HERD Team
Using Xpert to Reach the Unreached:
Mobile Diagnostics Case Finding in
Nepal
May 2013 – April 2015
Aim : Contribute to NTPs aim of achieving case detection
rate of 82% nationally
Objectives:
To identify over 2 years an
Additional cases of MTB+
(3136).
Ensure rapid diagnosis and
treatment of all TB and
MDR cases.
To continually monitor and
reflect on case finding and
referral strategies.
Project Target Areas and Districts
22 districts and 29 municipalities & cities
Kathmandu, Lalitpur, Bhaktapur, Kavre,
Chitwan, Makwanpur, Parsa, Bara, Rautahat,
Sarlahi,
Mahottari,
Dhanusha,
Kaski,
Rupandehi, Kapilbastu, Dang, Banke, Bardiya,
Kailali, Accham, Doti and Kanchanpur
TB REACH Projects in Nepal
Major Activities by Target Population:
Urban Slum: Door to Door
Screening, Mobilization of urban
health volunteers (UHV), Urban
slum health camp, continual case
finding activities
PLHA: Strong communication
and coordination with VCT and
ARV centres, distribution of
TB/HIV IEC materials, Screening
of PLHAs
Household Contacts: Identifying
and recording and follow up of
household
contacts
and
screening and sputum collection
Prisoners:
Screening
and
sputum collection
Factory Workers: Screening
and sputum collection
Refugees, Monks and Nuns:
Screening and sputum collection
Diabetics (In Kathmandu Valley
Only):
Coordination
and
communication with diabetic
clinics, screening patients for
symptoms and referring patients
for microscopy
Strategies
• Coordination with local RHD/DPHO/DHO and
health institutions.
• Coordination with respective target groups and
populations.
• Mobilization of outreach workers and
volunteers
• Mobilization of van.
• Conduction of microscopic camps.
• Case finding and referral strategies
Implementation Strategy
Case findings with the help of mobile van
Gene x-pert and Regular Microscopy
Coordination with respective stakeholders
•NTP
•Respective D(P)HOs
•TB Reach Partners
•Target groups
Selection of outreach workers and
volunteers
Training of outreach workers and
volunteers for active case findings
Data Monitoring Flow chart cont…
Volunteer
Screening
Identification of Symptomatics
Lab test (Microscopy and Gene X-pert
Positive cases
Treatment and follow up
Negative cases
Outreach workers
Location of GX Machines
Four static units with 2 module Xpert machines
in
1) HERD, Kathmandu
2) Manohara Clinic, Bhaktapur
3) Doti Hospital (FW)
4) Chitwan Hospital (Terai)
Two mobile van with 4 module Xpert machines .
Tools / Guide
1. Screenings register
2. Monthly reporting form
3. Sputum smear
request form
4. HH screening form.
5. Xpert request form
6. Xpert Register
7. Xpert users guide
8. Program guide for
vulnerable population
Kit Box and supporting Materials for UHV
Gene xpert installation
DHO Doti - 19 September 2013
Mobile TB Diagnostic service
Selection and Training of ORW/UHVs
Urban slum Kathamandu - 21 November 2013
Field implementation
Kathmandu and Nepalgunj - 3 December 2013
Mahendranagar - 20 Feb. 2014
External M & E
Kathmandu and Nepalgunj - 1 December 2013
Revision of TBR indicators
TBR Project (Grant Period )
15 February 2013 – 15 April 2015
Details
Date
TBR Project Case detection
start ( As per application )
May 2013
Xpert received
23 July 2013
3 Months
Xpert Installation
19 September 2013
2 Months
Field Implementation start
3 December 2013
2 Months
External M& E
1 December 2013
Remaining grant period - 10 Months,
No cost extension 8 Months
Gap
Current Progress end of Baisakh 2071
TARGET
Total
Total Gene
Total
Total
Total
Total
Microscop Total Gene Xpert
Symptoma Microscop
Positive
Screening
y Positive Xpert Tests Positive
tic
y Tests
Cases
Cases
Cases
Slum
37700
1788
1416
36
643
25
61
PLHIV
369
184
184
2
137
24
26
Household
contacts
1982
492
479
30
145
24
54
Prisoners
1600
778
774
6
241
6
12
Factory
Workers
Refugees/
Monasteri
es
4719
833
769
2
475
6
8
2465
611
591
2
434
12
14
Diabetics
104
2
2
1
0
0
1
48939
4688
4215
79
2075
97
176
TOTAL
District wise MTB+ cases at end of Baisakh 2071
SN
District
Sputum smear
Positive
Gene xpert
Positive
Total
1
Kathmandu valley
12
50
62
2
Doti
12
24
36
3
Banke
11
10
21
4
Dang
8
6
14
5
Makwanpur
10
1
11
6
Chitwan
5
5
10
7
Dhanusa
9
0
9
8
Mahottari
4
0
4
9
Bara
3
0
3
10
Kanchanpur
2
0
2
District wise MTB+ cases at end of Baisakh 2071
SN
District
Sputum smear
Positive
Gene xpert
Positive
Total
11
Kailali
0
1
1
12
Kapilbastu
1
0
1
13
Kaski
1
0
1
14
Rautahat
1
0
1
15
Rupandehi
0
0
0
16
Bardiya
0
0
0
17
Parsa
0
0
0
18
Sarlahi
0
0
0
19
Kavre
0
0
0
20
Acham
0
0
0
Total
79
97
176
Current Progress – end of Baisakh
Finding
Assumption
GX positivity
Finding
1%
2.54%
2.5%
3.89%
-
1.09%
15%
17.52%
3.5%
6.26%
15%
16.55%
2%
0.78%
10%
2.49%
1%
0.78%
2.5%
1.26%
Refugees/Monaste
ries
1%
0.34%
2.5%
2.76%
Diabetics
3%
-
15%
-
Assumption
Microscopy positivity
Slum
PLHIV
TARGET
Household
contacts
Prisoners
Factory Workers
Assumption base on external M& E.
Indicators of GX end of Baisakh 2070
Error Types
5006/5007
GX Site
GX Positivity % of error
% of invalid % of no result
DPHO Chitwan
41.67
18.30
12.42
2.61
0.65
DHO Doti
30.07
15.26
5.26
3.68
0.53
Van 1
4.12
5.42
4.16
2.90
0.00
Van2
4.49
9.62
3.58
2.34
0.12
HERD Lab
4.61
11.24
6.18
3.37
0.00
HERD Lab
Manohara
3.29
10.33
7.85
1.24
0.41
Total
8.27
9.42
5.11
2.62
0.17
TB REACH on NEWS
What next ?
• Analysis of progress at end of 3rd trimester.
• Revise working modality and discussion with
respective RHD and DHO/DPHO.