1. TB and TB-HIV in the Area Surrounding St. Philips Mission Mhlathuze Lubombo A ministry of the Missionary Sisters of the Sacred Heart

2. St. Philips Mission, Mhlathuze

3. Who is Cabrini Ministries? Catholic Faith Based Organization working in area surrounding St. Philips since 1971 Changing services as needs have changed Presently seeking to respond to the needs generated by the HIV-TB pandemic surrounding St. Philips Healthcare exclusively for HIV/AIDS and TB patients Childcare – for orphans and vulnerable children

4. Who is Cabrini Ministries? Active Partner in the Swaziland Stop TB Partnership Strong collaborators with the National TB Program Partner in various other national response co- operations including: HIV/AIDS Consortium NCCU Partnerships with other NGOs to provide comprehensive services

5. Current situation in area Families overburdened Food insecurity Extreme Unemployment Lack of financial means Lack of electricity Poor roads Unregulated costly transport Lack of clean water / Lack of water Lack of Sanitation Majority of clients do not read or write and have never left the area

6. Health issues in area HIV and AIDS TB

7. Health issues in area Lack of access to health services Lack of follow-up Malnutrition Strong hold of traditional healing, fear of other healing, fear of leaving area for treatment.

8. SERVICES PROVIDED TO: Anyone who wants to test for HIV or TB in the service area All those who are HIV or TB positive in the service area HTC, including partial service with referral to local clinics for those outside of Cabrini service area Presently actively serving over 2,000 HIV, AIDS, TB clients; number served increases by about 1% per month.

9. CM Healthcare Cabrini commenced as a TB diagnostic centre in 2010 So far we have initiated 121 patients on TB treatment 73% of all TB patients are co-infected with HIV 25% of all TB patients are MDR cases Provide a continuum of health care services for HIV, AIDS, & TB patients at their homesteads Provide access to healthcare, clinical management and support services and ongoing community education

10. CM Healthcare Health Care Outreach for HIV, AIDS and TB - Access to Care for rural people At Cabrini Ministries, TB care is fully integrated into HIV care Case finding – hard, labour intensive, but possible if there is the WILL to do it.

11. Current healthcare services offered HIV, AIDS, TB Education: prevention, adherence HIV testing and counselling TB sputum testing for every HIV+ client with TB symptoms ART pre-counselling and adherence counselling with individuals and groups; on homesteads ART outreach centre of Sithobela HC

12. Current healthcare services offered TB teaching and TB adherence teaching in the community; on homesteads Nutrition support weekly Transport to hospital (including chemotherapy) Home Visits daily to follow-up the very sick, dying, defaulters PMTCT with St. Philips Clinic Day and overnight care as necessary at drop-in Center

13. TB outreach TB fully integrated into all HIV services TB screening of all HIV tested and HIV positive people Ongoing TB screening of HIV patients on treatment when they come in for refills TB treatment initiation of all sputum positive patients Visit to patients within two weeks of TB treatment initiation to assess progress and encourage treatment compliance For all HIV+ TB patients the patient is prepared and initiated on HAART

14. TB outreach Food parcels are given to those in need Defaulters followed up through phone calls and/or homestead visits. Provide tents where necessary to assist with isolation of TB patients on homesteads Transport provided to MDR patients to Moneni

15. Community Linkages Since February, collaboration with 2 Government clinics (1 day per week each) Siphofaneni Sinceni to assist with HIV & TB treatment defaulters CM doctor present 1 day at each clinic for initiation of TB and ART medication

16. Successes Less than 3% default rate for TB treatment Able to integrate TB and HIV treatment activities Less than 1% default rate for HIV+ patients

17. Challenges Patients coming very late for treatment Reluctance by clients to start HAART 2 weeks post TB initiation Food shortages negatively impacting treatment compliance Pill burden

18. SIYABONGA KA KHULU