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HERD Team
Using Xpert to Reach the Unreached: Mobile Diagnostics Case Finding in
NepalMay 2013 – April 2015
Objectives:
To identify over 2 years an Additional cases of MTB+ (3136).
Ensure rapid diagnosis and treatment of all TB and MDR cases.
To continually monitor and reflect on case finding and referral strategies.
Aim : Contribute to NTPs aim of achieving case detection rate of 82% nationally
Project Target Areas and Districts
22 districts and 29 municipalities & cities
Kathmandu, Lalitpur, Bhaktapur, Kavre, Chitwan, Makwanpur, Parsa, Bara, Rautahat, Sarlahi, Mahottari, Dhanusha, Kaski, Rupandehi, Kapilbastu, Dang, Banke, Bardiya, Kailali, Accham, Doti and Kanchanpur
TB REACH Projects in Nepal
Major Activities by Target Population:Urban Slum: Door to Door Screening, Mobilization of urban health volunteers (UHV), Urban slum health camp, continual case finding activities
PLHA: Strong communication and coordination with VCT and ARV centres, distribution of TB/HIV IEC materials, Screening of PLHAs
Household Contacts: Identifying and recording and follow up of household contacts and screening and sputum collection
Prisoners: Screening and sputum collection
Factory Workers: Screening and sputum collection
Refugees, Monks and Nuns: Screening and sputum collection
Diabetics (In Kathmandu Valley Only): Coordination and communication with diabetic clinics, screening patients for symptoms and referring patients for microscopy
Strategies• Coordination with local RHD/DPHO/DHO and health
institutions.• Coordination with respective target groups and
populations.• Mobilization of outreach workers and volunteers• Mobilization of van.• Conduction of microscopic camps.• Case finding and referral strategies
Implementation Strategy
Case findings with the help of mobile van Gene x-pert and Regular Microscopy
Coordination with respective stakeholders•NTP•Respective D(P)HOs •TB Reach Partners •Target groups
Selection of outreach workers and volunteers
Training of outreach workers and volunteers for active case findings
Data Monitoring Flow chart cont…
VolunteerVolunteer
Screening
Identification of Symptomatics
Lab test (Microscopy and Gene X-pert
Positive cases Negative cases
Treatment and follow up Outreach workers
Location of GX Machines
Four static units with 2 module Xpert machines in
1) HERD, Kathmandu 2) Manohara Clinic, Bhaktapur3) Doti Hospital (FW) 4) Chitwan Hospital (Terai)
Two mobile van with 4 module Xpert machines .
Tools / Guide1. Screenings register
2. Monthly reporting form
3. Sputum smear request form
4. HH screening form.
5. Xpert request form
6. Xpert Register
7. Xpert users guide
8. Program guide for vulnerable population
Kit Box and supporting Materials for UHV
Gene xpert installationDHO Doti - 19 September 2013
Mobile TB Diagnostic service
Selection and Training of ORW/UHVsUrban slum Kathamandu - 21 November 2013
Kathmandu and Nepalgunj - 3 December 2013
Mahendranagar - 20 Feb. 2014
Field implementation
External M & E
Revision of TBR indicators
Kathmandu and Nepalgunj - 1 December 2013
TBR Project (Grant Period )15 February 2013 – 15 April 2015
Details Date Gap
TBR Project Case detection start ( As per application )
May 2013
Xpert received 23 July 2013 3 Months
Xpert Installation 19 September 2013 2 Months
Field Implementation start 3 December 2013 2 Months
External M& E 1 December 2013
Remaining grant period - 10 Months, No cost extension - 8 Months
Current Progress end of Baisakh 2071
TARGET Total Screening
Total Symptoma
tic
Total Microscop
y Tests
Total Microscopy Positive
Cases
Total Gene Xpert Tests
Total Gene Xpert
Positive Cases
Total Positive
Cases
Slum 37700 1788 1416 36 643 25 61
PLHIV 369 184 184 2 137 24 26
Household contacts
1982 492 479 30 145 24 54
Prisoners 1600 778 774 6 241 6 12
Factory Workers
4719 833 769 2 475 6 8
Refugees/Monasteries
2465 611 591 2 434 12 14
Diabetics 104 2 2 1 0 0 1
TOTAL 48939 4688 4215 79 2075 97 176
District wise MTB+ cases at end of Baisakh 2071
SN District Sputum smear Positive
Gene xpert Positive
Total
1 Kathmandu valley 12 50 62
2 Doti 12 24 36
3 Banke 11 10 21
4 Dang 8 6 14
5 Makwanpur 10 1 11
6 Chitwan 5 5 10
7 Dhanusa 9 0 9
8 Mahottari 4 0 4
9 Bara 3 0 3
10 Kanchanpur 2 0 2
District wise MTB+ cases at end of Baisakh 2071SN District Sputum smear
PositiveGene xpert Positive
Total
11 Kailali 0 1 1
12 Kapilbastu 1 0 1
13 Kaski 1 0 1
14 Rautahat 1 0 1
15 Rupandehi 0 0 0
16 Bardiya 0 0 0
17 Parsa 0 0 0
18 Sarlahi 0 0 0
19 Kavre 0 0 0
20 Acham 0 0 0
Total 79 97 176
TARGET Assumption Microscopy positivity Finding
AssumptionGX positivity Finding
Slum 1 % 2.54% 2.5% 3.89%
PLHIV - 1.09% 15% 17.52%
Household contacts
3.5% 6.26% 15% 16.55%
Prisoners 2% 0.78% 10% 2.49%
Factory Workers1% 0.78% 2.5% 1.26%
Refugees/Monasteries
1% 0.34% 2.5% 2.76%
Diabetics 3% - 15% -
Current Progress – end of Baisakh
Assumption base on external M& E.
Indicators of GX end of Baisakh 2070
GX Site
GX Positivity % of error
Error Types 5006/5007
% of invalid % of no result
DPHO Chitwan 41.67 18.30 12.42 2.61 0.65
DHO Doti 30.07 15.26 5.26 3.68 0.53
Van 1 4.12 5.42 4.16 2.90 0.00
Van2 4.49 9.62 3.58 2.34 0.12
HERD Lab 4.61 11.24 6.18 3.37 0.00
HERD Lab Manohara 3.29 10.33 7.85 1.24 0.41
Total 8.27 9.42 5.11 2.62 0.17
TB REACH on NEWS
What next ?
• Analysis of progress at end of 3rd trimester.• Revise working modality and discussion with
respective RHD and DHO/DPHO.