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

2. 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

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

4. 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.

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

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

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

8. Specimen processing schematic

9. RESULTS: Demographic characteristics
Data from 202 patients was analyzed
Mean age of 42
Range 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%

10. Distribution of sputum by quality

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

12. 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

13. 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

14. 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.

15. Acknowledgements Study participants Malindi SC Hospital KEMRI CRDR
Study Team

16. Thank you