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THE KENYA ASSOCIATION FOR THE PREVENTION OF TUBERCULOSIS AND LUNG DISEASES – KAPTLD

Introduction

The Kenya Association for the Prevention of Tuberculosis and Lung Diseases (KAPTLD) was created to bring harmony in the management of lung diseases in Kenya notably Tuberculosis (TB), Asthma, Chronic Obstructive Pulmonary Disease (COPD), Flus and tobacco smoke related diseases. In line with this, KAPTLD supports the efforts of the Kenyan National Tuberculosis and Leprosy Program (NLTP) with special emphasis on the private health practitioners and the private sector.

History of KAPTLD

KAPTLD has a history dating back to late 1950s.

The association started as the Kenya Association Against Tuberculosis (KAPT) in 1957. KAPT was a forum for exchange of ideas and experiences by those with a special interest in TB. The association was entirely focused on tuberculosis. KAPT was a part of a larger global movement against TB- the International Union Against Tuberculosis (IUAT).

When the global organization (IUAT) changed its name to the International Union Against Tuberculosis and Lung Diseases (IUATLD) to reflect a broader interest in lung health including asthma, ARI and tobacco related lung diseases, KAPT changed its name (1998) to the Kenya Association for the Prevention of Tuberculosis and Lung Diseases (KAPTLD) and thus diversified its activities beyond tuberculosis. This diversification eventually led to the merger between KAPTLD and that National Asthma Association of Kenya (NAAK), the two organizations effectively merged into one in 2004.

With the realization that close to 60% of all the TB patients in Kenya are co-infected with HIV, KAPTLD is gradually broadening its activities to cover HIV/AIDS as well.

Key achievements

1. PPM DOTS project

Among the key achievements was the initiation, in close collaboration with NLTP, of the private sector TB treatment project in 1999. This project has been a great success and has catapulted the association into the national and global limelight. The project known world over as evidenced by the decision of WHO DEWG to meet in Kenya later in the year (2006). The project entails training of health workers, support supervision, provision of quality fixed dose combination (FDC) anti-TB drugs, supervised patient dosing (DOT) and proper recording of TB cases.

2. Acceptance by the private sector

The association has been able to hold regular CMEs in TB for all cadres of health care workers through the private sector TB treatment project. In addition, the association has been able to hold regular (monthly) scientific meetings of the chest physicians and pediatricians, with the support of the pharmaceutical industry, in particular Glaxo-SmithKline. The establishment of a KAPTLD website and a newsletter aims at enlightening the general public on the activities of KAPTLD and developments in respiratory health.

3. The ISAC initiative in Kenya.

ISAC (Intensified support and Action Countries) is a special emergency initiative to accelerate DOTS expansion and reach the 2005 targets, within the Global Plan to Stop TB. It ultimately aims at achieving the 2010 mortality/prevalence reduction targets and the 2015 MDG of decreasing TB incidence. ISAC focuses international assistance and support efforts by the Stop TB Partnership on selected countries, including Kenya, through the DOTS Expansion Working Group (DEWG), in order to reach the Millennium Development Goals (MDGs). KAPTLD was selected by stop TB partnership as the lead agency for ISAC project in Kenya.

Besides other components, the project hired 20 Assistant District TB Coordinators (DTLCs) and 6 Assistant Provincial TB Coordinators (PTLCs) to boost the efforts of NLTP in the worst hit regions along the Mombasa Kisumu HIV belt. In addition, PATH (Program for appropriate Technologies in Health) hired 10 more DLTC assistants. The 36 staff are distributed all over Kenya and work in close collaboration with the NLTP staff and other Ministry of Heath staff on the ground. (All the 36 staff are managed by KAPTLD)

4. Asthma management guidelines

On realizing that asthma cases were on in the increase in Kenya and that there were not clear guidelines on proper management of asthma, KAPTLD spearheaded the development of the consensus statement for management of asthma in Kenya. This placed Kenya among the first 5 countries in Africa to have a clearly stated method of managing asthma. The booklet was launched in March 2006.

5. Established functional secretariat.

This has been made possible primarily by KAPTLD efforts in TB control. Funds for establishing the secretariat were initially received from the Dutch government and later from CDC and recently from the Intensified Support and Action Countries (ISAC) initiative of the stop TB partnership. Besides the 7-member secretariat, the association now has staff distributed in 6 provinces along the Mombasa Kisumu TB/HIV belt.

6. TB Performance awards.

KAPTLD has sourced funds and successfully organized two performance awards for the TB services providers in Kenya. The last performance awards were issued in March 2006 in which awards worth over Ksh 4.8 million were given to outstanding TB care providers.

Key strengths

Among our strengths is the good relationship with NLTP, a nationwide presence and access to a wide pool of professional advise (see Strategic plan for a detailed environmental scan).

1. Relationship between KAPTLD and NLTP

KAPTLD and NLTP have had a long and much intertwined history. NLTP uses KAPTLD to create a broad forum for the participation of various stakeholders in TB/HIV control. The private sector TB control project that is managed by KAPTLD was developed in the context of a NLTP/KAPTLD unit that initially intended to bring sanity in the management of TB in the private sector and reduce the risk of emergence of drug resistant TB while at the same obtaining data on the magnitude of TB managed by this sector. The project has been in existence since 1998 but became truly recognizable in 2002. Since then, nearly 5,000 TB cases have been successfully treated through this project. In 2004 the project contributed 10% of the nearly 18,000 cases of TB that were notified in Nairobi with treatment success rates similar to those observed in the public sector.

2. Successful PPM DOTS Tuberculosis Model

The KAPTLD private sector TB DOTS (Directly observed treatment Short course) model is one of the most successful in Africa. At the moment, the PPM (Private Public Mix) DOTS network has over eighty private providers all implementing DOTS strategy of TB management. KAPTLD provides support supervision and training to these centers and gradually links them to the NLTP TB care network. There are plans to have NLTP introduce free anti-TB medicine to all the private care providers in Kenya. Such a move will let KAPTLD concentrate efforts on Quality control and training.

3. Professional technical support

Activities of KAPTLD are implemented by a secretariat of with diverse professional backgrounds. Policymaking is done by a board composed of reputable chest physicians in Kenya. Besides, the technical advise offered to NLTP by such global bodies like the Royal Dutch TB association (KNCV), Centers for Disease Control (CDC) and the World Health Organization (WHO) trickle down to KAPTLD (being the main NLTP co-implementing partner). Members of the secretariat are also scheduled to regularly attend the International Tuberculosis management course organized by the International union against tuberculosis and lung diseases (IUATLD) to keep them abreast with the current TB management practices.

4. Nationwide presence

Under the ISAC initiative, KAPTLD employed 36 staff now distributed in 6 of the 8 provinces in Kenya (Eastern, Coast, Nyanza, Western, Nairobi, and Central provinces). In addition, KAPTLD has successfully applied for the Fidelis (Fund for innovative DOTS Expansion Through Local Initiatives). The project due to start in July 2006 will recruit 20 Nurses/Clinical officers to help DOTS expansion efforts in twenty (20) districts. The Fidelis project will entail active case finding and improvement of patient referrals (to reduce the patient related delays to proper TB care). 5. Workplace respiratory health program

KAPTLD runs a workplace respiratory health program in Nairobi. The program aims at creating awareness on respiratory health through a workplace approach with emphasis on HIV, tuberculosis and other lung diseases especially those relating to occupational health.

Partners

Besides the aforementioned partnership with the NLTP, KAPTLD has formed strong partnerships with PATH (through the March 2006 PATH-KAPTLD agreement), pharmaceutical companies (GSK, Astra Zeneca, Sanofi Aventis among others), the John Snow Inc, Community Habitat Finance (CHF). KAPTLD is also a member of the Global STOP TB partnership, which enables us access to a wide variety of resources. A section of the KAPTLD board members are also key players and consultants in the global asthma drug facility, the DEWG among other policy-making organs.

Conclusion

With the current capacity, donor interest and the potential for expansion, KAPTLD is in a position to contribute significantly to the attainment of the TB-HIV related MDGs in Kenya.