March 24th, 2022: Amref Health Africa is joining the world to commemorate World TB Day, which takes place every March 24 of every year, under the theme ‘Invest to End TB. Save Lives. This year’s commemoration builds on previous efforts by various National Governments to invest resources to ramp up the fight against TB and achieve the commitments to end TB made by global leaders. The commemoration comes amidst renewed efforts to fight the spread of the COVID-19 pandemic that has put End TB progress at risk and to ensure equitable access to prevention and care in line with WHO’s drive towards achieving Universal Health Coverage.
TB remains the world’s most deadly infectious disease; it claims more than a million lives each year and affects millions more, with enormous impacts on families and communities. TB is the second leading infectious killer after COVID-19 and the 13th leading cause of death worldwide. It was also the leading killer of people with HIV and a major cause of deaths related to antimicrobial resistance. In 2020, an estimated 9.9 million people fell ill with TB worldwide while 1.5 million people died from TB. In 2019, there were an estimated 208,000 TB related deaths among people living with HIV (PLHIV) globally, accounting for approximately one-third of all HIV-related deaths.
According to World Health Organization (WHO) report published in 2020, Tanzania is one of the 30 countries with the highest burden of tuberculosis (TB) in the world. Under this year’s theme “Invest to End TB, Save Lives”, Amref will continue to work with its main partners CDC, USAID, and Global Fund to support the United Republic of Tanzania to attain the WHO End TB Strategy which aims to end the global TB epidemic by 2035, reducing global TB incidence and mortality rates by 90% and 95%, respectively.
Amref Health Africa Interventions to End TB in Tanzania.
Amref Health Africa in Tanzania joins the Ministry of Health to commemorate the great steps it has made towards ending Tuberculosis (TB) in Tanzania. Amref Health Africa in Tanzania collaboration with various partners including the government under the National TB and Leprosy Programme (NTLP) and NGOs implement three major projects that support the country’s efforts to end TB by 2035 through a robust community based approach for vigorous new TB case finding and diagnosis at the community level, strengthen referral to TB treatment, tracking TB defaulters; as well as TB/HIV collaborative approach at health facilities.
Community health systems strengthening approach to improve New TB case finding: This is one of the most effective approaches, which have been implemented by Amref within 16 regions of Tanzania Mainland and Zanzibar. The first eight regions include Dodoma, Mara, Simiyu, Tanga, Kagera, Mbeya, Ruvuma, and Shinyanga, which are supported by Amref Health Africa in Tanzania through its three years (2021-2023) Global Fund HIV/TB project in collaboration with the Management and Development for Health (MDH) as a sub-recipient.
The other 8 regions which include Kigoma, Katavi, Songwe, Rukwa, Mwanza, Geita, Pwani and Dar es Salaam and two Zanzibar Island regions are supported by Amref Health Africa in Tanzania through a five-year (2020-2025) USAID “Afya Shirikishi” project in collaboration with three other local NGOs namely; the Tanzania Communication and Development Center (TCDC); Service Health and Development for People Living Positively with HIV/AIDS (SHDEPHA + Kahama and Mwitikio wa Kudhibiti Kifua Kikuu na Ukimwi Tanzania (MKUTA).
Through these two projects, Amref and its partners have been able to train over 2,000 Community Health Workers (CHWs) who conduct community sensitization on TB, systematic TB screening, TB contact tracing, and TB treatment defaulter tracing. This community based approach also engages over 900 Accredited Drug Dispensing Outlets (ADDOs) and Traditional healers, who are linked with CHWs to strengthen referral systems among their clients. The project also supports TB diagnostic services by supporting over 200 Motorcyclists for sputum sample transportation, from community TB screening activities and lower-level health facilities to GeneXpert sites. This has seen an increase of 51% of TB notified cases being contributed from community referrals, 56% being bacteriologically confirmed TB cases attained in 2021.
Through the Ministry of Health Mobile Van for TB screening, the Global Fund project was able to contribute to 1,676 TB cases out of 8,573 TB cases (20%) notified through Mobile Van Campaigns. TB/HIV collaborative approach: a robust TB/HIV program is being implemented by Amref Health Africa in Tanzania through its five years (2018-2023) Afya Kamilifu project, supported from US PEPFAR through US Center for Disease Control (CDC) in Tanzania; whose implementation started in 2018. Amref Health Africa in Tanzania works jointly with the University of Maryland Baltimore (UMB) and Tanzania Communication and Development Center (TCDC) in implementing the Afya Kamilifu project. Working with the central and local government, the Afya Kamilifu project is being implemented in Tanga, Mara, and Simiyu regions in mainland Tanzania as well as Unguja and Pemba in isles of Zanzibar.
The project aims at ending HIV-associated TB among PLHIV through the implementation of a combination of strategies: high index of clinical suspicion, early detection, and treatment of TB, comprehensive HIV testing among patients with TB symptoms, widespread ART coverage, TB preventive treatment (TPT), and effective infection prevention and control (IPC). The Afya Kamilifu project has successfully screened at least 95% of its over 150,000 PLHIV served in the 3 regions of Tanzania and the isles of Zanzibar. The project helps to prevent TB cases and to ensure that those that have contracted TB are initiated on treatment according to the NTLP guidelines. The PLHIV who are negative for TB, are being supported to start Isoniazid Prevention Therapy (IPT). The project has also strengthened the Laboratory TB diagnosis services through training clinicians and lab staff on diagnosis, management, and treatment of TB in all four supported regions.
Covid19 Response Mechanism:
Amref Health Africa in Tanzania recognizes TB and COVID-19 symptoms may overlap, and patients may be co-infected. The project ensures that TB and COVID19 symptom screening algorithms and infection prevention and control procedures are being implemented at all facilities and community settings. Amref Health Africa in Tanzania under its Global Fund and Afya Kamilifu projects ensures PLHIV at community and health facilities are routinely evaluated for TB & COVID-19 symptoms and being encouraged to get COVID- 19 vaccination. From October to March 13, 2022, a total of 77,900 (70%) of people living with HIV were fully vaccinated (Tanga 79%, Simiyu 59%, Mara 66%, and Zanzibar 97%) while 110,805 (92%) received at least one dose. During the same period, a total of 4,403 (76%) health care workers in supported facilities are fully vaccinated (Tanga 84%, Simiyu 89%, Mara 67%, Zanzibar 69%) while 4,895(84%) received at least a single dose. All (100%) community health workers in these supported regions are fully vaccinated.
Speaking during the World TB Day commemorations, Dr Aisa Muya, Director of Programmes at Amref Health Africa in Tanzania noted that there is a need to intensify TB case finding using effective HIV case finding, TB prevention as well as optimize TB/HIV care and treatment. “We will continue to work closely with the Local Governments in the Mainland and Zanzibar while engaging, all stakeholders in the fight against TB, and collectively work towards achieving the national and international goals of eradicating TB by 2035,” she said.
She urged the government and all other stakeholders to include TB in their strategies and plans, and invest more in TB programmes, which are important steps to accelerate the eradication of the infectious disease by 2035.
ABOUT AMREF HEALTH AFRICA TANZANIA
With the focus to reach and works with the most vulnerable African communities to achieve lasting health change, Amref Health Africa has been active in Tanzania since 1957 and in 1987 the country office was established in Dar es Salaam. Since then, Amref Health Africa in Tanzania has been among the major supporters of the Government of Tanzania’s health care initiatives particularly the Ministry of Health, and President Office Region Authority and Local Government. Amref has supported the development of a number of national health policies, strategies, and guidelines for equitable health service delivery.
Currently, Amref Health Africa in Tanzania implements over 15 active projects across different regions in Tanzania. Amref’s projects are categorized into four main thematic areas: Reproductive, Maternal, Newborn Child and Adolescent Health (RMNCAH); Disease Control and Prevention (DCP) program which comprises of HIV and AIDS, Tuberculosis (TB), Laboratory Services, Obstetric Fistula, Water, Sanitation and Hygiene (WASH) and Capacity Building Program. Amref Health Africa’s approach has mainly been community-based services reaching needy communities whereby the majority are women (54.0%) and children (37.5%).
Amref Health Africa in Tanzania’s projects responds to national health priorities and sustainable development goals (SDGs) in addressing the needs of needy communities mostly women and children. We work to increase the effectiveness, efficiency, and sustainability of health services by strengthening health systems, improving access to services, advocating stronger community health systems, and influencing health policies. With the 2018-2022 strategy, Amref Health Africa in Tanzania remains a strong supporter of the Universal Health Coverage Agenda.