After seeing the impact of COVID-19 in Lagos, the Sustaining Health Outcomes through the Private Sector (SHOPS) Plus team recognized it was only a matter of time before a lockdown could derail TB service delivery in the northern state of Kano. Shortly after a lockdown in Lagos was imposed, the team began to roll out a series of interventions designed to mitigate the impact of the COVID-19 pandemic and an imminent lockdown in Kano.

MITIGATING COVID-19 IMPACTS THROUGH TRAININGS, VIRTUAL MONITORING, AND ELECTRONIC REPORTING

The team realized that fear arising from lack of accurate information on COVID-19 and insufficient knowledge of infection prevention and control was contributing to providers’ aversion to seeing potential TB clients with a cough. Therefore, the SHOPS Plus team held training for program staff, clinical providers, and patent and proprietary medicine vendors (PPMVs) on COVID-19 and TB, including similarities and differences and infection prevention and control. Since a countrywide restriction on large gatherings was already in place at this time, the training was held in small groups of about 15 providers. SHOPS Plus trained 63 clinical providers and 61 PPMVs over a period of two weeks. Providers were subsequently provided with basic infection prevention and control materials such as hand sanitizers, surgical facemasks, and hand gloves to motivate them and allay their anxiety about attending to patients with a cough.

Learning from how the Lagos program team adapted to the lockdown in Lagos, the program team in Kano built the capacity of the Kano providers for virtual meetings and mentoring. SHOPS Plus introduced them to Zoom technology and supported them in downloading the Zoom app for ECHO teleconferencing.

The providers were also trained to download, register, and start using the digital app for TB Screening and Tracking for Accelerated Referral and Reporting (TB STARR) developed by SHOPS Plus. TB STARR enables providers to report TB service delivery data and the program to monitor performance in real-time, which is especially useful in the event of a lockdown preventing SHOPS Plus staff from physically visiting private providers. SHOPS Plus emphasized with providers the need to quickly adapt to the current situation. This and a better understanding that TB case finding activities can continue safely in spite of COVID-19 helped change the minds and attitudes of private providers to keep them providing TB services.

Concurrently, the SHOPS Plus TB program supported the Kano State TB and Leprosy Control Programme (STBLCP) to fast track the distribution of additional stock of anti-TB drugs and commodities to private facilities to avoid a stock out in the event of a lockdown. Patients who were receiving treatment were called and asked to pick-up one month supply of drugs to avoid treatment interruption.

Based on lessons from Lagos, where the lockdown affected the ability of program staff to travel to facilities to provide support, the Kano team produced branded reflective neon jackets for all program staff to enable easy identification and facilitate travel to facilities. In addition, the National TB and Leprosy Control Programme (NTBLCP) provided cover letters to private sector providers and program staff due to their critical role in TB case detection and treatment to facilitate movement in the event of a lockdown. The team quickly rolled out a series of interventions to mitigate the impact. These interventions included trainings on COVID-19 and TB, providing infection control materials, and building provider capacity to host virtual meetings and use the TB STARR app. This app enables providers to report TB service delivery data and monitor performance in real-time, which is especially useful during lockdowns.

Concurrently, the SHOPS Plus TB program supported the Kano State TB and Leprosy Control Programme in fast-tracking the distribution of additional stock of anti-TB drugs and commodities to private facilities to avoid a stock out. Patients who were receiving treatment were able to get one-month supplies of drugs to avoid treatment interruption. Despite COVID-19, these preemptive strategies resulted in higher TB case finding in April, when the lockdown commenced, than the previous month.