USING INNOVATION TO IMPROVE ACCESS TO AAFB MICROSCOPY IN UGENYA DISTRICT, KENYA
Matibabu Foundation Kenya’s (MFK) decision to establish AAFB (Alcohol Acid Fast Bacilli) microscopy in March 2010 was majorly influenced by the high TB-HIV co-infection rate in the greater Siaya district (The greater Siaya district had a total of 3 smaller districts, i.e., Ugenya, Gem and Alego), which at 70% (PTLC Nyanza-report 2010) which was almost twice the national co- infection rate of 44% and an unavailability of the service in Ugenya District – the location of the project.
By November 2010, MFK had established 9 months’ experience in AAFB microscopy with 454 tests already conducted for a total of 4 government health facilities in Ugenya district. In addition, the organization had over 2 years’ experience implementing a CDC-funded HIV project in prevention, care and treatment, and laboratory networking for HIV disease monitoring tests such as CD4/CD3, Full Haemogram and clinical chemistry for 17 health facilities in Ugenya district, conducting approximately 2,500 tests per month.However, a gap still existed in the number of clients accessing AAFB microscopy especially from other facilities that were as far as 8kms from the MFK lab, mostly due to the high transport costs. This reduced the quality of patient management, leading to death in some cases or continued spread of TB in the community as the patients were not able to submit the second sputum sample which is a requirement for conclusive AAFB microscopy results.
Following a consultative meeting with the Centers for Disease Control and Prevention (CDC), and the District Tuberculosis and Leprosy Coordinator (DTLC), MFK conducted a baseline assessment of all the government health centers in Ugenya district, during which the assessment team identified 9 out of 17 health facilities that were not capable of carrying out AAFB microscopy for Tuberculosis screening. In 2010 August the organization facilitated a sensitization session for clinicians and sample transporters from all the 9 facilities that focused on sample (sputum) collection, packaging and safe transportation to the central laboratory where they are then processed. It was after this sensitization that the TB sample transport network was officially launched in November 2010 to stop movement of clients to and from the central lab.
Other preparatory activities included procuring cooler boxes for sputum transportation, distributing them to the facilities, and developing a schedule containing specific days when the facilities would bring in their sputum samples
Sample transporters are volunteers who are facilitated to transport samples for AAFB microscopy to the central lab in MFK and documented results from the central lab to the health facility.
The In-charge of the central lab at MFK and the District Medical Laboratory Technologist (DMLT) provide monthly supportive supervision and on job training (OJT) to the clinicians and sample transporters to ensure continuous quality improvement (CQI) of the TB sample transport network.
MFK also carries out internal quality control on a daily basis and external quality assurance (EQA) on a quarterly basis. The EQA is performed by the district medical laboratory technologist in SDH for the AAFB microscopy slides in a continued effort to improve healthcare in Ugenya district.
Increased number of tests brought in for AAFB microscopy at the central laboratory (see figure 1 below)
Figure1: Number of AAFB microscopy tests carried out at the MFK lab between March 2010 and November 2011
MFK Lab Database
The above results will in the long term minimize the spread of TB and reduce the number of deaths caused by TB.
NB – The red point: Low turn- out of patients in the facilities hence few samples sent for AAFB microscopy, this was followed with a visit to the facilities by the lab in charge, held one on one meetings with the clinicians to find out the cause and it was decided that the community needed sensitization which then was implemented by the Community Health Workers hence a noticeable increase in July. TB Directly Observed Treatments were introduced to reinforce.
- The “boda boda” or motorbike transportation in the rural has proved to be a reliable and affordable way of improving access to healthcare services in a resource limited setting.
Continuous supportive supervision and OJT are a critical component of healthcare improvement.
MFK currently sends samples for multidrug resistant (MDR) and extensively drug resistant (XDR) suspects for sputum culture & sensitivity to Kenyatta National Hospital (KNH) in Nairobi; however the results take a minimum of 4 months. Having a Polymerase Chain Reaction (PCR) machine for sputum analysis at the central lab will further reduce turn-around time for these samples hence improving early diagnosis and accurate treatment of the same.