Improved TB testing in Malawi following targeted supportive supervisions for TB LAM uptake

Title

Improved TB testing in Malawi following targeted supportive supervisions for TB LAM uptake

Presenter

Yamikani Gumulira

Authors

G. Saemisch (1), Y. Gumulira * (2), D. Telela (2), E. Matupa (2), B. Wilson (3), P. Nyasulu (3), R. Nyirenda (3), J. Mpunga (4)

Institutions

(1) Clinton Health Access Initiative, Boston, United States, (2) Clinton Health Access Initiative, HIV Access Program, Lilongwe, Malawi, (3) Ministry of Health, Department of HIV and AIDS, Lilongwe, Malawi, (4) Ministry of Health, National TB Control Programme, Lilongwe, Malawi

BACKGROUND: Tuberculosis (TB) case finding in people living with HIV (PLHIV) has been a focus of HIV programs for years. Malawi historically depended on sputum microscopy and, more recently, GeneXpert for TB diagnosis. GeneXpert improved pulmonary TB detection, however, given that significant proportions of PLHIV with TB are unable to produce sputum or have extra-pulmonary TB, TB detection remained a challenge. Although the Malawi Department of HIV and AIDS (DHA) introduced the TB lipoarabinomannan (LAM) Point of Care (POC) test in a bid to address these issues, uptake of the test remained low. Therefore, the DHA conducted tailored supportive supervision visits to improve TB LAM uptake.
DESCRIPTION: In 2018, the DHA adopted the World Health Organization recommendation that all PLHIV with CD4<200, WHO stage 3/4 or who are seriously ill, have access to TB LAM testing for TB diagnosis. By January 2021, TB LAM implementation had scaled up to 118 sites across 28 districts. Following the lifting of COVID movement restrictions, capacity building through supportive supervision visits were conducted in July 2021 utilizing a checklist/scorecard at implementation sites to identify and address uptake barriers and share TB LAM best practices with health care workers (HCWs).
LESSONS LEARNED: Malawi has seen a steady increase in the percentage of AHD patients who receive a TB LAM test since the supportive supervision visits were conducted. From January ' June 2021, sites were testing AHD patients for TB at an average of 81.4%. However, following capacity building and uptake reinforcement, the average TB testing rate increased to an average of 97.5% during July ' September 2021. In addition to the scorecard, crucial components of the supervision visits include interviews with providers, stock inventory, and review of data capturing tools.
CONCLUSIONS: Malawi was one of the first low- and middle-income countries to adopt TB LAM testing and tailored supportive supervisions have been crucial in improving TB testing. Scale up to ~300 sites is planned for 2022 to increase access to POC TB testing. National HIV and TB programmes can learn from Malawi's experience improving TB LAM uptake for PLHIV with AHD.

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