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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 - December 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.

Project updates
During July-September 2023 reporting period, the project team developed two distinct websites to further its objectives. The first website, dedicated to childhood and adolescent TB contact tracing, is undergoing enhancements and security encryption measures. The project's stakeholders have been actively informed of this resource, as the link to the site was shared with the General Coordinators of healthcare workers across the 18 catchment sites. The second website which remains under development  will be integral to sustaining the project's accomplishments. Ongoing work includes uploading relevant documents to the website, and a plan to merge the Contact Tracing website with the CATB domain, with intentions to share it in the near future.
Regarding the provision of APL/Chest X-ray services for school children and adolescents aged 5-17, reports from the catchment sites reveal that 196 children and adolescents were referred to the laboratories as of September 23, 2023. These referrals are part of agreements established through Memorandums of Agreement (MOA) with the project. Some sites have yet to provide their data, while others are expected to commence referrals in the coming quarter. Two sites in Isabela have revised their MOAs and are in the process of securing signatures again.
In terms of stakeholder engagement, two Provincial Stakeholders’ dissemination meetings took place during this quarter. The first meeting took place on July 5, 2023, in the Province of Kalinga with 36 participants attending, including representatives from Provincial Local Government Units, the Health Sector, Municipal and City Health Offices, and the Governor's Office. The second meeting occurred on September 29, 2023, in the Province of Isabela and involved 26 stakeholders, including local healthcare workers in the TB Program, two Medical Doctors, and members of the project team.
Unfortunately, due to typhoons and heavy flooding in the Province of Pangasinan, a planned meeting for that area was rescheduled to the following quarter. Additionally, plans for meetings with the Centers for Health Development regional offices in Region I and Cordillera Region, along with training sessions for selected science teachers in the Province, will also be deferred to the next quarter.
In cooperation with the Provincial Health Offices and Health Promotion Officers, the project is coordinating training sessions for school-based science teachers across the catchment sites. These trainings have been rescheduled to commence on October 10 and are set to occur in four separate schedules during the next quarter.
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