Enhanced early TB diagnosis through integrated sputum sample courier with HIV programs in six provinces in Zambia

BACKGROUND: The Ministry of Health (MoH) has made it policy that the Xpert MTB/Rif® rapid diagnostic tool is the primary TB test in Zambia, however the country has limited numbers of Xpert platforms, with 274 machines catering for, leaving a gap of access to testing services for the majority of the population. Specimen courier system implementation was fragmented by disease or program and was poorly funded without partner support but the project implemented integration of service provision.
DESCRIPTION: USAID Eradicate TB project (ETB) partnered with the MoH and the HIV program to provide an efficient integrated sputum and viral load (VL)sample transportation service utilizing the existing HIV program motorbike transportation system. With project support, the intra-district courier system for rapid diagnosis of TB for 48 Xpert MTB/Rif® testing sites, referred to as 'hubs,' supporting 187 peripheral facilities in 19 districts was integrated with the VL courier system. The samples are triple packaged by laboratory staff and maintained at 2-8^oC using ice packs. ETB enabled, transporting specimens 3- 5 times per week. The motorbike riders are trained in the required biosafety measures.
LESSONS LEARNED: A total of 40,920 sputum samples were couriered between October 2019 to September 2020; 40,542 (99%) were successfully tested with results transmitted back to the referring facilities. Laboratories recorded a 1% rejection rate due to no sample in sputum containers . The courier service also takes back hard copies of results to referring facilities within 24-48 hours enabling early treatment initiation.
CONCLUSIONS: Integration of essential services across different vertical programs provides an opportunity for enhanced access to cost effective, efficient, rapid TB diagnosis and treatment to improve outcomes. Based on this successful experience, the ETB supported MOH to formulate guidelines for integrated courier for nationwide scale up.