Private Sector as a key player for TB action

1. Private Sector as a key player for TB action GBC’s Conference on TB, HIV/TB Co-Infection & Global Fund Partnership Dr Salome Charalambous

2. The Aurum Institute • Independent public benefit organisation that originated in the South African gold mining industry • Mission: “An African institution that transforms health in the community.” • TB and HIV prevention and treatment • Medical research and health systems management

3. Why TB in prisons? • Currently there are ~189,748 people incarcerated in South Africa • High TB rates and the emergence of drug resistant TB strains due vercrowding, poor ventilation, malnutrition and depressed immune status • Implications for morbidity and mortality in these offenders and staff members in prison • TB infection control becomes an issue as these offenders are released back into the general community

4. Preventive therapy Increase active case finding Reduce latent TB prevalence Reduce active TB prevalence HIV prevention Reduced burden of disease Reduce HIV incidence/prevalence Reduce TB transmission Reduce rate of TB in HIV +ves Diagnose HIV & treat with ART Reduce institutional TB transmission Strategic framework for TB control (Adapted from Churchyard GJ, Corbett EL. Handbook of Occupational Health. SIMRAC, 2001)

5. FACILITIES WHICH WE SUPPORT

6. HIV Treatment programme(results to March 2010) From stats reported by the DCS, Databases implemented in Jhb and Pretoria * Figures for current (underestimated)

7. Lessons learnt • Rapid implementation due to highly structured and disciplined environment • Procurement of drugs initially difficult due to lack of clarity on responsibility for this • Security within the prisons: difficulties with delivery of equipment and installation and maintenance of data systems • Difficult to appoint a doctor who was not familiar with the prison system due to security concerns • High losses being experienced due to continuous movement within the prison system

8. Integration of TB-HIV services • Started at Attridgeville prison and rolled out to others. • A TB focal person and a TB-HIV committee • Screening for TB prior to enrollment • Separate cells were identified to isolate smear+ve TB pts. • TB Training for nurses at all facilities: • 14 nurses trained on infection control in May 2010 • Training of peer educators on TB using training academies • 30 in Johannesburg, 25 in Pretoria, 25 in Boksburg • Refresher training 3 months later • Mantoux test: training and first testing done as a special activity with community mobilisation (no longer required)

9. Ceiling fans in all the consulting rooms and a UV light and fan in the main consulting room. Metal window cages with welded mesh wires were procured and windows were unwelded so as to improve ventilation in the clinic

10. TB-HIV integration results • 1637 offenders have been tested for TB at admission to prison between Jan and June 2010 • 173 HIV-infected offenders were screened for TB • 190 HIV positive offenders are on co-trimoxazole preventive therapy • 44 inmates have been started on IPT • 7 inmates currently on TB treatment • 12 offenders placed in isolation cells

11. Advocacy & community mobilisation 3000 offenders gathered for the launch of the TB screening research project “Herisa Refuba” Tsonga for Stop TB following an intensive community mobilisation campaign where the department of corrections drama, choir, poetry and rapper groups put together messages about TB

12. One offender: “Get tested, please Gents, I urge you. I was diagnosed with TB and they picked it up early enough to save me but I can’t walk properly anymore.. Because of TB.”

13. Lessons learnt • Community mobilisation very useful in educating offenders but also increasing demand for services • Challenges with infection control with regards infrastructural changes that may be required • Advantage of setting: relatively cheap to implement structural changes as have a workforce and building expertise that able to assist with these • Difficulty with INH mainly due to lack of clarity in guidelines and need for Mantoux test

14. 'One of the most unfailing tests of a civilization lies in how a country treats its criminals.’ Winston Churchill

15. Aurum Institute for Health Research Prof. G J Churchyard Dr D Clark Dr F Randera Dr A Tongman Dr L Telisinghe S. Maboy J. Lethoba G. Gresak T. Puso R. Hamilton T. Dwadwa M. Modiba P. Hippner M. Eisenstein C. Ramatopa G. Kubeka London School of Hygiene and Tropical Medicine Dr K Fielding Dr A Grant Department of Corrections, South Africa CDC South Africa / President’s Emergency Plan for AIDS Relief Acknowledgments