Tuberculosis

Summary

Screening and Diagnostic Approaches During the fiscal year 2023-2024.

Rwanda identified 152,734 presumptive TB cases with a positivity rate of 4%, translating to 6,136 confirmed cases and 52% were referred by CHWs. HIV testing among these presumptive cases showed an 8.6% HIV positivity rate. Enhanced TB casefinding efforts in high-risk areas, such as slums and correctional facilities, showed a higher positivity rate of 7%. Screening in correctional facilities involved 26,959 inmates and led to the detection of 241 TB cases, including 8 multidrug-resistant TB (MDR-TB) cases. Rwanda expanded its network of GeneXpert machines from 70 to 91 sites to improve rapid TB diagnosis, including drug-resistant TB surveillance and integration of HIV and hepatitis C testing. WHO-recommended molecular diagnostics (WRD) were used as initial testing in 69.1% of all TB cases and 86% among bacteriologically confirm and universal drug susceptibility testing for at least rifampicin resistant (DST) was 95.7% among bacteriologically confirmed TB. The performance of smear microscopy quality control was 96% (155/161) among CDTs that performed smear QC at least three times per year, and 75.6% (155/205) among all CDTs nationwide however 94% (62/66) of GeneXpert sites participating in panel testing achieved passing marks of 80%. TB Notification In FY 2023-2024, Rwanda notified 8,551 TB cases, including 92 rifampicin-resistant TB (RR-TB) cases. CHWs played a crucial role in this effort, contributing 31.3% of the notifications, surpassing the national target. TB notifications have fluctuated, with a decrease noted this year, particularly in Rwamagana District. The majority of cases were in males (73.5%) and affected primarily the 25-44 age group. Kigali City reported the highest number of TB cases (27.3%), followed by the Eastern and Southern provinces. Bacteriologically confirmed cases comprised 73% of notifications, with pulmonary TB representing 85%. TB-HIV co-infection was observed in 14% of cases. High-risk groups accounted for 56.5% of cases, with inmates and the elderly being the most affected. Childhood TB cases made up 9% of the total, with mentorship programs improving detection. Drug-resistant TB cases decreased, particularly in Kigali City and Eastern Province. TB Prevention TB&ORD surveillance system monitors compliance with TB prevention measures, with 90.8% of health facilities implementing the minimum IC package. Annual TB screening for healthcare workers and CHWs is a key component of this plan. In 2023-2024, 95% of health facility staff and 93% of CHWs were screened, identifying 25 confirmed TB cases. Contact tracing screening of TB was done among household contacts of TB index cases. Among under five years, achieved a 98% screening rate, resulting in 56 confirmed TB cases and 97% of eligible received tuberculosis preventive therapy (TPT). TPT was also extended to contacts over five years old, with 86% undergoing Tuberculin Skin Test (TST) and 98.1% of those with positive iv results receiving TPT. Among people living with HIV (PLHIV), 95.8% on antiretroviral therapy (ART) received TPT by June 2024. Despite these achievements, continued efforts are needed to enhance TB screening and treatment coverage in high-risk populations.

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