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

2. Partnerships to Prevent, Find and Treat TB/DRTB and HIV 12 October 2010 Prof Harry Hausler, Director

3. 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

4. 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

5. 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

6. TB/HIV Care: Programs • HIV counselingand 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

7. 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

8. 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

9. 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

10. 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 • LizoNobanda step down facility

11. 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

12. 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

13. 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

14. Community Based HCT (CBHCT)

15. Workplace – Wellness Day

16. Community Care Workers (CCWs) – Western Cape

17. CCWs – Sisonke

18. 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

19. 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

20. 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…

21. Advocacy

22. Moving Forward in Partnership to Fight TB/DR-TB and HIV THANKS!

23. 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