A USAID-supported lab in Zambia uses new technology to improve TB diagnosis.
Photo credit: TB Care Zambia

With some of the highest TB-HIV co-infection rates in the world, Zambia is addressing the issue by scaling up implementation of the Three I’s. The Three I’s are: early identification and treatment of TB, isoniazid preventive therapy (IPT), and infection control activities. The Xpert diagnostic is an integral part of the Three I’s initiative and central to intensified case-finding efforts and enhanced TB screening.

Xpert is a high-sensitivity diagnostic technology, used to better diagnose drug-sensitive and drug-resistant TB. A district “hub and satellite” model is being implemented with the use of the Xpert diagnostic test. To expand the reach of the laboratories, the satellite facilities transport specimens to the “hub” to fast-track access to this new diagnostic. Four provinces with high co-infection rates were selected for implementation of activities, including IPT provision and infection control measures. A total of 29 health care facilities, 14 laboratories and 8 prisons in 11 administrative districts have implemented these intensified activities. In some districts, prison screening has also been established, and specimens enter into the “hub” model from each prison satellite facility.

Courier systems between the hub and satellite facilities for delivering specimens and reporting patient results have been strengthened as a result of USAID’s support. USAID and partners conducted facility baseline assessments for infection control and Xpert installation, conducted extensive trainings, and developed robust monitoring and evaluation measures as part of this scaled-up implementation.

Preliminary screening numbers from the implementation sites in Zambia already point to early successes. Out of the 1,600 PLHIV screened with Xpert, 207 had active TB and have been started on treatment. 37 were found to be resistant to rifampicin, one of the more potent anti-TB drugs, most often a marker of MDR-TB. Although countries are still in the early implementation phase, some initial lessons learned are being documented. These include the importance of strong collaboration between the TB and HIV programs, as well as active engagement and country ownership required for delivery of these essential services. USAID-supported, targeted and focused technical assistance has been instrumental for these early successes.