Public-Private Mix (PPM) Interventions to Find the Missing People with TB in Kenya

The National TB Prevalence Survey (2016) showed that close to 50% of Kenya’s Tuberculosis (TB) cases go undetected and untreated. Health facilities in the private sector contribute significantly to the missing TB cases since 42% of patients with TB symptoms first seek care from private providers.

The high number of missing people with TB remains a great challenge to ending TB in Kenya as transmission continues in the community unabated. If not treated, one person with TB can infect 10 to 15 people in a year. Without proper treatment, up to two-thirds of people with TB will die. Many in the community with non-severe TB symptoms do not seek medical care or opt to purchase over the counter prescriptions. This makes it necessary to strengthen TB diagnosis where they first seek these services e.g. chemists and pharmacies.

To address this, Amref Health Africa through the Global Fund TB project in partnership with the National Tuberculosis, Leprosy and Lung Disease Program (NTLD-Program) and Population Services Kenya (PS Kenya), is on a mission to find the missing people with TB through the Public-Private Mix (PPM) approach.

Targeting private health facilities not previously offering TB services, the interventions are aimed at strengthening the contributions of small private clinics, chemists/pharmacies, parastatal/institution clinics, company clinics, mission dispensaries, nursing homes and standalone laboratories in finding people with TB.

The PPM initiative is engaging both formal and informal private health providers to carry out TB screening to all patients visiting the facilities, testing all those presumed to have TB and ensuring the referral of those found to have TB. The interventions being implemented include training of health care workers on TB screening, diagnosis and treatment, establishments of a linkage system between private facilities, diagnostic sites and treatment sites, provision of sample collection and transport mechanisms, on the job training and ongoing support supervision.

These interventions are being implemented in eight selected urban settings: Garissa, Ngong, Thika, Kisumu, Changamwe and Jomvu in Mombasa, Embakasi East and West in Nairobi, Naivasha and Kilifi.

The recommended first test for TB in Kenya is the GeneXpert, a highly sensitive molecular diagnostic tool. All facilities engaged on the PPM initiative are linked to a facility with a GeneXpert machine and provided with sample collection equipment. A motorcycle rider has also been engaged in each urban centre to help transport samples to the central facility for testing.

By the end of October 2019, 3,686 people had been screened for TB in these facilities and 389 had signs and symptoms of TB. All samples were tested for TB using the GeneXpert technology; 21 of them tested positive for TB and the clients were initiated on treatment.