Utilization of Audio visual medium for conveying sputum collection instructions for tuberculosis diagnosis Presenter: Fred ORINA

Introduction Tuberculosis still remains a disease with high public health implication due to: Mode of transmission- airborne Emergence of MDR and XDR Diagnosis a challenge because of low suspicion index quality of specimen produced even with highly sensitive new molecular platforms Relay of collection instructions

Objective Assessment the effectiveness of audiovisual digital platform in conveying instructions for sputum collection to presumed tuberculosis patients

Methodology Development sputum collection Booth Standardized instructions for: Cough production technique promoting deep coughing Emphasis on Time to be taken for collection Volume required Specimen handling procedure after collection.

Study area Population (2009 census)  • Total 207,253

Relay of sputum collection instructions Approach 1 (AVI) Approach 2

Patient recruitment and sample collection  Randomized block design Trained healthcare workers Audio visual Instructions Platform

Specimen processing schematic

RESULTS: Demographic characteristics Data from 202 patients was analyzed Mean age of 42 Range 18-73 years Variables   Total (n=202) AVI (n=102) Routine (n=100) p value n % Gender Male 102 50.5% 52 51.0% 50 50.0% 0.889 Female 100 49.5% 49.0% Age in years 18 – 30 66 32.7% 30 29.4% 36 36.0% 0.598 31 – 45 69 34.2% 35.3% 33 33.0% 46 and above 67 33.2% 31 31.0% HIV Infected   +VE 68 33.7% 32.4% 35 35.0% 0.691   -VE 134 66.3% 67.6% 65 65.0%

Distribution of sputum by quality

Distribution of sputum specimens by time of collection No significant difference (p>0.05) between spot and morning samples Accurate sputum collection instructions

Primary outcomes POC diagnostics Variables Total (n=202) AVI(n=102) Routine (n=100) p value n % ZN results   Positive 28 13.9% 16 15.7% 12 12.0% 0.448 Negative 174 86.1% 86 84.3% 88 88.0% GeneXpert results 47 23.3% 25 24.5% 22 22.0% 0.673 155 76.7% 77 75.5% 78 78.0% POC point of care GX = GeneXpert TB = Tuberculosis GX better tool in diagnosis of TB than ZN microscopy as a POC tool More patients were diagnosed with sputum from booth

Pros and cons of AVI Pros Cons Privacy of participant Ability of participant to review/playback the instructions Availability of online solutions Cons Some level of literacy to operate Relied on grid power to fx

Conclusions and recommendations Audio visual instruction platforms can be used as an alternative to trained staff for relay of sputum collection instructions to presumptive tuberculosis patients Quasi experimental studies on impact of the use of audio visual instructions on tuberculosis detection.

Acknowledgements Study participants Malindi SC Hospital KEMRI CRDR Study Team

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