Tuberculosis

During 2020-2021 FY, TB case detection and monitoring of TB activities at decentralized level were challenged due the covid-19 pandemic where the country experienced two different waves of transmission leading to control measures including restriction of people movement as total or partial lockdown. Despite all this, the country has been able to ensure continuity of service mainly based on the strengthening of community health workers and the digitization of certain services such as the implementation of an individual case-based surveillance system which allowed to provide support remotely.
Early accurate diagnosis followed by prompt appropriate treatment is vital for ending TB. Rwanda adopted actives cases finding of TB among people at high risk to develop TB and use of chest x-ray as screening tools.
During this 2020-2021 FY, 176,636 TB presumptive were identified versus 140,860 in the previous FY representing an increase of 25%. Sixty four percent (63.6%) of presumptive were referred by Community health workers compared to 43.4% in 2019-2020 FY. This increase was due to bidirectional screening during covid-19 pandemic and enforcement of community detection during lockdown. Using chest x-ray as triage tools, 14917 people among prisoners (9971), youth at transit center (3712) and PLHIV (1234) were screened and 14,8% had abnormal Chest x-ray suggestive TB and were TB presumptive.
Covid-19 pandemic has negatively affected different sectors of the country life including health services. Comparison of TB notification before (January-June 2019) and during the Covid-19 period showed a 7% decrease in January-June 2020 period and a 10% decrease during January-June 2021.
 The total number of all TB cases diagnosed was 5,435 including 28 RR/MDR-TB cases. Among them children under 15 years represented 6.3% (346), male represented 72,1% and 26.3% were referred by CHWs. Eighty three percent (83.5%) had pulmonary TB, 99% (5382) were new and relapse, 75.6% were bacteriologically conformed TB of which 73.7% were detected using GeneXpert test. The proportion of HRG was 53.4% compared to 50.4% in 2019-2020 FY. 89.1% of bacteriologically confirmed TB have their drug susceptibility test and 72.9% of newly TB cases were diagnosed using molecular test for initial diagnostic. TB treatment was initiated to 98% of notified TB cases.
Rwanda National TB reference laboratory was designated by WHO as Supra Reference laboratory candidate to support Madagascar and Comoros. To ensure quality of diagnostic at laboratory, external quality control assurance was conducted in 79% of Center for Diagnostic and Treatment (CDT) at least 3 times per years; 8933 smears microscopy were reviewed, and 7 slides were high false negative, and 6 CDTs had major errors. Proficiency panel of GeneXpert received
3 from CDC Atlanta were provided to 42 out 64 experts sites and 38 sites passed the score of 85% and more.