WAVE V towards a community test and treatment strategy for TB


Wave5 Project Summary

 The evaluation population (EP): comprise the rural communities of West Arsi Zone (Oromia Region) and Sidama Zone (Southern Region). In West Arsi zone, we will include the two woredas (or districts) called Shashemene Zuria and Kofole and in Sidama zone we will includethe woreda Wondo Genet. Shashemene Zuria, Kofole and Wondo Genet are geographically adjacent to each other, have similar socioeconomic conditions and culture and comprise about 623,472 population. The main economic activities are subsistence farming and cash crops such as coffee, sugar, khat and avocado. The areas have a poor road infrastructure resulting in poor utilization of the health services. Similar to the rest of the country, it is estimated that only 30% of the population access the services provided at health centers.


Description of health facilities: There are 23 health centers and 92 health posts in the evaluation area. All 23 health centers provide TB treatment services and 19 conduct smear microscopy. Most individuals accessing smear microscopy services are self-referred and are screened using spot-spot sputum examinations, as recently endorsed by the NTP. There are no XRay facilities, hospitals, GeneXpert or culture facilities in the EP.


Health centers are staffed by medics, nurses/midwifes and support staff, including five health officers. Each health officer supports one health post of the five assigned to the health center. The health posts at located at kebele (village) level and are staffed by two Health Extension Workers (HEWs). The HEWs visit the households to implement the 16 basic packages of health care within the Ethiopian Health Extension Program (HEP) and staff the health posts. The villages are also organized in a grass root network for health promotion called the Health Development Army (HDA) in which one female community leader promotes healthy lifestyles among her five neighboring families (thus commonly named the 1:5 network).


TB epidemiology: Passive case finding is the main stay for getting patients to care, which is compromised by the limited access to diagnostics. A total of 639 all forms TB cases were reported from the evaluation population in 2015. This number translates to a case notification rate of 102 per 105 population and a case detection rate of 49%. This low case detection suggests there are large numbers of cases that did not reach or were not reported by the health services.


Population size: The intervention will focus on two rural districts of Oromia (Shashemene Zuria and Kofole) and one district in the Southern Region (Wondo Genet) which altogether have 93 rural villages. Districts in Ethiopia are called Woredas. The project area has an estimated population of 623,472 inhabitants, of which 470,294 (75%) live in Oromia and 153,178 (15%) in the Southern Region. The targeted population represents about 70 % of the population in these areas after exclusion of young children unable to expectorate.

Project Goal and Objectives


The major goal of the project towards a community test and treat strategy for TB through community based intervention in 2 districts of West Arsi Zone of Oromia region.


1)    To Engage the HDA in 1:5 household networks to identify TB cases in the community and improve access to TB diagnosis and treatment  in the targeted districts

2)    To use Xpert MTB/RIF and ULTRA as the first diagnostic test for TB screening

3)    To identify 47,029 (10% of total population) individuals with TB symptoms  and in support by the project improve linkage to treatment by providing TB treatment in the community

4)    To evaluate a transport preservation medium to maintain the integrity of sputum for molecular testingandarrange referral systems for  identified TB patients

5)    Building the capacity of the project and government staffs engaged on improving TB diagnosis

Project Strategy

 Through the course of project implementation the project will employ the following strategies:

  • engaging HDAs and HEWs who are expected to make a house to house visits to establish contacts and find TB cases from among families and communities;
  • establishing strong collaborations with all relevant government structures at all levels and the communities;
  • launching the project and creating awareness to all involved directly or indirectly in the process of project implementation;
  • Identification of TB suspects and communication;
  • conducting training and workshops to professionals and HEWs as well as HDAs who will be involved throughout the project implementation;
  • undertaking x-ray and laboratory investigations with better equipment, treatment and case finding and applying gender sensitive approaches.







Additional information