Tackling Tuberculosis in Megacities

In Tanzania, tuberculosis (TB) is the third major cause of disease and death after malaria and HIV/AIDS, and the country is one of the 22 high-TB burden countries in the world. Apart from other factors such as poverty and the HIV epidemic, the lack of a fast, efficient and simple TB diagnostic method is the main reason for the fast spread of tuberculosis.

APOPO started its second-line TB screening program in mid-2008 after the successful completion of the proof of principle study. Second-line screening means sputum samples are screened primarily at the diagnostic facilities of TB clinics and then screened for the second time by trained rats. Sputum samples that were negative at the TB clinics diagnostic laboratory but found positive by the trained rats are confirmed at APOPO’s diagnostic laboratory. The confirmed results are sent back to the respective TB clinics for patient tracking, treatment and follow up.

Dar es Salaam contributes more than 20% of the Tanzanian national TB burden and APOPO utilizes its innovative detection technology for the containment of the deadly disease in this emerging African megacity. The second-line screening program started with four TB clinics and rapidly expanded to currently serve fourteen. A TB detection rat can screen 40 sputum samples in just seven minutes, which is equal to what a skilled lab technician would handle in a full day’s work. Because the rats can screen hundreds of samples in a single day, APOPO will seek for further expansion with the goal of covering all 62 TB diagnostic centers in Dar es Salaam.

APOPO’s rats detected thousands of TB patients who were initially diagnosed negative in the TB clinics. As every untreated patient can infect 10 to 15 other people per year, APOPO’s intervention had a major multiplication effect on preventing TB transmissions. This operation also serves as a quality control tool that identifies the diagnostic centers with the most missed cases. APOPO collaborates with the National Tuberculosis and Leprosy Program (NTLP) and its Central Tuberculosis Reference Laboratory (CTRL) to institute stringent quality control measures and to provide refresher training for laboratory personnel.

To track and treat patients who have been sent home earlier based on a negative microscopic test is a major challenge. To tackle this, APOPO recently established a partnership with a Tanzanian NGO called Mapambano ya Kifua Kikuu na Ukimwi Tanzania (MKUTA), which is composed of former TB patients. MKUTA volunteers are talking and convincing each and every TB suspect so as to provide a reliable telephone number and physical address that would make tracking at a later stage easy. A pilot implementation of this exercise produced promising results which will lead to a long term partnership agreement with MKUTA.

APOPO aims to curb the spread of TB in Dar es Salaam, and hopes that this project can demonstrate the viability of the implementation in other megacities.

Georgie Mpangala, Lab Manager, Kinondoni Municipal Council

Georgie Mpangala, Lab Manager, Kinondoni Municipal Council

I was very excited and curious to first hear that rats can detect TB. I used to double-check their indications in my lab and realized that the results were perfect.

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