Project Title

An Innovative Collaboration Model Between the National TB Control Program and Informal Healthcare Providers to Detect Additional Cases of TB In Cameroon

EDCTP Project Call

Career Development Fellowship (CDF)

Project Objectives

The main aim of this project is to determine the effect of a structured integration scheme of IHPs into the NTCP practices on TB case detection of three cities: Douala, Ebolowa and Bafoussam and to provide evidence of cases missed by the NTCP in the populous neighborhood of these cities while assessing TB-HIV co-infected patients’ health-seeking behavior and the use PMTCT by infected pregnant women in the informal sector.

Study Design

This is a concomitant mixed design combining the qualitative and quantitative approaches.

Project Summary

Background: The informal health provider (IHP) has been defined as an individual who provides health care to populations without having formally recognized training as a healthcare care professional, is unregistered and operates without oversight by the government. In Cameroon, although the government may be aware of the role of IHPs as key players in the health care markets, regulating them is a challenge due to the country’s limited technical and financial capacity to enforce the rules governing as well as the demand and supply of health services. In 2015, Dr. Sylvie Kwedi Nolna conducted a study that assessed the feasibility of integrating IHPs into the NTCP to improve TB case detection in Yaoundé (intervention city) as compared to Douala (control city). This feasibility study showed that the IHPs were willing to collaborate with the NCTP by being trained, using NTCP tools, and referring suspected TB cases to the NTCP for confirmation. Study Objectives: We are proposing to evaluate the effect of integrating IHPs into the NTCP to improve TB case detection in three main cities in Cameroon: Douala, Ebolowa and Bafoussam by providing IHPs with proper training for handling TB suspects and intensively montoring their ability to refer TB suspects to the NCTP. At the same time, the study seeks to identify TB-HIV co-infected cases discovered in the informal sector and assess their health seeking behaviors. Among the study participants, pregnant women testing positive for HIV will be evaluated in terms of their use of the Prevention of Mother-To-Child Transmission (PMTCT) program received by the IHPs. Study type and setting This is a concomitant mixed design combining the qualitative and quantitative approaches in Douala, Bafoussam and Ebolowa. Study Procedures: The IHPs will be provided with pre-intervention questionnaire which will first solicit demographic information and then ask a series of multiple choice questions pertinent to the handling of TB suspects. The pre-test score of each IHP participant will be recorded. The IHPs will be provided with a manual with detailed procedures for the referral of a suspect case of Tuberculosis to the BMU. During the 12 months following the training, on a bimonthly basis, the IHPs will be visited by NTCP staff for an assessment of their compliance with the referral procedures provided to them and the number TB cases referred to a BMU will be recorded. The study team will put in place a system to facilitate the screening and enumeration of suspected TB cases that are consulted by IHPs. All TB/HIV co-infection cases will be notified and referred to the HIV Care unit for follow up and treatment. In addition, information regarding co-infected patients health-seeking behavior practices will be assessed. HIV infected pregnant women attending the clinic will be included in the assessment of PMTCT services in the informal sector

Host Organisation

Sites

Current Organisation

University of Yaoundé I

Current Job Title

Epidemiologist

Biography