Background: In Botswana, the HIV prevalence among TB patients is 61%. The Advancing Partners and Communities project- Botswana (APC) is a three-year USAID-funded project implemented by FHI 360 through community based organizations by integrating TB/HIV activities at community level and promoting TB cure in eight districts. Community Health Workers (CHWs) are trained on four-symptom TB screening to conduct contact tracing, intensive and active case finding. The report on evaluation of community tuberculosis approaches in Botswana (2012-2013) recommends that CHWs collect and transport sputum for TB investigation to improve referral completion and TB diagnosis.
In 2016 the project experienced challenges with referral completion of presumptive TB clients identified in the community. From 1,978 presumptive TB clients identified and referred to facilities for further investigations, 1,053 (53%) had completed referrals. Barriers to referral completion include lack of transport, long distance to facilities and nomadic clients, among others. The project then emphasized community sputum collection to close the gap of referral completion.
Description: CHWs were trained on safe home sputum collection and transport from community to the facility. CHWs were provided with cooler boxes, gloves, sputum bottles, and respiratory masks to collect and transport sputum from community to facilities.
Lessons learned: Out of 1,237 presumptive TB clients identified and referred to facilities in 2017, 816 (66%) clients completed referral. Among those who had completed referral, 267 clients (33%) had their sputum collected at community level. Fifty-four APC clients were diagnosed with TB through community TB screening, including 16 TB patients (30%) who had their sputum collected within the community. HIV testing was proposed and provided to those with unknown HIV status.
Conclusions/Next steps: With the implementation of community sputum collection, the referral completion rate has increase from 53% in 2016 to 66% in 2017. Community sputum collection enhances TB diagnosis, particularly for clients far from facilities and those nomadic. The project will continue to support CHWs in high TB/HIV districts of Botswana to collect sputum at community level.

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