Infection Control in Tanzania

Dr. Peter C. Mgosha (MPH,)MINISTRY OF HEALTH AND SOCIAL WELFARE

NATIONAL AIDS COTROL PROGRAMMEP.O.BOX 11857

DAR Es SALAAM TANZANIA

Out line Presentation

• Tanzania profile

• Background

• TB/HIV notification

• TB/HIV Achievements

• Strategies for TB infection control

Tanzania profile

• One of the 3-5 East African Countries• Population: 38.7m (38,710,723)

Above 15 yrs: 21.7m (21,710,169)Under 5 yrs: 7.2 m (7,215,011)

Background: HIV fueling TB epidemic in Tanzania

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5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

55,000

60,000

65,000

70,000

19

79

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year

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Smear + Smear - Extra-P Relapse Return Failure Other

Source: NTLP, 2008

41%

50%

96%

64%

33%

26%

53%

46%

93%

63%

69%

20%

59%

44%

95%

65%

78%

28%

67%

43%

97%

70%

78%

31%

81%

40%

96%

73%

85%

30%

0%

20%

40%

60%

80%

100%

120%

Tested HIV HIV + Ref.CTC Reg.CTC CPT ARV

TB/HIV notification - Tanzania2-3-4 Quarter 2007 and 1-2 Quarter 2008

2nd qtr 07 3rdqtr 07 4th qtr 07 1st qtr 08 2nd qrt 08

Cumulative notified TB cases…………….Cumulative TB/HIV cases……….Started CPT ………Started ART ………

Achievements

o Scaling-up started in 2005o Service mechanisms based on pilot siteso Recording and reporting systemo TB manuals have been reviewedo Training materials developedo Needs assessment tool developedo TB/HIV policy developedo ARV provision in TB clinics is a keyo TB screening tool to all PLHA developed and is in use

Achievement cont….

– Basic TB/HIV activities• DCT(PITC)-81%• Referral of patients• Recording and reporting• Screening of TB from HIV services

– Provision of ARV in TB clinic• One Dar es Salaam based district (Temeke)• 10 districts under CDC support• 45 districts in GF-ATM round 3 support• 36 districts in GF-ATM round 6 support

Achievements cont…

• 25 districts until Dec, 2006

• By July, 2007, 70 districts

• By June, 2008, TB/HIV activities covered the whole country TB/HIV officers recruited

• Community involvement-(Post TB cases club; MUKIKUTE-Temeke)

The infection control StrategiesBased on : A: Administrative measures

• Assigning responsibility for TB infection control in the setting

• Conducting a TB risk assessment of the setting

• Developing and instituting a written TB infection control plan to ensure prompt detection, airborne precautions

• Treatment of persons who have suspected or confirmed TB disease

• Ensuring the timely availability of recommended laboratory processing, testing, and reporting of results to the ordering physician

A: Administrative control Measures cont….

• Implementing effective work practices for the management of patients with suspected or confirmed TB disease

• Ensuring proper cleaning and sterilization or disinfection of potentially contaminated equipment

• Training and educating health facility staff (HFS) and evaluating HFS who are at risk for TB disease or who might be exposed to M. tuberculosis

• Using appropriate signage advising respiratory hygiene and

cough etiquette and coordinating efforts with the council health management teams and regional health management teams

B: Environmental Control Measures

Ventilation patterns: • Windows and doors are routinely kept open and any

ventilation produced by the fans are usually directed to the air flow outside the waiting room throughout the windows and the doors.

• Open areas are dedicated to be waiting rooms

C: Personal protection• Personal Respiratory Protection- HCW encouraged to wear N-95

respirator any time entering the MDR TB ward; respirators have to closely fit to the face to prevent leakage around the edges

• Baseline TB screening- To prevent the occupational risk, regular TB screening of HCW is a recommended activity especially for certain health categories particularly exposed to active TB cases. e.g. CTC

• HCW identified as having active TB disease should be removed from the unit where they are providing service, regardless of the type of department

• Provider initiated counselling and testing (PICT)

• Occupational HIV exposure and post exposure management

C: Personal protection cont…

• Disinfectants and waste management are usually maintained to all H/C Departments

• Encouraging laboratories to have at least two rooms, one for reception and the other one for performing the test.

• The preparations should be performed in a well ventilated room with sunlight.

• Laboratory safety precautions of handling specimen-wear gloves, wearing laboratory coats should be

followed.

C: Personal protection cont…

• TB Lab (e.g. Muhimbili National Hospital) smear, culture and Drug Susceptibility test (DST) are performed in a safety cabinet class II with double/single filter.

• Culture media, sputum containers and glass slides are autoclaved or burned in the incinerator prior to disposal.

Challenges• Suboptimal TB infection control at HF (suboptimal early identification of

TB suspects, separation of TB suspects/cases, cough hygiene education , room ventilation)

• Absence of TB infection control plan of the HF

• Low awareness on TB infection control among HCW

• Shortage of HR

• Stigma

• Lack of national TB IC guideline/SOP and training Package

• Absence of IPT guideline/SOP

Way-forward• Developing TB IC national guidelines/SOP

• Developed TB IC training package

• Developed TB IC posters targeted to HCWs

• Developed Cough Hygiene posters targeted to patients

- Developing IPT guideline/SOP

• Recruiting more TB/HIV officers to coordinate TB/HIV collaborative activities in districts

MATERIAL AVAILABLE