ID: HR19-552

Presenting author: Bassirou Gandema

Presenting author biography:

Bassirou is an Ivorian peer educator in Abidjan. He has been working with PWUD for years, focusing on those living with Tuberculosis, improving their access to health and treatment

A Peer-driven, low threshold Tuberculosis screening and treatment program to address high tuberculosis prevalence among People Who Use Drugs in Abidjan, Ivory Coast.

Renaud Boulet, Bassirou Gandema, Marie Julie Toha

Issue:

In Abidjan, drugs (cocaine/crack and heroin) are mainly used by inhalation in open drug scenes, in often very precarious circumstances. Their mode of consumption and living conditions significantly increases the risk of tuberculosis (TB) transmission. The strong stigmatization of both drug use and tuberculosis results in a late-stage diagnosis.

Setting:

The number of precarious People Who Use Drugs (PWUD) in Abidjan is estimated between 6,000 and 10,000 people (2014 MdM study). In 2017, a study conducted by MdM, showed that the prevalence of tuberculosis in PWUD is 9.8%, i.e. 50 times higher than the general population (0.21% WHO 2014).

Project:

In June 2018, a low-threshold community screening project was set up. A team of two peer educators (PE) visited open drug use scenes to raise awareness on TB transmission and collect sputum directly at the drug scenes from PWUD showing signs of TB. Strong peer-driven awareness campaigning increased acceptance of the project and uptake of screening samples of people that were initially unwilling to know their status for fear of being rejected by their community. If the diagnosis turned out positive, a peer-driven support program ensures entering and maintaining care in the public TB treatment program.

Outcomes:

From June to August 2018, 8 outreach patrols were conducted, 76 PWUD were screened (9.5 PWUD/patrol) and 20 were found TB positive (2.5 PWUD /patrol). Over the same period, the traditional outreach program, including a medical team, conducted 23 outreach sessions and referred 156 PWUD that were showing signs of illness. Only 59 (38%) effectively followed up the screening referral (2.5UD/mobile unit). 6 PWUD were diagnosed TB+ (0.3 UD/mobile unit).
This groundbreaking peer driven approach for TB screening and diagnosis shows great potential with an 8 fold higher yield of Tuberculosis positive detection and effective entry into treatment.