ProTEST Lessons Learned Workshop

1. ProTEST Lessons Learned Workshop South Coast Hospice Pilot Site, UGU DISTRICT KwaZulu-Natal Audrey Penrose, SC Hospice Cathy Connolly, Medical Research Council Stephen Knight, University of Natal Harry Hausler, Technical Advisor, TB & HIV/AIDS

2. Acknowledgments • Dr Laura Campbell – Phase 1 project manager • Sr Dudu Ndlovu - Phase 2 Clinical Coordinator • District TB, HIV/AIDS and PHC Coordinators • South Coast Hospice Team

3. This presentation • Situation Analysis • Background & Baseline • Voluntary Counseling and Testing • Preventive Therapy • Conclusion

4. Population • uGu District • 6 municipalities • Hibiscus Coast • Ezinqoleni • Umzimabantu • Umdone • Umzumbe • Vulamehlo • 704 141 (8% of KZN) • Highest density in coastal towns • Traditional housing in rural areas - homesteads scattered • 15 – 49 year old’s 234 166 (1996 Census)

5. Providers / Stake holders • South Coast Hospice • uGu South Community • KwaZulu-Natal Health Department • uGu Health District • Provincial AIDS, TB, Home-based Care & VCT Programmes • Medical Research Council, Durban • National TB/HIV/AIDS Adviser • School of Family & Public Health Medicine, Univerisity of Natal

6. Fig. 1: National and KwaZulu-Natal antenatal HIV prevalence % Source: National Health

7. Fig.2: Incidence of TB in KwaZulu-Natal & Numbers of TB cases at Murchison Electronic TB register introduced

8. Table 1: Results of HIV testing in TB Patients at Murchison Hospital TB Clinic

9. Fig.3: Reasons Why TB Patients Accept HIV Testing N = 99

10. Fig. 4: Reasons Why TB Patients Refuse HIV Testing N = 54

11. TB patients who refuse HIV testing: • younger • better educated • more female • more informed about HIV transmission • less likely to have had sufficient information or privacy to make decision • Most would be willing to test with access to treatment

12. Fig. 5: Outcome of a sample of all TB patients from Murchison TBCP : 1998 - 2001

13. Fig. 6: Follow up of Patients previously lost to follow up in the Murchison TB Control Programme – Jan-June 2001

14. TO ESTABLISH UGU SOUTH AS AN HIV/AIDS/TB/STD PILOT SITE PHASE 1: May 1999 – April 2001 PHASE 2: March 2002 – April 2003 EVALUATION & CAPACITY BUILDING THE PURPOSE OF THE PROJECT WILL BE TO CONSOLIDATE THE PILOT ACTIVITIES WITHIN THE UGU DISTRICT HEALTH SYSTEM AND TO EXTEND PILOT ACTIVITIES TO OTHER SITES IN THE UGU DISTRICT IN KZN

15. Use of Lay Counselors • Feasible & acceptable to clinical staff & community • Allows clinic professional nurses more time for other duties • Positive impact on uptake of VCT • Good quality counseling • Increase in self referrals Phase 1: 10 Phase 2: 25

16. Rapid Tests • Performed by PHC clinic staff • Clients received same-day results • Easy to perform - “Oroquick” • No. of rapid HIV tests used increased by 1036% per quarter in Phase 1

17. Fig. 7: Number of people counseled for VCT and number of VCT counselors

18. Fig. 8: Gender distribution of people counseled for VCT phase 1 and phase 2 combined

24. TB Preventive Therapy – IPT • Problem with record keeping in Phase 1 • System fully implemented in phase 2 • Clinic staff – overworked • Adherence factors difficult to quantify

27. 107 68 25 46 122 153 154 74

28. Includes WHO stage 2

30. Improvements in Phase 2 Full-time clinical coordinator Regular support for counselors & clinic nurses On-going onsite supervision Rapid tests – supplied by DoH Improved record keeping system Improved standard operating procedures

31. The future • Full analysis of phase 2 • Adherence • Analysis of clinical staging etc • Integration and take-over by Health District • After April 2003 ??? • What happens to the pilot site?