TB Care AssociationTB Care Association 11

DOT/ AdherenceDOT/ Adherence

Cape TownCape Town

TB Care AssociationTB Care Association 22

Beautiful City Beautiful City

TB Care AssociationTB Care Association 33

CASE LOAD PER SUB-DISTRICTCASE LOAD PER SUB-DISTRICT 20052005

Southern

7%

576/ 100 000

Khayelitsha

23%

1612/ 100 000

Eastern

17%

1047/ 100 000Tygerberg

8%

496/ 100 000

N Panorama

12%

782/ 100 000

M Plain

12%

754/ 100 000

Central

6%

606/ 100 000

Klipfontein

15%

1028/ 100 000

TB Care AssociationTB Care Association 44

DOT COVERAGEDOT COVERAGE 20052005

44

25

43 4

7

24

45

42

34

54

67

52

41

58

34

48 5

4

3

8

5

12

18 20

11 12

0

10

20

30

40

50

60

70

80

Klipfontein Central M Plain N

Panorama

Southern Eastern Tygerberg Khay

Community & Workplace Clinic Other & No Support

TB Care AssociationTB Care Association 55

HIV and TB HIV and TB – how do they – how do they compare?compare?

About the Disease – one is new - the other About the Disease – one is new - the other is oldis old

Both are highly stigmatisedBoth are highly stigmatised Both are highly infectiousBoth are highly infectious

– Spread can be controlled in one - not the otherSpread can be controlled in one - not the other One has a bulging purse the other notOne has a bulging purse the other not Both fuelled by poverty & unemploymentBoth fuelled by poverty & unemployment One cannot be cured – the other canOne cannot be cured – the other can More females affected – more males More females affected – more males

affectedaffected Patients carefully selected for Rx– no Patients carefully selected for Rx– no

selection in the otherselection in the other

TB Care AssociationTB Care Association 66

Where do we begin?Where do we begin? Took on an ARV Patient Advocate projectTook on an ARV Patient Advocate project

De Noon, Milnerton

TB Care AssociationTB Care Association 77

ARV care 7 steps to RxARV care 7 steps to RxClinic Visit

Medical; Lab tests;nutritional assessment;

contraception

Group Education Sessions

What is HIV; prevention;Treatments, adherence

VCTKnow your status

Check your CD4 count

Counselling SessionsRx readiness; psycho-

social assessment;Knowledge about Rx,

adherence; side-effects

Home visit(Patient Advocate)

Checking support needed for Rx adherence

Home Assessment

Rx readiness Assessment

MO reviews clinical & lab findings

Clinic team reviews readiness

Rx Start-up & Follow-up PlanSee Dr; Pharmacist;Nurse,

Therapeutic Counsellor & DieticianSet date for check-ups and

Support groupsRegular pill counts

TB Care AssociationTB Care Association 88

TB care 3 leaps to RxTB care 3 leaps to Rx

Clinic visitInformed of TB diagnosis

Counselled 5 – 15 minutes Rx instructions given

Return dates for sputum checksand clinic visits recorded on

green card

Patient PresentsHistory taken; weighed;

Blood pressure; Haemaglobin &Temperature checked;

asked to produce sputum; return date given

Rx CommencedAfter 2 weeks given option of community

or workplace supervision

TB Care AssociationTB Care Association 99

The Choices & OptionsThe Choices & Options

Homebased care Homebased care – nurse driven– nurse driven

IMCI – health IMCI – health promotion – promotion – nurse driven nurse driven

HIV - Lay HIV - Lay counsellors counsellors

ARV – community ARV – community based treatmentbased treatment

TB Care AssociationTB Care Association 1010

Community based CarersCommunity based Carers

Not doneDoneHome Assessments

Only visits to recallVisits patients homes

Visits

R30 per patientMax 15 patients

pm

R780 pm – 40 hrs pw

Stipends

Grade 8Grade 11 & 12Fluent in English

Education

35 – 60yrsUnder 35Average Age

TB TreatmentSupporter

ARV PatientAdvocate

TB Care AssociationTB Care Association 1111

Patient Care Patient Care

Not includedIncluded in package of care

Support groups

2 – 4 daily5 – 6 dailyNumber of tablets

1 x 5 days 6 - 8mths

2 x daily for life

Frequency

Taken under supervision

Taken on their own

Daily Treatment

TBPatients

ARVPatients

TB Care AssociationTB Care Association 1212

Preparing for Preparing for integrationintegration

Train all TB T/Supporters about ARVTrain all TB T/Supporters about ARV Train all ARV P/Advocates about TB Train all ARV P/Advocates about TB Train T/Supporter and P/Advocates Train T/Supporter and P/Advocates

to actively promote VCT in the to actively promote VCT in the communitycommunity

Push for HIV to be just another Push for HIV to be just another diseasedisease

Prepare TB patients adequately – 7 Prepare TB patients adequately – 7 stepssteps

Pilot the adherence model for TBPilot the adherence model for TB

TB Care AssociationTB Care Association 1313

Way forward - the Way forward - the challengeschallenges

Address stigma and confidentialityAddress stigma and confidentiality

Develop a standardised training Develop a standardised training manualmanual

Develop a standardised stipend Develop a standardised stipend systemsystem

Only implement in well managed Only implement in well managed health facilitieshealth facilities

TB Care AssociationTB Care Association 1414

The Big Question The Big Question ??

WHO’s TB DOT model v Adherence model WHO’s TB DOT model v Adherence model – – can we push the boundaries?can we push the boundaries?