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Cycle 5 (2015 Deadline)

Using contact tracing to assess barriers to diagnosis and treatment and develop an educational campaign surrounding childhood tuberculosis in Northern Philippines

PI: Flordeliza Bassiag, Isabela State University
U.S. Partner: Tania Thomas, University of Virginia
Project Dates: December 2016 - November 2019

Project Overview:

The Northern Philippines is not exempt from the burden of childhood tuberculosis (TB), given its geographical locations with mountains and urbanizing valleys in all three regions of Ilocos, Cagayan Valley, and the Cordilleras, encompassing ten provinces and seven cities. The project will use contact tracing among adults with smear-positive TB in order to assess the disease prevalence and incidence among children in the Northern Philippines, and it will identify a spectrum of barriers to the diagnosis and treatment of childhood TB. Household contact investigations will be conducted among smear-positive index patients on TB treatment through DOTS/health facilities (public or private) within the three regions to screen for and obtain accurate baseline statistics of childhood TB and latent TB infection among children under 15. Cross-sectional surveys, key informant interviews, and focus group discussions will be employed among families and healthcare workers to identify barriers to the diagnosis and treatment of childhood TB. Results of the survey will be used to inform an educational campaign that builds upon the strategies of the Department of Health of the Philippines for improving lung health in children affected by tuberculosis.

The project aims to increase pediatric TB case detection from 1.2% to 15%, the global average detection rate for high TB-burden countries. Identification of barriers affecting treatment will inform methods to improve successful implementation of national childhood TB guidelines in the Philippines. The community-based education campaign will serve as an important advocacy tool for the lung health of children and will help decrease the stigma associated with TB. The global community is working towards the goal of “Zero TB deaths among children.” Completion of the project aims will provide critical evidence about the burden of TB-exposed and diseased children in rural Northern Philippines. Contact investigations will build research capacity among individuals and at the programmatic and institutional levels. It will also foster local capacity building at the grassroots level by promoting educational campaigns. Active case finding will generate accurate baseline statistics on TB-exposed children from an understudied region, which can aid in resource allocation and benchmark creation for future programs.

Summary of Recent Activities

As of January 2019, the study continued to enroll participants from the catchment sites and conduct in-home screenings. Contact tracing was completed in June 2018. The total enrolled participants under Phase 2 (December 2017-June 2018) for adult TB indexed cases was 389 comprised of 243 males and 146 female adults. The total number of enrolled children below 15 years old within household contacts is 662 comprised of 322 males and 340 females. Overall, adult participants enrolled to the study on contact tracing is 788 or 87.5% of the target samples that yielded a total of 1,492 children below 15 years old. To date, in-home screening of the enrolled children is ongoing which started only in June 2018. The total of screened children with records is 349 excluding those that are ongoing at the site. Actual figures on the number of children who visited the health facility with their parents for proper management and care was not yet quantified as this requires continuous monitoring at the health facilities. The team coordinated with the Provincial Tuberculosis Coordinator and the regional offices for the provision of Tubeculin Skin Test to the catchment sites since their supply ran out of stock. This was to ensure that the children in the study referred will be given free tests and examinations. Focus group discussions and surveys with healthcare workers were completed in November 2018. The results and conclusions from the discussions will help update the educational materials that will be used and distributed during community orientation sessions regarding childhood tuberculosis. Modules for schools, TB ambassadors, and village healthcare workers/TB Coordinators are being drafted. The USG-funded Partner, Dr. Tania Thomas, visited some health facilities within the catchment sites in the Provinces of Isabela and Pangasinan in late May. She met with the health personnel of the Eastern Pangasinan District Hospital. The visit emphasized the roles of health facility TB personnel in tracing contacts of the adults, TB treatment regimen and other related topics. A seminar was conducted for the faculty of the Colleges of Nursing, Animal Science and the Arts and Sciences.

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