The Sunday News
Robin Muchetu, Senior Reporter
ABOUT 63 percent of the 19 500 notified cases of Tuberculosis in Zimbabwe last year were from men, with 50 percent of all tested people being HIV positive, a situation that reveals that HIV and TB co-infection remains a cause for concern.
World Tuberculosis Day is celebrated each year on 24 March, a day set aside to build public awareness about the disease and efforts to eliminate it.
However, over 3 000 people die every day from the disease globally while 1,3 million died from TB in 2022 alone.
Zimbabwe has made significant strides in revolutionising the testing and treatment of infectious diseases, with the Intensified Case Finding Stamp Strategy being implemented for key populations by the Union Zimbabwe Trust (UZT), which is an organisation that promotes innovative public health solutions by developing, implementing and evaluating Tuberculosis, lung health, and communicable disease programmes in Zimbabwe.
Dr Ronald Ncube, UZT Executive Director Stamp Strategy prompts health care providers to screen for TB when a person visits a health facility.
“The Stamp Strategy is a simple innovation adopted by the Ministry of Health and Child Care, to improve the detection of TB among clients seeking care from any health facility.
“It uses ‘guiding TB screening questions’ inscribed on a stamp (date stamp), that is stamped on client cards by a health worker manning entry points or reception areas at health facilities.
“The stamp prompts the consulting health worker to screen for TB as part of health care service delivery,” said Dr Ncube.
He said the goal of the Stamp Strategy is to ensure that more people with suggestive signs and symptoms of TB are identified and investigated for TB disease when they visit health centres for any services.
Clients found without active TB and eligible for TB Preventive Therapy (TPT) will then receive it.
“In so doing, missed opportunities in TB diagnosis and treatment as well as TPT initiation are minimised,” said Dr Ncube.
Health workers from four of eight districts supported by the United States Agency for International Development (USaid) through the Kunda-Nqob’iTB (KN-TB) programme, namely; Gwanda, Insiza, Chirumanzu and Zvishavane have since been trained on the Stamp Strategy.
“These districts were prioritised based on significant gaps noted in TB case finding and TPT uptake, despite ongoing support.
“Outside USaid-supported project areas, support has been received from the Global Fund against Aids, TB, and malaria, to introduce this innovation in priority low TB notifying districts,” he added.
Sample Stamp
Following orientation on how to use the Stamp Strategy in August 2023, Gwanda and Insiza districts collectively realised a seven percent increase (from 62 893 to 67 072), in the number of clients screened for TB after introducing the Stamp Strategy.
This resulted in a 19 percent rise in the number of TB clients identified, from 292 to 348.
Dr Ncube said the Stamp Strategy is anticipated to contribute to finding missing clients with TB, breaking the cycle of community transmission towards a shared aspiration of ending TB by 2035.
Dr Fungai Kavenga, the Acting Deputy Director Aids and TB Unit (TB Control) in the Ministry of Health and Child Care National TB and Leprosy Control Programme said 19 500 TB cases were notified in 2023, with males contributing 63 percent of the cases.
“Our TB incidence stands at 204 cases per 100 000 population. About half of the TB patients notified in 2023 were also co-infected with HIV. The proportion of childhood TB cases (below 15 years) among the total notified TB cases was six percent,” said Dr Kavenga.
He said the Ministry is targeting to screen for active TB among high-risk groups.
“This is an intervention, which ensures that TB services are taken to high-risk populations to eliminate access barriers.
“This approach was decentralised to provincial level, after being implemented for more than five years through national level and partner support.
“Each province in the country was allocated a mobile truck equipped with an X-ray machine and mobile laboratory service,” added Dr Kavenga.
The total number of TB cases diagnosed through the approach was 447.
A total of 6 105 people were tested for HIV, with 197 of them testing positive under the targeted screening for TB.
Dr Kavenga said in a bid to strengthen TB case finding among children, the national TB programme with support from partners conducted Childhood TB training for all the districts in the country targeting health care workers.
There was a rollout of new initiatives in the diagnosis and treatment of TB in children. These initiatives included the use of stool samples in the diagnosis of TB and the use of child-friendly formulations for children’s TB medicines.
Dr Kavenga, however, lamented that there were some challenges in the national TB programme.
“There is a funding gap for the national TB response (less than 50 percent is funded in the TB National Strategic Plan, and there were stockouts of key TB medicines in the third quarter of 2023. Stigma and discrimination are still happening in communities. There is a low rate of scale-up of innovations such as stool utilisation in the diagnosis of TB in children and the rollout of digital platforms use,” he said.
Dr Kavenga raised concern over the low participation of the private sector in the provision of TB diagnosis and treatment services.
Other stakeholders in the fight against TB said TB is one of the world’s leading infectious disease killers, killing over 3 000 people every day yet it is curable.
Mr Itai Rusike, Executive Director of the Community Working Group on Health said this is unacceptable.
“We know how to end TB. We have the lifesaving tools to prevent, diagnose and treat TB, but we must break down the barriers and inequities that cause millions of people to suffer and die from TB every year. The global community must act with a focused response that fights for equity and puts people and communities at the centre. This is our moment to end TB for good,” said Mr Rusike.
He said inequity is the biggest barrier to ending TB, as those living in poverty or with environmental risk factors, can face catastrophic costs to access diagnosis and treatment.
Mr Rusike said scaling up the progress in the fight against TB is crucial to winning the battle against the disease.
“We must bring focused testing, treatment and care services to the people who most need them. The Global Fund provides 76 percent of all international financing to fight TB. An all-in response to fight TB today actively contributes to building a safer, healthier and more equitable world tomorrow.
“When we fight TB, we fight other deadly diseases and prepare for the next pandemic. The same laboratory workers, diagnostic machines, supply chains, primary health care facilities, disease surveillance capabilities, and community health workers that fight TB prepare the world for future health threats,” added Mr Rusike.
Zimbabwe will host the World TB Day main celebrations at Somvubu High School in Bubi District, Matabeleland North Province. @NyembeziMu
