Standard Operating Procedures

Standard Operation Plan (SOP) for TB screening at pharmacies

Introduction

Tuberculosis (TB) remains one of the major health problems in South Africa and is the leading cause of death in the country. TB is mainly managed in the public sector with a few patients receiving treatment from the private sector. The Government has embarked on a national agenda of screening 90% of vulnerable communities, ensuring 90% of presumptive TB clients are initiated on treatment and ensuring that 90% of TB patients are cured, which was launched in 2015 by Honourable Deputy President Ramaphosa.

Concerted efforts are needed to address the issue by involving all sectors including private sector. The private health sector, including pharmacies can contribute substantially to the detection of additional TB cases in the community. Involving pharmacists would help increase early detection of TB cases so that people with TB can be found, linked to care and treated faster.

This SOP gives guidance on how to utilize the TB screening tool and Information Education and Communication (IEC) material distributed to the pharmacies.

Objective

For pharmacists to provide TB screening services to clients

Pharmacist should screen for TB in the following patients visiting their facilities:

  • Clients presenting with cough symptoms
  • Clients with chronic illnesses such as HIV, Diabetes and other lung diseases coming for follow up of their medication

How to use the screening tool

  • Section A: entails capturing client’s demographic information. The section that requires the patients folder number can be left open or write ‘N/A’
  • Section B: entails capturing the client’s medical history.
  • Section C: entails asking the 4 TB screening symptom questions.
    • There is a section for adults and a section for children.
    • Please note that screening for children is done by questioning the parent/guardian.
    • When screening children, indicate whether the child is above or under the age of 5.
    • Adults and children cannot be screened on the same screening sheet. A separate sheet should be used for each patient.
  • Screening process
    • Each clients must be asked the 4 TB symptom questions
    • If a clients is experiencing any of the symptoms as explained in the tool, you tick ‘yes’ or ‘no’ if they are not.
    • If a client states ‘yes’ to any one of the 4 questions they are known to presumptive for TB and need to be referred to their nearest public health facility/clinic to get tested for TB (you can ask them which facility/clinic is closest and convenient for them to go to).
    • If a client states ‘no’ to all of the questions then it means that they are not symptomatic for TB and therefore don’t need to be referred.
  • Under ‘date of last TB test’ the year (e.g. 2015) would also be sufficient if they do not remember the exact date or month. If it is their first time being screened then you may write the actual date you screened them.
  • Under ‘sputum collected’ tick ‘no’ as the sputum will be collected at the public health facility/clinic.
  • Organization’ you write the name of your pharmacy, please write ICPA member in brackets next to you name.
  • Under ‘screened by’ the pharmacists will put their own name there.
  • Referral Process
    • The top part of the screening tool must be torn out by the proliferated side and be given to the client to present at the public health facility.
    • The carbon copy (yellow sheet), which will serve as a duplicate must remain in the book for your records of the total number of people screened.

IEC Material

  • The IEC material are TB smart cards in various languages and a TB and Pregnancy brochure. These provide your clients with more information on TB.
  • The materials are for be distribution to your clients. They can be placed anywhere in the pharmacy where the clients can easily see them and take.

Reporting on numbers screened

  • At the back of the screening tool there is a form to assist you in consolidating the numbers of patients that will have been screened for TB. Kindly consolidate the screening numbers for your unit and send the total number of people screened to leratole@urc-sa.com , broken down as follows:
    • Number of people screened
    • Number of people with TB symptoms
    • Number of people referred for sputum investigation
    • Number of people diagnosed with TB (if known)
    • Number of people initiated on TB treatment (if known)
  • We request that consolidated numbers be send on a weekly basis to enable us to track progress. Reports should be send every Friday by end of day.
  • USAID TB care II will provide feedback to the participating pharmacies on the progress in screening clients for TB.