APRECIT

Evaluation of strategies to improve the screening and overall management of latent tuberculosis infection in Cameroon and Madagascar

Type

Research

Region

Africa

Country

Cameroon Madagascar

Partners

14

Status

In progress

Context

Tuberculosis (TB) remains the number one infectious killer worldwide. In 2017, 10 million people contracted the disease and 1.6 million of them died (including 300,000 people with HIV ). When TB is active and detectable, it can be treated. Patients may receive 6 to 24 months of treatment, depending of the drug susceptibility of the Mycobacterium tuberculosis strain responsible for the disease.

Latent TB infection (LTBI) is asymptomatic and a cause for growing concern. Up to one third of the world’s population is estimated to have LTBI, and on average, 5 to 10% will develop active TB disease over their lifetime. Because people with LTBI represent a large human reservoir for TB, it poses a major challenge to efforts to end the global TB epidemic. To eliminate TB by 2050 in line with the WHO END TB strategy, programmatic management of individuals with LTBI is necessary.

Objective

The APRECIT* project, launched in 2019, is designed to evaluate different screening strategies and to improve overall programmatic management of latent TB infection and high-risk groups in Madagascar and Cameroon.

Activities

In partnership with the Malagasy and Cameroon National TB Programs, this project involves assessing:

  • A community intervention strategy within households of active TB cases for the identification and management of individuals with LTBI and high-risk groups (children under age 5 and HIV-positive individuals), in quantitative terms and from a cost/efficacy perspective;
  • Diagnostics with 2 interferon-gamma-release assays (IGRA) compared to the gold-standard tuberculin skin test to identify individuals with LTBI;
  • The prognosis value of IGRA to predict progression from LTBI to active TB infection, in terms of sensitivity/specificity and from a cost/efficacy perspective.

In each country, 1,250 household contacts of people with active TB are being recruited for a total of 2,500 direct beneficiaries. Community health agents visit households and perform the LTBI screening tests at home. All voluntary participants are monitored for 24 months.

Project highlights & impacts

  • Encouraging collaboration between TB programs and HIV/AIDS programs, for example to share “point of care” diagnostic laboratory testing, human resources, blood sampling circuits and other resources already in place
  • Working within the framework of national TB programs to ensure the viability of activities even after the project has ended, to make a lasting impact on TB incidence
  • Raising TB awareness among the general population using videos, brochures, and other communication tools
  • Strengthening health systems overall to deliver better care to patients           

What’s next?

The project will last for three years, 2019-2022, and will contribute to reaching the 3rd target of the Strategy to End the Global TB Epidemic by 2035 – namely, to ensure that no families must bear the burden of catastrophic costs due to tuberculosis.

Sponsor

  • Expertise France, Initiative 5%

Partners

Cameroon

  • Centre Pasteur du Cameroon
  • AFASO (Association for Women’s Solidarity)
  • CAMNAFAW Cameroon
  • Cité Verte District Hospital
  • Efoulan District Hospital, Yaoundé
  • Health Economics & Policy Research and Evaluation for Development Results Group (HEREG)
  • Mvolyé Catholic Health Center
  • National HIV/AIDS Committee
  • National TB Control Program (PNLT) of Cameroon

Madagascar

  • Institut Pasteur de Madagascar
  • Analakely University Hospital and Public Health Center (CHUSSPA)
  • National TB Control Program of Madagascar
  • University Teaching Hospital of Fenoarivo, Pneumo-Phtisiology Department

In 2017, TB killed 1.6 million people, including 300,000 people with HIV, making it one of the top 10 causes of death worldwide.

WHO Tuberculosis fact sheet

The Global Fund

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