Finding the missing many: improving Tuberculosis care in Kajiado county through active case finding and community approaches

BackgroundTuberculosis related deaths remain a priority globally. Despite advancements in TB care, access to quality care remains inequitable to the disadvantage of those in rural and urban informal settlements. The Awareness, Traditions, and Innovation in combating Tuberculosis (ATI TB) project incorporated active case finding (ACF), use of GeneXpert technology and decentralized services to improve TB care in Kajiado County. This study sought to establish the impact of the project as well as implementation lessons learnt during its tenure in Kajiado County, Kenya.MethodsThis evaluation adopted a mixed-methods approach with retrospective cohort analysis for the quantitative data and qualitative data sought through key informant interviews with 28 purposively sampled respondents. The qualitative data was analyzed thematically using Taguette while quantitative data was analyzed using R Software yielding descriptive statistics and measures of association.ResultsWhile the males were a minority among the presumptive cases (623; 46%), they were the majority (59.3%) among the confirmed TB cases. 70% of the confirmed cases were aged between 15 and 44 years; with those aged between 25- and 34-years being majority (30% of the cases). Majority of the confirmed cases within the project were from rural Kajiado West (79; 66.9%). Though 61% of the presumptive cases were through ACF, only 7% of these tested positive. Conversely, 13% of the self-referrals tested positive. 53% (66) of the positive cases with valid data were self-referrals while ACF accounted for 47% (58) of the positives.ConclusionContinued capacity development among health workers, sustained and targeted sensitization and screening among vulnerable groups, strategic collaborations, alongside increased budgetary prioritization of health and TB care by government and partners, and government investments in Social Determinants of Health can ensure gains in TB care are sustained.a. The higher and rising incidence of TB (All forms) among the males compared to females in Kajiado highlights the need for sustained sensitization, active case finding and care for all genders but more targeted to the males in Kajiado County.b. Active Case Finding increases the potential for identification of Drug Resistant TBc. The rising cases of relapses among patients with Extra-Pulmonary Tuberculosis in Kajiado County necessitates increased attention, awareness creation, heightened sensitization on Extra-Pulmonary TB, capacity development among health workers for improved diagnosis, care, and treatment for extra-pulmonary TB alongside improved adherence for respective patients.d. The higher number of positive TB cases among the self-referrals (walk- in patients) compared to those identified via active case finding underscore the reality of unmet care needs at community level, most of which are underdiagnosed and under reported.e. Integrated and Patient centered care approaches that not only target TB but address other determinants of health (socio-cultural, economic, environmental, political) are more likely to yield better engagement, ownership, impact and sustainability.