Kenya (Project Closed in September 2013)
Population: 38.9 Million Total TB cases notified (2012): 89568 Treatment Success Rate for new smear-positive and/or culture-positive (2011): 88%
Kenya is situated in the eastern part of the African continent. According to the 2009 Population Census report, the country is divided into 8 provinces and 158 districts and has a population of 38.9 Million people. The TB program has 12 Operational zones (by sub dividing four of the largest provinces into 8) and 215 TB operational districts to facilitate TB Control activities in Kenya. It has a total area of 582,646 square kilometers of which 571,466 square kilometers form the land area. The Kenyan economy is predominantly agricultural with a strong industrial base.
Kenya is one of the 22 high TB burden countries and is ranked 13th according to the WHO Global Tuberculosis Report 2010. The Government of Kenya (GOK) is implementing all the six components of STOP TB strategy which have been further divided into 15 thematic areas in the 2011-2015 National strategic Plan. During the year 2010, 106,083 patients were notified (all forms of tuberculosis) representing a 4% decrease compared to the 110,065 cases reported in 2009. The high burden of tuberculosis has mainly been attributed to the high prevalence of HIV, now estimated at 7.1% for the general population. According to 2010 data, 41% of tuberculosis patients had HIV co-infection. In 2010, a total of 112 MDR TB cases were identified and notified to the WHO. By the end of 2010, the country had cumulatively initiated 180 patients on treatment with 70 of them being initiated within the year. DR TB expected to rise over the years. The actual burden will be better understood after the planned Drug Resistance Survey (DRS) and TB prevalence survey to be conducted in 2012. Tuberculosis treatment success rate for the 2009 cohort is 85.5% for new smear positive pulmonary TB cases (n = 37,402). The case detection rate (TB all forms) is 85% as reported in the WHO 2010 Global report. Kenya attained the global TB control targets (70/85) in 2007. These successes can be attributed to the fairly well developed essential health care infrastructure including the laboratory network; 1,538 AFB microscopy centers translating to one microscopy center per 26,000 persons and 2,818 treatment centers, a trained health workforce that has integrated tuberculosis case detection and management, monthly supportive supervisions and quarterly review meeting. The care for tuberculosis patients is among the elements of essential health package delivered at all levels of health care, and incorporates both the private and public health sectors. Kenya’s TB control program has relatively good number and mix of human resource. In total 297 Health professionals are deployed by the GOK to be engaged in TB control program including 46 at national, 36 at provincial and 215 at district level technically reporting to Division of Leprosy, TB, and other lung disease (DLTLD). A total of 155 District Medical Laboratory technicians are participating in quarterly External Quality Assessment (EQA) at district level. In addition to these staff, DLTLD has also recruited 115 lab personnel, 5 technical staffs at national level and 50 medical assistances deployed in districts with the support of Global Fund and other partners. The TB treatment service at health facility is fully integrated in the general health services with a designated DOTs clinic.
Handover of a GeneXpert machine to Coast Provincial Hospital one of three provided to Coast Province - Kenya
The HIV/AIDS Situation
The high burden of tuberculosis has mainly been attributed to the high prevalence of HIV, estimated at 6.2% from Sentinel surveillance in 2010. According to 2010 annual report of DLTLD, 41% of notified tuberculosis patients had HIV co-infection. Approximately 17% of all notified cases were referred from HIV testing, care and treatment sites. HIV testing of TB patients has been reported to be 91% in 2010. By the end of 2010, about 99% of all HIV infected TB patients had been put on CPT and the national ART uptake rose to 47 % from the previous year’s 34%. Through the introduction of Prevention with Positives (PwP), about 25% of HIV positive TB patients’ sexual partners were invited and tested for HIV. Implementation of IPT is limited to selected settings. DLTLD in collaboration of Partners including TB CARE I developed draft IPT recording and reporting tools to start routine reporting to national level.
TB CARE I Kenya
The main roll of TB CARE I/Kenya is providing operational support to the DLTLD with need based technical oversight. KNCV Tuberculosis Foundation is a lead partner in Kenya coordinating its collaborating partners namely MSH, FHI 360 and ATS. Additionally, there are two implementing partners, KAPTLD and KANCO sub-contracted by KNCV. TB CARE I is being used as an additional plat form to coordinate activities of the NTP by involving all stakeholders in its Partners meetings.
Key Areas of Focus in Year 2 Work Plan of TB CARE I
TB CARE I is designed to support the implementation of the NTP’s five years’ Strategic Plan (2011 – 2015) by aligning TB CARE I activities to the priority TB Control activities of the GOK. During APA 2, the project will focus in all the 8 technical areas of TB CARE I with a main focus on Health systems and Monitoring & Evaluation: 1. Universal and Early Access 2. Laboratories 3. Infection Control 4. Programmatic Management of Drug Resistant TB (PMDT) 5. TB/HIV 6. Health System Strengthening (HSS) 7. Monitoring & Evaluation, Operations Research and Surveillance 8. Drug Supply and Management