TB Care Association1 DOT/ Adherence Cape Town

TB Care Association2 Beautiful City

TB Care Association3 CASE LOAD PER SUB-DISTRICT 2005

TB Care Association4 DOT COVERAGE 2005

TB Care Association5 HIV and TB – how do they compare? About the Disease – one is new - the other is old About the Disease – one is new - the other is old Both are highly stigmatised Both are highly stigmatised Both are highly infectious Both are highly infectious –Spread can be controlled in one - not the other One has a bulging purse the other not One has a bulging purse the other not Both fuelled by poverty & unemployment Both fuelled by poverty & unemployment One cannot be cured – the other can One cannot be cured – the other can More females affected – more males affected More females affected – more males affected Patients carefully selected for Rx– no selection in the other Patients carefully selected for Rx– no selection in the other

TB Care Association6 Where do we begin? Took on an ARV Patient Advocate project Took on an ARV Patient Advocate project De Noon, Milnerton

TB Care Association7 ARV care 7 steps to Rx Clinic Visit Medical; Lab tests; nutritional assessment; contraception Group Education Sessions What is HIV; prevention; Treatments, adherence VCT Know your status Check your CD4 count Counselling Sessions Rx 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 Plan See Dr; Pharmacist;Nurse, Therapeutic Counsellor & Dietician Set date for check-ups and Support groups Regular pill counts

TB Care Association8 TB care 3 leaps to Rx Clinic visit Informed of TB diagnosis Counselled 5 – 15 minutes Rx instructions given Return dates for sputum checks and clinic visits recorded on green card Patient Presents History taken; weighed; Blood pressure; Haemaglobin & Temperature checked; asked to produce sputum; return date given Rx Commenced After 2 weeks given option of community or workplace supervision

TB Care Association9 The Choices & Options Homebased care – nurse driven Homebased care – nurse driven IMCI – health promotion – nurse driven IMCI – health promotion – nurse driven HIV - Lay counsellors HIV - Lay counsellors ARV – community based treatment ARV – community based treatment

TB Care Association10 Community based Carers Not doneDoneHome Assessments Only visits to recallVisits patients homesVisits R30 per patient Max 15 patients pm R780 pm – 40 hrs pw Stipends Grade 8Grade 11 & 12 Fluent in English Education 35 – 60yrsUnder 35Average Age TB Treatment Supporter ARV Patient Advocate

TB Care Association11 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 lifeFrequency Taken under supervision Taken on their own Daily Treatment TB Patients ARV Patients

TB Care Association12 Preparing for integration Train all TB T/Supporters about ARV Train 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 to actively promote VCT in the community Train T/Supporter and P/Advocates to actively promote VCT in the community Push for HIV to be just another disease Push for HIV to be just another disease Prepare TB patients adequately – 7 steps Prepare TB patients adequately – 7 steps Pilot the adherence model for TB Pilot the adherence model for TB

TB Care Association13 Way forward - the challenges Address stigma and confidentiality Address stigma and confidentiality Develop a standardised training manual Develop a standardised training manual Develop a standardised stipend system Develop a standardised stipend system Only implement in well managed health facilities Only implement in well managed health facilities

TB Care Association14 The Big Question ? WHO’s TB DOT model v Adherence model – can we push the boundaries?