A step towards 2025 in the fight against TB
By Chancy Namadzunda:
The year 2020 marked the end of the 2015-2020 National Tuberculosis Control Program (NTP) strategic plan and the beginning of a New Strategic Plan (NSP) spanning from 2021 to 2025.
The objective of the NTP is to reduce the morbidity, mortality and transmission of tuberculosis until the disease is no longer a public health problem in the country, through key strategic approaches such as pursuing and improving coverage and quality of patient care; addressing TB comorbidities and key population, and strengthening supporting policies and systems.
As the 2015-2020 strategic plan walked the last mile, key achievements were registered such as the declining of TB incidence which was at 146/100,000 population (2019 WHO Global TB report) at an average rate of 7.1 percent, according to the NTP 2020 annual report.
The report further indicates that in 2020, the estimated treatment coverage was 56 percent, a total of 15,380 cases were notified during the period. Of this, 15,127 were new and relapse TB patients with case notification rate at 79/100,000.
“Treatment success rate was 88 percent for cohorts of patients enrolled in 2019, which has increased from 87 percent reported in the previous year. Death rate has been maintained at 8 percent. There were 417 TB registration sites in all the five zones. These registration sites enroll and treat TB patients. And 402 TB microscopy sites were operational by end of December 2020. The program has also expanded GeneXpert service to 89 sites (115 platforms).
“A total of 101,391 TB tests were performed. Close to 57 percent of the TB tests were performed using Genexpert. Presumptive TB cases have declined by 31 percent in 2020 compared to 2019. Tuberculosis tests performed through GeneXpert has declined by 33 percent,” reads part of the report
The year 2020 marked the last year of the New Funding Model II (NFM II) implementation period under the support of the Global Fund.
Cumulatively, the overall fund utilization rate of 98.2 percent was achieved with 63 percent of the grant used for offshore procurement of TB commodities, according to the report.
At the commencement of the new 2021-2025 NSP, NTP received US$16 million additional financing for 2021 from the World Bank.
Achievements
In an interview with The Atlas Malawi, NTP Monitoring and Evaluation Officer Dickens Chimatiro said at the end of the third quarter of 2021, the program had reported a total of 3 007 512 clients from outpatient departments representing a 7 percent increase from the same period in 2020. Additionally, a total of 23,814 presumptive TB cases were reported in quarter three of 2021, representing 18 percent increase from the same period in 2020.
In the same quarter, Chimatiro said, they registered a percentage increase in presumptive TB cases tested for TB in the laboratory from the same quarter in 2020.
“We registered notable increase in notification in some districts, a sustained performance in childhood TB notification contribution for the period at 9 percent, sustained coverage of TB and HIV service and sustained performance in contact investigation.
“On treatment outcome and treatment monitoring, there was a sustained performance in treatment success rate at 90 percent, death rate for the third quarter of 2021 was at seven percent, sustained performance on Tuberculosis Infection Control practices, improved coverage of N95 masks to 81 percent and turnaround time from screening positive to diagnosis has improved to 68.4 percent.
“Again, a total of 64 drug resistance TB patients we enrolled between January and September 2021, all patients started treatment. Between this period, there was significant progress in drug resistance TB interim patient treatment outcome.
“Again, we registered an increase in District Health Information Software (DHIS2) national reporting rate and timelines performance for case findings in TB and HIV report forms which were at 94 percent,” he said.
Challenges
Despite strides made in the fight against TB, there were also some setbacks such as registering a three percent decline in TB notifications and eternal quality assurance low coverage in the 2021 third quarter compared to the same period in 2020, Chimatiro said.
“With 7 percent death rate for the 2021 third quarter, we registered more deaths in Dowa district at 15 percent, followed by Machinga at 13 percent and Blantyre at 12 percent. More deaths were also reported among extra pulmonary tuberculosis cases. More lost-to-follow-up were reported in Nkhata Bay at 7 percent,” he said.
As a way forward, Chimatiro said there should be continued death audit, conduct operational research to assess causes of mortality in the districts that reported high death rates and review reasons for higher level of lost-to-follow-ups among smear positive TB patients.
