Urban TB and Multi Drug resistance (MDR)

We have five major urban centers in Kenya namely Nairobi, Mombasa, Kisumu, Eldoret and Nakuru. Out of these centers Nairobi and Mombasa cities have implimented urban TB control initiatives which are aimed at intensifying case detection and notification. These two cities reported a high proportion of the countries caseload ( Nairobi reported 17% of the country's caseload while Mombasa reported 56% of the caseload of coast province and 5% of the country's case load in 2006) Activities undertaken so far include involvement of the private sector, mapping of the slums health facilities and increasing the programme officers in these cities. Now Nairobi has 2 PTLCs and 17 DTLCs while Mombasa has 8 DTLCs but one PTLC and a PTLC assistant.

Performance Improvement Approach

A total of 45 programme officers were trained in application of PIA in programme work. This was accomplished with support from RCQHC, PATH and WHO. Those trained were all DTLCs in Nairobi and in PATH supported districts and PTLCs in Nairobi and South rift. The objective of these workshops were to build capaciy among the DTLCs to enable them to analyse the institutional context for their zones, identify their main stakeholders, define the desired programme performance, vis-a-vis the actual performance and hence the gap in performance, do the root cause analysis to explain the gaps, design appropriate interventions and implement the selected interventions. So far the only report from the coordinators is from Busia where case notification increased by 14%, smear positivity amongst TB patients by 10% DTC increased by 45% while defaulter rate fell by 5% in 2006 compared to 2005.

Multi drug resistant TB

The surveillance system for MDRTB was revitalized in 2003 when the central reference TB laboratory was refurbished. Since then it is the division's policy to have all retreatment TB patients screen for drug resistance and the achivements so far are shown in the table below. The number of MDRTB patients detected in the country has grown from 20 in 2003 to 91 by half year 2007 making a cumulative total of 300 MDRTB cases by June 2007. The Division through the Ministry Of Health (MOH) successfully applied to the green light committee of WHO and received a go ahead to start treatment for MDRTB starting with a cohort of 40 patients. Also the Division received support from the global fund for aids, TB and Malaria which is being used to set up a treatment site in Kenya . A MDRTB treatment center is being established at Kenyatta national hospital where MDRTB patients will be admiteed for the intensive phase or till their smears/culture converts and then continue on a strict health worker administered DOTS as outpatients in the nearest health facility. The total duration of treatment will be at least 24 months. The intensive phase will be a minimum of six months of Capreomycin, Ofloxacin, Protionamide and Cycloserine while the continuation phase will be for a minimum of 18 months of Ofloxacin, Protionamide and Cycloserine.