Overview of strategy and goals for FY14

CAP-TB PROJECTChina

August 2013

CAP-TB: Strategic Model

Awareness Go to health facilities

Diagnosis Begin Treatment Continue Treatment

Complete Treatment

Poor awareness of TB /MDR-TB

Private pharmacies / clinics preferred

Poor communication between patients and health providers

Poor knowledge of length treatment /regimen /cost

Poor knowledge of length treatment /regimen /cost

Poor knowledge of length treatment /regimen /cost

Low risk perception

Time, cost, distance to TB clinics

Economic burden Time, distance to TB clinic

Stop treatment when they feel better…..

Lack of support from family and peers

Don’t understand government free policy

Lack of knowledge on selecting right institution

Poor quality of services (waiting time, attitudes)

Poor knowledge of adverse effect management

Lack of support and care from family, peers and doctors

Stigma

Poor inter-personal communication and counselling; lack of IC of household

Economic burden

Stigma Stigma Stigma

Patient’s Perspective on Barriers to Seeking TB care

CAP-TB China FY14

Goal: To increase early case detection and to improve treatment success and reduce MDR-TB-related incidence and mortality in Yunnan Province

Objectives:•To strengthen the involvement of Women’s Federation and community volunteers in TB/MDR-TB prevention and education in Xi Shan District;•To increase early case detection through interventions with high risk groups for TB/MDR-TB (migrants, PLHIV, DM and elderly) and strengthen referrals from the private sector; •To improve patient adherence through adequate treatment education, counseling and psychosocial support with greater involvement of community and patients aligned with appropriate medical care;•To strengthen capacity building in TB and MDR-TB diagnosis, treatment and care for Yunnan TCC, Kunming No.3 Hospital and others.

Prevention and

Education

Targeting Migrants• • Conducted rapid assessment on Migrants / TB Care in Xi Shan district• In Fu Hai community, 90,000 migrants and about 6,000 local residents.

(93% migrants)• Conducted outreach in construction sites

FY14• Increase community educational activities in Fu Hai community • Educational activities for construction workers at the workplace / job

market • School children as bridge population for migrant workers

Communities with Migrants

Construction Workers

School Children

Fu Hai community

Prevention and

Education

Targeting Diabetes Patients

• There are 12,000 diabetes in Xi Shan district • Bi-directional screening started from June, FY13• Conducted the first site visits in July • 330 patients screened during the last 2 weeks of June after

initiation of the screening

FY14• Continue bi-directional screening of diabetes/TB in routine

community health service (10 CHC and TCC )• Continue collecting and analyze the screening data by using

monthly reports and daily patients records• Document the process for the local government in order to

expand the screening model

Prevention and

Education

Treatment

Targeting PLHIV

Conducted rapid assessment on HIV/TB • Yunnan province has highest HIV prevalence in China • Yunnan HIV Inpatient Care Center 30% of PLHIV patients are

co-infected with TB• HIV Outpatient Care Center and “Blue Sky” HIV CBO

Provided a 4-days TB/HIV training for clinicians on diagnosis, treatment and management of TB/HIV co-infection

FY14Supporting clinicians: continue to provide trainings and case review workshops to enhance clinicians capacity for TB diagnosis and treatment of TB/HIV

Supporting “Blue Sky” HIV CBO• Screen and refer HIV patients for TB care; • Provide TB prevention education among PLHIV• Conduct regular group activities in Care Center (in-

patient)

Prevention and

Education

Targeting Elderly

• “Essential public health service program”: Since 2011, government has provided an annual physical check-up for elders. But, this check-up does not include TB screening

FY14: • Integrate TB Symptom screening and X-ray into annual

physical check-up; • Pay home visits to disadvantaged elderly people for TB

education by Women’s Federation in Chinese festivals; • Organize small group activities and events for elderly people in

the project communities with the support of the community elderly union.

Prevention and

Education

Working with private sector

• Worked with private clinics and pharmacy on TB referral • Conducted Consultation with Private Sector Pharmacy and Clinics

in May FY13• Poor knowledge of TB symptoms ( clinicians listed more symptoms

than pharmacy staff )• Most of them were not concerned about becoming infected by a

client. Minimal IC practices, particularly among pharmacy staff

FY 14• Improve the training quality targeting private clinics• Provid posters on key message of TB to pharmacies• Provide regular facilitation to increase referrals from private

clinics and pharmacies in the communities• To develop of IEC material to facilitate the dissemination of

key messages

Diagnosis

Improve TB diagnosis

•There is only one Gene Xpert in Yunnan provided by CAP-TB program •Conducted training on rapid test •Coordinated with No. 3 Hospital on MDR-TB referral to TCC

FY14•Continue lab training on Gene Xpert and LED microscopy for technicians •Conduct EQA for No. 3 Hospital lab by Yunnan CDC /Kunming CDC •Support provincial lab on ISO15189 credit •Continue provide MDR-TB diagnosis training for No. 3 Hospital and TCC

TreatmentInitiation

MDR-TB management

•With the support from Union, conducted TB/MDR-TB management training and case review for clinicians at TCC •Conducted regular distance consultations for MDR-TB cases by Skype

FY14•Engagement of No. 3 Hospital •Provide training and case review for clinicians (especially for No 3 hospital) in proper management of TB/MDR-TB •Continue conducting regular distance consultations for MDR-TB cases by Skype•9-month “ short regimen” for MDR-TB in Kunming, Honghe and Yuxi

TreatmentSuccess

User friendly health care services

Health providers•Provide quality and user friendly treatment and care to patients at Yunnan TCC and Kunming No.3 Hospital; •Conduct client satisfaction surveys for quality improvement ;

Peer support group •Provide online education to TB/MDR-TB patients on treatment, via QQ Group through peer counselors; •Conduct treatment adherence education for TB/MDR-TB patients, face to face, either one-on-one or small group through (peer) counselors.

Cross-cutting

Strategies

Infection Control

•Conducted IC rapid assessment in different health services sites•Improved IC in health services according to assessment •Developed household IC checklist•Conducted group activity on IC education for MDR-TB patients and family members

FY14•Continue providing IC training for clinicians, community health workers and TB patients•Provide IC within household.

Thanks! Xie Xie