241 6 12

Factory Workers

4719 833 769 2 475 6 8

Refugees/Monasteries

2465 611 591 2 434 12 14

Diabetics 104 2 2 1 0 0 1

TOTAL 48939 4688 4215 79 2075 97 176

District wise MTB+ cases at end of Baisakh 2071

SN District Sputum smear Positive

Gene xpert Positive

Total

1 Kathmandu valley 12 50 62

2 Doti 12 24 36

3 Banke 11 10 21

4 Dang 8 6 14

5 Makwanpur 10 1 11

6 Chitwan 5 5 10

7 Dhanusa 9 0 9

8 Mahottari 4 0 4

9 Bara 3 0 3

10 Kanchanpur 2 0 2

District wise MTB+ cases at end of Baisakh 2071SN District Sputum smear

PositiveGene xpert Positive

Total

11 Kailali 0 1 1

12 Kapilbastu 1 0 1

13 Kaski 1 0 1

14 Rautahat 1 0 1

15 Rupandehi 0 0 0

16 Bardiya 0 0 0

17 Parsa 0 0 0

18 Sarlahi 0 0 0

19 Kavre 0 0 0

20 Acham 0 0 0

Total 79 97 176

TARGET Assumption Microscopy positivity Finding

AssumptionGX positivity Finding

Slum 1 % 2.54% 2.5% 3.89%

PLHIV - 1.09% 15% 17.52%

Household contacts

3.5% 6.26% 15% 16.55%

Prisoners 2% 0.78% 10% 2.49%

Factory Workers1% 0.78% 2.5% 1.26%

Refugees/Monasteries

1% 0.34% 2.5% 2.76%

Diabetics 3% - 15% -

Current Progress – end of Baisakh

Assumption base on external M& E.

Indicators of GX end of Baisakh 2070

GX Site

GX Positivity % of error

Error Types 5006/5007

% of invalid % of no result

DPHO Chitwan 41.67 18.30 12.42 2.61 0.65

DHO Doti 30.07 15.26 5.26 3.68 0.53

Van 1 4.12 5.42 4.16 2.90 0.00

Van2 4.49 9.62 3.58 2.34 0.12

HERD Lab 4.61 11.24 6.18 3.37 0.00

HERD Lab Manohara 3.29 10.33 7.85 1.24 0.41

Total 8.27 9.42 5.11 2.62 0.17

TB REACH on NEWS

What next ?

• Analysis of progress at end of 3rd trimester.• Revise working modality and discussion with

respective RHD and DHO/DPHO.