Tuberculosis Preventive Therapy (TPT) focal point strategy and its impact on TPT cascade in Nampula Province

BACKGROUND: Tuberculosis (TB) preventive therapy (TPT) is an evidence-based strategy to reduce morbidity and mortality among people living with HIV (PLHIV). In Mozambique, TPT has been recommended for PLHIV since 2007; however, uptake has been limited. In 2019, 67% of new ART patients initiated TPT nationally (Ministry of Health). In Nampula, in the same period, only 41% of new ART patients initiated TPT. ICAP supports the Provincial Health Services and 59 health facilities (HFs) in Nampula to implement TB/HIV collaborative activities.
DESCRIPTION: In June 2020, ICAP implemented a TPT focal point (TPT FP) strategy to improve TPT uptake and completion, allocating cough officers and lay counselors at 17 high volume HFs to improve TB case identification and TPT initiation and completion. ICAP developed training and support materials and monitoring and evaluation tools and designed patient and information flow. Cough officers conducted daily TB screenings in waiting areas of maternal and child health and HIV services, fast-tracking presumptive TB cases for diagnosis and identifying and referring all eligible TPT patients. The TPT FPs used a 'TB Prevention and Treatment Cascade Longitudinal Register' to monitor patients from initiation through completion and to conduct outreach to patients missing appointments as necessary. ICAP HF teams reviewed data weekly with HF management to identify gaps and to adjust the strategy as needed. We reviewed retrospective data from pre (May 2020) and post (September 2020) strategy implementation to assess TPT initiation improvements.
LESSONS LEARNED: There was an 84% (from 1,363 to 2,512) increase in the number of patients initiating TPT in the 17 HFs comparing pre and post implementation data form the 17 HF, compared with a 23% increase observed in 42 HFs with the standard of care in the same period. With intensive monitoring and notable engagement of HF staff, five of the 17 HFs had improved performance, with an increase of 263% (from 363 to 1318) during the same period.
CONCLUSIONS: Targeted interventions, including dedicated human resources and close monitoring, are essential to address gaps within the TPT cascade. ICAP will continue to closely monitor and address gaps and to expand this strategy to all supported HFs in Nampula.