Background: TB in Zambia
Zambia has the ninth highest TB incidence worldwide (433/100,000) with particularly high risk of infection in specific sub-groups such as HIV infected persons, pregnant women, children and prisoners. The high HIV prevalence of 14.3% countrywide and 22% in the capital, Lusaka continues to fuel the TB epidemic with WHO estimating that 70% of Zambian TB patients are infected with HIV. TB is a leading cause of death among HIV-infected persons.
Goals of CIDRZ TB program
The focus of the CIDRZ TB Team is twofold:
Service activities: collaboration with the Zambian Ministry of Health (MoH) to improve care for TB/HIV co-infected patients and scale-up TB/HIV care and integration activities in Lusaka, Eastern, Western and Southern provinces.
Research Activities: operations and clinical research to determine optimal methods of prompt and accurate diagnosis and treatment of TB infection, especially in high risk populations
TB Service Activities
Improving TB diagnosis and clinical care in HIV-infected patients: CIDRZ provides training in TB diagnosis and clinical management of co-infected patients through didactic trainings as well as one-on-one mentoring for doctors, clinical officers and nurses. CIDRZ provides support for laboratory diagnosis of TB through equipment provision and external quality assurance. Infection control in facilities to prevent transmission of TB in HIV care settings has been strengthened through training of health care workers .
HIV Diagnosis in TB-infected patients: Provider-initiated Testing and Counseling (PIT is being implemented in TB clinics in order to diagnose and refer HIV-infected TB patients to HIV Care and Treatment clinics.
Systems development & implementation: Referral and communication systems between the vertical TB and HIV programs were established to facilitate and monitor appropriate co-management of patients infected with both TB and HIV. The team conducts follow-up visits and organizes workshops with health care staff to ensure the functioning of the systems.
Training: In partnership with the MOH, CIDRZ offers training to district health staff regarding TB/HIV integration and encourages task shifting to counter current health care worker shortages.
Community: Improving community understanding of the interaction between TB and HIV, including social and cultural issues around TB/HIV co-infection is an important focus. This is occurring through community sensitization meetings, street theater performances and distribution of educational materials.
Enhancing TB Services in Zambian Prisons: Prisoners are a neglected population at high risk for both TB and HIV infection. The TB team works in 3 of the country’s largest prisons providing TB screening and referral for both TB and HIV care and treatment. Further expansion to other prisons is expected to occur in 2011. (TB Reach Initiative, Stop TB partnership / WHO)
- Implementation of TB Screening in Mother & Child Health clinics: TB screening is not routinely carried out in this population and is therefore likely under-diagnosed. Pilot clinics are being implemented to determine the feasibility of routine screening in this population.
TB Laboratory Services
In August 2007, the CIDRZ TB laboratory was established at the CIDRZ Central Laboratory in Kalingalinga to provide microbiology-based TB diagnostics. The present specimen processing and culture laboratory at CIDRZ meets the requirements set for BSL2 plus (in main lab) and BSL 3 laboratories in a containerized unit. External quality assessment for microbiology is provided by multiple organizations: UK NEQAS, INSTAND e. V and CAP. This unit is equipped with four Class II microbiological safety cabinets, two MGIT 960 automated culture instrument, a BACTEC 120 Blood Culture system, three refrigerated centrifuges, one Memmert Incubator, two light and two fluorescence microscopes. Molecular techniques (line probe assay) are employed for detecting M. tuberculosis complex with simultaneous screening of Isoniazid and Rifampicin resistance directly from positive sputum smears. The same techniques are used to identify clinically relevant mycobacterial species (mycobacteria other than tuberculosis) identification. With the given space, equipment and staffing the lab can run 16,000-18,000 liquid and solid cultures per year.