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PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER)
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 - April 2023

Project Overview:
5-173 TB tracing factsheet
This Factsheet was produced by Population Reference Bureau under the Research
Technical Assistance Center (RTAC).  The information in this policy brief is based on research led by Ms. Flordeliza Bassiag at Isabela State University and Dr. Tania Thomas at the University of Virginia. 
5-173_contact tracing orientation
´╗┐Orientation of frontline healthcare workers on childhood TB and contact tracing. Photo credit: Dr. Bassiag
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.

2022 Project updates
 
During April-June 2022 reporting period, orientations and trainings for healthcare workers continued  To be able to further enhance the knowledge of the frontline healthcare workers on tuberculosis in children, the team in collaboration with the Provincial TB Program conducted four (4) orientations and training on childhood TB, contact tracing and Tuberculosis Preventive Treatment (TPT) in the three catchment sites in Isabela.  The event convened 176 female and 16 male frontline healthcare workers (HCWs).  Part of the training was to come up with their action plans based on what they learned in the training and the existing TB indexed case data from their locality starting three months ago and onwards.  The HCWs were equipped with the tools and knowledge on how they can implement their plans. The Province and local TB Program units will monitor their own plans and will provide reports to the ISU-PEER research office on a quarterly basis.
 
The project team also conducted two provincial meetings attended by some stakeholders province-wide on May 25 for the Province of Kalinga and June 8, 2022 for the Province of Pangasinan.  Participants of these meetings included the Provincial Health Officers and TB Coordinators in the province, districts and municipal levels, medical technologists and DOH regional representatives.  The project team presented to them the activities for the PEER supplemental and RTAC.  They also requested the team to present the results of the studies conducted under PEER-USAID project which turned-out to be of benefit to the stakeholders.   40 female and 25 male participants attended these meetings.
 
For the school-based orientation on CATB, the schedules have been moved to the month of August in celebration of the TB Month in the country due to various school activities this quarter. This will be undertaken on a virtual platform or hybrid.
 
In terms of conferences, during this quarter two papers were presented to the Asia-Pacific Union conference in a virtual platform.  The “Cost Effectiveness analysis on Expanding TB Preventive Therapy to Household contacts Aged 5-14 years in the Philippines” presented orally and “Healthcare Workers Perceived Barriers to Diagnosis and Treatment to Childhood Tuberculosis in northern Philippines” presented as poster.  Both papers were submitted to journals for publication.
 
During the Provincial meetings with the stakeholders, the PI presented the results of the following:
Identification of Barriers to Diagnosis and Treatment among Households Surrounding Childhood Tuberculosis in Northern Philippines
Healthcare Workers Perceived Barriers to Diagnosis and Treatment to Childhood Tuberculosis in northern Philippines
Cost Effectiveness analysis on Expanding TB Preventive Therapy to Household contacts Aged 5-14 years in the Philippines
Cascade of Care on Childhood Tuberculosis in northern Philippines 
Knowledge, attitudes and practices on childhood tuberculosis among community households in northern Philippines
 
For the SMS-based reminder system on treatment and follow-up for childhood and adolescent tuberculosis in Northern Philippines, the project was able to enroll a total of 73 children and adolescents as of this time to receive SMS messages on treatment schedule and follow-up reminders coming from the provinces of Isabela and Kalinga.  The project also developed a simple user manual for the local government to adopt SMS for tuberculosis.  The research project will be providing SMS-blast to two provinces – Pangasinan and Kalinga to be bought from its supplies and materials allocation.
 
The team continually work with the local government agencies especially now that new governors in the two catchment sites (Kalinga and Pangasinan) are in place, and there are new Mayors and local legislators as well, which will need orientation in the coming months about the project and its achieved milestones to assure their continued support for the local health, especially on childhood TB contact tracing, diagnosis and treatment.  

During this quarter, the team trained more than 100 frontline healthcare workers on Childhood Tuberculosis, contact tracing and on TB preventive therapy which included the DOH newly hired Human Resources for Health (HRH).The City of Ilagan also passed their Ordinance on tuberculosis based on the project-driven drafted ordinance provided to them.
 
For the supplemental activity related to SMS-based reminder system on treatment and follow-up for childhood and adolescent tuberculosis in Northern Philippines, the project was able to enroll a total of 73 children and adolescents as of this time to receive SMS messages on treatment schedule and follow-up reminders coming from the provinces of Isabela and Kalinga.  The project also developed a simple user manual for the local government to adopt SMS for tuberculosis.  The research project will be providing SMS-blast to two provinces – Pangasinan and Kalinga to be bought from its supplies and materials allocation.
 
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