Partnerships to Prevent, Find and Treat TB/DRTB and HIV

12 October 2010Prof Harry Hausler, Director

Overview

• TB/HIV Care Association• Challenges with drug-resistant (DR)-TB• Decentralised DR-TB - Khayelitsha• Partnerships to prevent, find and treat DR-TB• Role of Community Care Workers to extend

services to communities

TB/HIV Care Association

• Celebrating 81 years of caring – founded 1929

• Initially social support for TB patients in Cape Town Metro

• DOT supporters, patient advocates for ART• CDC/PEPFAR funding for Project Integrate

(2007-)• National DOH funding for integrated

TB/HIV Community Care Workers (2008-)• Now in 5 districts, 4 provinces of SA

TB/HIV Care: Objectives

• Prevent new HIV and TB infections• Improve the diagnosis, care & adherence

support for TB patients & PLHIV• Build the capacity of individuals &

organisations to provide optimal TB & HIV prevention & care

• Participate in operational research and the development and implementation of M&E systems to improve TB & HIV prevention and care

TB/HIV Care: Programs• HIV counseling and testing linked to TB and STI

screening• Clinical TB/HIV training and mentorship – 3 I’s

and NIMART• Community based services for prevention, case

finding and treatment adherence• Support to:– Workplaces– Correctional services (prisons)– TB hospitals

Challenges with DR-TB• Drug resistant DR-TB can develop in a person who does not adhere

to treatment or is given suboptimal regimen or by infection with MDR strain

• DR-TB and drug susceptible TB are transmitted the same way – airborne

• Undetected cases are most infectious• In SA in 2009:

– Estimated 13000 MDRTB cases– Lab confirmation 9000 cases– 4143 registered on treatment

• Treatment 18-24 months with 6 months injections• Hospitalisation required until culture conversion – high default• Fear and stigma

Rationale for decentralised MDRTB treatment

• Inadequate number of hospital beds• Patients may remain untreated while waiting

for admission• Patients often abscond from hospital to return

to their families• Decentralised treatment more patient-

centred, allows patients to remain with their families, less expensive

Khayelitsha Decentralised DR-TB Project

• Improved diagnosis – drug susceptibility testing for all TB suspects with previous TB tx, patients with positive sputum smears at end of 2/3 months treatment, high risk (HCW, prisons, known DR-TB contacts)

• Since 2008, DST performed using rapid polymerase chain reaction (PCR) method (Hain Genotype MDRTBPlus) – results in 24 h

• In 2010, piloting Gene Xpert

Khayelitsha DR-TB Project• Diagnosis given at local clinic• Counseled by dedicated DR-TB counselor and

treatment started by medical officer• Patient data sent to Brooklyn Chest Hospital for

registration and authorisation of Rx• Severely ill and XDRTB patients hospitalised• Counseling at home, infection control assessment

and contact screening• Patient visits clinic daily for treatment• Lizo Nobanda step down facility

The Need for Partnerships• The size of the TB/DR-TB and HIV burden is

too great for any one role player to tackle alone

• Need for partnerships between government, private sector, non-governmental organisations, researchers, health workers, and communities to develop effective strategies to fight TB/DR-TB and HIV and to ensure access to services and coverage of the entire population

Business Activities• Prevent TB/DRTB and HIV

• Educate managers and workforce about how TB is spread, cough hygiene, the link between TB and HIV, HIV prevention, condom use, IPT

• Find TB/DRTB and HIV– Provide HIV testing linked with TB screening– Ensure that sputum collected and DST performed for

retreatment suspects or high risk patients• Treat TB/DRTB and HIV

– Sick leave until no longer infectious – Antiretroviral treatment for all DRTB patients– Workplace adherence support – Allow time to go for follow up visits to encourage adherence– Psychosocial support

TB/HIV Care Workplace Programme

• Educate employers and employees on TB and HIV

• Link workplaces to community based HCT programme for HIV testing and TB/STI screening and referral

• Coordinate workplace adherence support for working TB and ART patients

Community Based HCT (CBHCT)

Workplace – Wellness Day

Community Care Workers (CCWs) – Western Cape

CCWs – Sisonke

CCW Package - HIV• Prevent– Distribute condoms– Promote: decreased exposure, HCT, PCR,

disclosure/acceptance, circumcision, safe feeding• Find– Provide HCT

• Treat– Remind clients to attend scheduled visits (6 monthly

CD4, annual Pap)– Adherence support (pill counts, support groups) for

CPT, ART

CCW Package - TB• Prevent– Trace child contacts and refer for IPT– Promote: infection control (cover cough, open windows),

know TB symptoms and seek care • Find– Screen for TB symptoms– Refer or collect sputum from symptomatics and provide

results• Treat– Remind clients to attend scheduled visits (2/3 month and

5/7 month smears)– Adherence support for TB treament, IPT

How Business can work in partnership to help stem the tide

• Identify and meet with local NGO• Work together to prevent, find and treat

TB/DRTB and HIV– In the workplace– In the communities where workers live

• And join with NGOs in…

Advocacy

Moving Forward in Partnership to Fight TB/DR-TB and HIV

THANKS!

Acknowledgements• Funders

– CDC PEPFAR– Departments of Health and Social Development– Community Chest– Lotteries– ABSA, Alan and Gill Gray Trust, Bargaining Council for the Building Industry, BOE, EL

Darter Charitable Trust, Jet Lee Will Trust, Joan St Leger Lindbergh Charitable Trust, C&E Harding Trust

• Management team and staff of TB/HIV Care• Communities that we serve• People infected and affected by HIV and TB