More than 650,000 people live clustered in Tondo, an area of about nine square-kilometres stretching between the port and the business district of Manila, one of the most densely populated slums in the world. During COVID-19 prolonged lockdowns and disruptions to TB services in the Philippines meant those in overcrowded areas faced a double risk. As elsewhere, restrictions on movement, concerns over the risks of visiting health facilities, shortages of medical personnel and the closure of health facilities led to a sharp drop in the number of diagnosed TB cases, as well as disruptions to TB treatment

An MSF team conducts contact tracing of households
Tackling tuberculosis in the slums of Tondo, Manila, Philippines

In collaboration with the Manila Dept of Health, MSF teams launched an active case-finding project for TB in Tondo. The aim is to screen people, trace contact cases, and refer TB-positive patients to local health centres. They also follow up with patients to ensure they adhere to the treatment regimen and break the chains of transmission. The project makes screening accessible and available near the area where where community members live and work.

But the presence of the X-ray device alone is not enough to encourage people to get screened. When the project started few people wanted to be screened because of preconceived notions and fears about TB. Among the fears is potentially discovering an infection and being rejected by family and neighbours who are afraid of getting sick themselves, or losing their jobs. Treatment takes time and requires visiting the health centre on a regular basis for six months to refill medication. Transportation to health centres can also be expensive. The main challenge is to encourage people to participate in screening even if they feel healthy.

MSF’s health promotion team, in collaboration with local authorities, is trying to overcome these obstacles. Every day, the health promotion teams encourage people to get screened, knocking on every door. The team also conduct awareness-raising sessions to address misconceptions about the disease. The message is clear: TB can be cured and treatment reduces the risk of infection in the household. Now, between 400 and 450 people come for screening in the MSF truck every week.

Infants and young children are particularly prone to severe and fatal forms of the disease. However, the diagnosis of children is more complex than adults, as it is difficult for them to produce the sputum needed for laboratory analysis. In addition, nutritional deficiencies in Tondo make children even more vulnerable. Protecting children through preventative measures in parallel with the treatment of adults when contamination is suspected is a priority.

The rate of confirmed TB cases among the 6,400 people the teams have screened in the last 10 months is on an average five per cent. The teams continue to track down TB door after door, day after day.

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