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Real-time data to inform decision-making about maintaining health services in Kenya during the COVID-19 pandemic

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The International Union Against Tuberculosis and Lung Disease (The Union) in close collaboration with the National TB Programme and the National HIV/AIDS Programme in Kenya, the Respiratory Society of Kenya (ReSoK), the Special Programme for Research and Training in Tropical Diseases at WHO (TDR) and Resolve to Save Lives, an initiative of Vital Strategies (Resolve) implemented a project at the early stage of the COVID-19 outbreak to strengthen the routine and real-time monitoring and evaluation system for TB and HIV case detection.

The quarterly (3-monthly) recording and reporting systems were strengthened in 18 selected health facilities in Nairobi, the capital city, by recording and reporting on a monthly basis. It was hypothesised that if there were declines seen in TB case detection, diagnosis and treatment as well as declines in persons presenting for HIV testing or those diagnosed HIV-positive being referred for antiretroviral therapy (ART), then programmes could act more quickly on monthly information rather than quarterly information to try and reverse these trends.

This project, which compared TB and HIV parameters during 12-months of COVID-19 with 12-months of pre-COVID-19, showed a large negative impact in the first six months on numbers presenting with presumptive TB and on numbers diagnosed with TB. There was a smaller decline in numbers being successfully treated for TB. There was also a large negative impact on numbers being HIV-tested at health facilities. This means fewer people being diagnosed and treated for both TB and HIV.

Kenya innovatively put in place interventions which in the second six months yielded increases in numbers presenting with presumptive TB, numbers being registered and diagnosed with TB, numbers successfully completing anti-TB treatment and numbers being HIV tested.

For TB case detection, the interventions included: i) integrated screening and fast tracking of investigations for TB and COVID-19 in patients presenting with respiratory symptoms; ii) active TB case finding in hot spots in the city; iii) enhanced TB case finding that included screening of TB through mobile phones using a dedicated Unstructured Supplementary Service Data (USSD) dialling code, asking patients to dial into a toll-free TB screening call centre manned by health care workers and use of automated TB screening machines positioned at strategic spots in the community; iv) active tracing of close contacts of index patients; and v) improved TB screening amongst people living with HIV.

For TB treatment, the interventions included: i) longer appointments for TB drug-pick-ups; ii) phone adherence counselling; iii) home visits for missed appointments; and iv) increased attention to reduce the outcome “not evaluated”.

For HIV testing, the interventions included: i) mobile vans for HIV testing and HIV testing of partners; and ii) use of community health volunteers to reach out to those not knowing their HIV status.  

Prof Tony Harries said “We cannot know to what extent the monthly stream of data directly led to programmatic interventions and improvements. However, it was clear that the Programme Directors and health workers at the facilities appreciated and used this regular and timely data. In pandemic / epidemic situations, real-time data is essential to respond effectively to the challenges posed by these public health crises.”

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