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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
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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
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This presentation Situation Analysis Background & Baseline
Voluntary Counseling and Testing Preventive Therapy Conclusion
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Population uGu District 704 141 (8% of KZN)
6 municipalities Hibiscus Coast Ezinqoleni Umzimabantu Umdone Umzumbe Vulamehlo (8% of KZN) Highest density in coastal towns Traditional housing in rural areas - homesteads scattered 15 – 49 year old’s (1996 Census)
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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
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Fig. 1: National and KwaZulu-Natal antenatal HIV prevalence
% Source: National Health
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Electronic TB register introduced
Fig.2: Incidence of TB in KwaZulu-Natal & Numbers of TB cases at Murchison Electronic TB register introduced
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Table 1: Results of HIV testing in TB Patients at Murchison Hospital TB Clinic
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Fig.3: Reasons Why TB Patients Accept HIV Testing
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Fig. 4: Reasons Why TB Patients Refuse HIV Testing
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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
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Fig. 5: Outcome of a sample of all TB patients from Murchison TBCP : 1998 - 2001
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Fig. 6: Follow up of Patients previously lost to follow up in the Murchison TB Control Programme – Jan-June 2001
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TO ESTABLISH UGU SOUTH AS AN HIV/AIDS/TB/STD PILOT SITE
PHASE 1: May 1999 – April 2001 TO ESTABLISH UGU SOUTH AS AN HIV/AIDS/TB/STD PILOT SITE 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
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Use of Lay Counselors Phase 1: 10 Phase 2: 25
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
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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
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Fig. 7: Number of people counseled for VCT and number of VCT counselors
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Fig. 8: Gender distribution of people counseled for VCT phase 1 and phase 2 combined
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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
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107 68 25 46 122 153 154 74
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Includes WHO stage 2
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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
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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?
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