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TB Tanzania
 TB is the most common life threatening opportunistic infection in people living with HIV/AIDS (PLHIV) and remains a leading cause of death including those receiving antiretroviral treatment. High TB case rates in sub-Saharan Africa have been largely attributed to the escalating human HIV epidemic. The annual risk of developing active TB in HIV-positive individuals co-infected with M. tuberculosis is estimated to be 5-10% compared to a lifetime risk of 10% in HIV- negative individuals. Proper attention to TB within HIV care is extremely important and yet has been a persistent challenge for HIV programs throughout Tanzania and indeed the region. Despite this interplay between HIV and TB, the treatment programs have remained largely separate. There is a need to try new approaches to integrate HIV and TB care properly, and to closely monitor the treatment of TB within HIV care, and vice versa.
D-tree International is working to develop and test a Tuberculosis (TB) module to extend our current program for using handheld computers (PDAs or smart phones) to assist heath workers at HIV care and treatment centers in Tanzania. The new module will add to these guidelines by guiding health workers through the Tanzanian national algorithm for evaluation of TB among HIV-infected persons.
The e-TB module will be used once a patient is suspected for TB, based on standardized screening questions about coughing, sweating, fevers, etc. These questions will be added to the e-CTC system, and trigger referral to TB care.
The following functionality for e-TB is envisaged. It will maintain a list of clients, recording their ID number (probably NACP HIV number) and their initials, sex, and age. New patients can be added to the registry on the device. It will maintain a running history of each client’s test results and status. When the health worker using e-TB selects a client, they will be prompted to guide the client to the next stage of the algorithm shown in Figure 1. For example, if they were sent for first smear last time, e-TB will prompt the user to enter the smear result, and then send the client for the 2nd smear. Similarly, if there were 2 negative smears but the client is HIV positive, then e-TB will prompt the user to send the client for an X-ray.
The e-TB module will also help troubleshoot for the many cases in which things don’t go as planned. For example if the person was told to come back the day after their first smear, but came back after 20 days, e-TB will advise whether to repeat the first smear or just get the 2nd. Or if the client didn’t get an X-ray because of equipment failure, travel costs, etc, the system will prompt the user to decide whether to try to proceed without the X-Ray or send the client back for the X-ray.
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