1. Infection Control in Tanzania Dr. Peter C. Mgosha (MPH,) MINISTRY OF HEALTH AND SOCIAL WELFARE NATIONAL AIDS COTROL PROGRAMME P.O.BOX 11857 DAR Es SALAAM TANZANIA

2. Out line Presentation Tanzania profile Background TB/HIV notification TB/HIV Achievements Strategies for TB infection control

3. Tanzania profile One of the 3-5 East African Countries Population: 38.7m (38,710,723) Above 15 yrs: 21.7m (21,710,169) Under 5 yrs: 7.2 m (7,215,011)

4. Background: HIV fueling TB epidemic in Tanzania Source: NTLP, 2008

5. Cumulative notified TB cases……………. Cumulative TB/HIV cases………. Started CPT ……… Started ART ………

6. Achievements oScaling-up started in 2005 oService mechanisms based on pilot sites oRecording and reporting system oTB manuals have been reviewed oTraining materials developed oNeeds assessment tool developed oTB/HIV policy developed oARV provision in TB clinics is a key oTB screening tool to all PLHA developed and is in use

7. Achievement cont…. – Basic TB/HIV activities DCT(PITC)-81% Referral of patients Recording and reporting Screening of TB from HIV services – Provision of ARV in TB clinic One Dar es Salaam based district (Temeke) 10 districts under CDC support 45 districts in GF-ATM round 3 support 36 districts in GF-ATM round 6 support

8. Achievements cont… 25 districts until Dec, 2006 By July, 2007, 70 districts By June, 2008, TB/HIV activities covered the whole country TB/HIV officers recruited Community involvement-(Post TB cases club; MUKIKUTE-Temeke)

9. The infection control Strategies Based on : A: Administrative measures Assigning responsibility for TB infection control in the setting Conducting a TB risk assessment of the setting Developing and instituting a written TB infection control plan to ensure prompt detection, airborne precautions Treatment of persons who have suspected or confirmed TB disease Ensuring the timely availability of recommended laboratory processing, testing, and reporting of results to the ordering physician

10. A: Administrative control Measures cont…. Implementing effective work practices for the management of patients with suspected or confirmed TB disease Ensuring proper cleaning and sterilization or disinfection of potentially contaminated equipment Training and educating health facility staff (HFS) and evaluating HFS who are at risk for TB disease or who might be exposed to M. tuberculosis Using appropriate signage advising respiratory hygiene and cough etiquette and coordinating efforts with the council health management teams and regional health management teams

11. B: Environmental Control Measures Ventilation patterns: Windows and doors are routinely kept open and any ventilation produced by the fans are usually directed to the air flow outside the waiting room throughout the windows and the doors. Open areas are dedicated to be waiting rooms

12. C: Personal protection Personal Respiratory Protection- HCW encouraged to wear N-95 respirator any time entering the MDR TB ward; respirators have to closely fit to the face to prevent leakage around the edges Baseline TB screening- To prevent the occupational risk, regular TB screening of HCW is a recommended activity especially for certain health categories particularly exposed to active TB cases. e.g. CTC HCW identified as having active TB disease should be removed from the unit where they are providing service, regardless of the type of department Provider initiated counselling and testing (PICT) Occupational HIV exposure and post exposure management

13. C: Personal protection cont… Disinfectants and waste management are usually maintained to all H/C Departments Encouraging laboratories to have at least two rooms, one for reception and the other one for performing the test. The preparations should be performed in a well ventilated room with sunlight. Laboratory safety precautions of handling specimen-wear gloves, wearing laboratory coats should be followed.

14. C: Personal protection cont… TB Lab (e.g. Muhimbili National Hospital) smear, culture and Drug Susceptibility test (DST) are performed in a safety cabinet class II with double/single filter. Culture media, sputum containers and glass slides are autoclaved or burned in the incinerator prior to disposal.

15. Challenges Suboptimal TB infection control at HF (suboptimal early identification of TB suspects, separation of TB suspects/cases, cough hygiene education, room ventilation) Absence of TB infection control plan of the HF Low awareness on TB infection control among HCW Shortage of HR Stigma Lack of national TB IC guideline/SOP and training Package Absence of IPT guideline/SOP

16. Way-forward Developing TB IC national guidelines/SOP Developed TB IC training package Developed TB IC posters targeted to HCWs Developed Cough Hygiene posters targeted to patients - Developing IPT guideline/SOP Recruiting more TB/HIV officers to coordinate TB/HIV collaborative activities in districts

17. MATERIAL AVAILABLE