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TB Screening and Management

The Ministry of Health's primary pediatric TB care provider

As the Ministry of Health’s primary pediatric TB care provider, Baylor Swaziland continues to provide high-quality, integrated TB/HIV care for patients and family members at risk, as well as conduct research that informs internal and national policy. Our TB operations are carried out in collaboration with the Global TB Program at Texas Children’s Hospital and Baylor College of Medicine.

In 2016-2017, Baylor Swaziland screened 19,665 patients — 99% of everyone who visited us for care — for TB symptoms. Among them, 731 people reported at least one symptom, and 81 were diagnosed with TB, including 36 children under 15 years of age. The TB Centre of Excellence (TB COE) in Mbabane offers onsite digital radiography and rapid TB diagnostics—decreasing the time to diagnosis and treatment for patients to same day. In June 2017, we introduced depression screening for this high-risk population.

Intensive Case Finding

Our staff maintains a robust case-finding program that seeks out and evaluates household contacts of TB patients receiving care at Baylor Swaziland and the Mbabane Government Hospital TB clinic. We conduct these home visits two to three days per week. In 2016-2017, the TB COE piloted a new TB contact regis ter for the National TB Control Program modeled on tools developed through our earlier WHO-funded Butimba TB project. As examples of our number of successful TB projects and initiatives, the following programs took place during the 2016-2017 year:

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  1. We enrolled our first pediatric and adult patients with multidrug-resistanttuberculosis (MDR-TB). This fills an important need in Mbabane, where there are no other access points for patients with drug-resistant TB. We continue our family-centered care in order to offer follow up and monitoring for child contacts of MDR-TB patients.

  2. We have analyzed data collected through the Butimba project to inform TB control activities in Swaziland. For example, we reviewed the efficiency of school contact tracing vs. household contact tracing and found that TB symptom based contact trac-ing at schools was not an efficient means of identifying secondary TB cases when compared to household contact tracing (Ustero et al, Plos One, 2017). In addition, we developed a systematic means of mapping households of patients with TB through the use of descriptive directions provided by patients (Brunetti et al, BMC Global Health Research and Policy, 2018). This data can be used to guide resource allocation bythe National TB Control program to areas with the most TB cases.

  3. Training remains a focus of the Baylor TB team. We are the lead partner in an educational program that trains 50 non-Baylor healthcare workers annually on TB specimen collection. Throughout the year, we participated in pediatric TB management trainings and have hosted nurses on attachment to the TB COE. Twice a month, we provide mentoring and training to TB nurses at the Mbabane Government Hospital TB clinic. Inaddition, we work with doctors caring for children and adolescents with drug-resistant TB at the National TB Hospital.

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