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 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)

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. Electronic TB register introduced
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

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

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
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

15. 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

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?