The Ministry of Health in Zambia, in collaboration with supporting partners, is expanding implementation of aligning six months of TPT with ART refills, as clients enroll in a fast-track ART refill model. This is a follow on from a successful pilot, which had the following specific aims:
- Assess the feasibility and processes around introduction of six months of TPT in the fast-track model
- Determine the uptake of six months of TPT among clients
- Train staff to actively screen for TB and use a structured information approach for delivering TB messages designed to increase knowledge and empower clients.
The pilot was implemented by the Zambian national DSD task force with implementation support from the Centre for Infectious Disease Research in Zambia (CIDRZ), a local implementing partner. This pilot enrolled 825 clients and assessed their HIV outcomes and TPT completion.
In this model, treatment literacy on TB symptoms and side effects of TPT is provided to all clients. A peer educator then follows up with clients by phone at two weeks, after one month, and monthly thereafter to support TPT adherence. If problems are raised, the client is encouraged to return to the clinic for a clinical review. Clients are also encouraged to seek medical attention if they experience any side-effects or adverse events while taking TPT. Monitoring and evaluation (M&E) tools for TPT have been adapted, and completion of TPT is documented at the next clinical visit in six months’ time.
Eligibility
Same ART regimen for 6 months, virally suppressed, no active TB, no condition requiring regular clinical follow up
Building Blocks for TPT
Screening for TB
What
Verbal symptom screen
When
Every clinical visit, during every phone call
Where
Primary care clinic or hospital
Who
Nurse, clinical officer, doctor
Initiation of TPT
What
TPT eligibility assessment Scripting INH and ART for six months
Provision of TPT and ART refill
Register TPT start TPT treatment literacy
When
At clinical visit
Where
Primary care clinic or hospital
Who
Nurse, clinical officer, doctor
TPT refill
What
TPT adherence check TPT follow-up assessment (side-effects and/or TB symptoms)
When
Given six months’ supply at clinical visit, follow up by phone at two weeks, then one month, then monthly
Where
By phone to client at home
Who
Pharmacist, pharmacist technologist, peer educator, doctor if clinical issues raised
Completion of TPT
What
TB symptom assessment TPT completion documented
When
Next clinical visit after six months
Where
Primary care clinic or hospital
Who
Nurse, clinical officer, doctor
Further reading
Interested in in Leveraging differentiated ART delivery models for stable clients to scale up TB preventive therapy? Read more here. Also available in French and Portuguese
Learn about TPT integration within community-based ART distribution points in the Democratic Republic of Congo here
Learn about TPT integration within HIV clubs in South Africa here
