2. Partnerships to Prevent, Find and Treat TB/DRTB and HIV 12 October 2010 Prof Harry Hausler, Director

3. Overview TB/HIV Care Association Challenges with drug-resistant (DR)-TB Decentralised DR-TB - Khayelitsha Partnerships to prevent, find and treat DR-TB Role of Community Care Workers to extend services to communities

4. TB/HIV Care Association Celebrating 81 years of caring – founded 1929 Initially social support for TB patients in Cape Town Metro DOT supporters, patient advocates for ART CDC/PEPFAR funding for Project Integrate (2007-) National DOH funding for integrated TB/HIV Community Care Workers (2008-) Now in 5 districts, 4 provinces of SA

5. TB/HIV Care: Objectives Prevent new HIV and TB infections Improve the diagnosis, care & adherence support for TB patients & PLHIV Build the capacity of individuals & organisations to provide optimal TB & HIV prevention & care Participate in operational research and the development and implementation of M&E systems to improve TB & HIV prevention and care

6. TB/HIV Care: Programs HIV counseling and testing linked to TB and STI screening Clinical TB/HIV training and mentorship – 3 I’s and NIMART Community based services for prevention, case finding and treatment adherence Support to: – Workplaces – Correctional services (prisons) – TB hospitals

7. Challenges with DR-TB Drug resistant DR-TB can develop in a person who does not adhere to treatment or is given suboptimal regimen or by infection with MDR strain DR-TB and drug susceptible TB are transmitted the same way – airborne Undetected cases are most infectious In SA in 2009: – Estimated 13000 MDRTB cases – Lab confirmation 9000 cases – 4143 registered on treatment Treatment 18-24 months with 6 months injections Hospitalisation required until culture conversion – high default Fear and stigma

8. Rationale for decentralised MDRTB treatment Inadequate number of hospital beds Patients may remain untreated while waiting for admission Patients often abscond from hospital to return to their families Decentralised treatment more patient- centred, allows patients to remain with their families, less expensive

9. Khayelitsha Decentralised DR-TB Project Improved diagnosis – drug susceptibility testing for all TB suspects with previous TB tx, patients with positive sputum smears at end of 2/3 months treatment, high risk (HCW, prisons, known DR-TB contacts) Since 2008, DST performed using rapid polymerase chain reaction (PCR) method (Hain Genotype MDRTBPlus) – results in 24 h In 2010, piloting Gene Xpert

10. Khayelitsha DR-TB Project Diagnosis given at local clinic Counseled by dedicated DR-TB counselor and treatment started by medical officer Patient data sent to Brooklyn Chest Hospital for registration and authorisation of Rx Severely ill and XDRTB patients hospitalised Counseling at home, infection control assessment and contact screening Patient visits clinic daily for treatment Lizo Nobanda step down facility

11. The Need for Partnerships The size of the TB/DR-TB and HIV burden is too great for any one role player to tackle alone Need for partnerships between government, private sector, non-governmental organisations, researchers, health workers, and communities to develop effective strategies to fight TB/DR-TB and HIV and to ensure access to services and coverage of the entire population

12. Business Activities Prevent TB/DRTB and HIV Educate managers and workforce about how TB is spread, cough hygiene, the link between TB and HIV, HIV prevention, condom use, IPT Find TB/DRTB and HIV – Provide HIV testing linked with TB screening – Ensure that sputum collected and DST performed for retreatment suspects or high risk patients Treat TB/DRTB and HIV – Sick leave until no longer infectious – Antiretroviral treatment for all DRTB patients – Workplace adherence support – Allow time to go for follow up visits to encourage adherence – Psychosocial support

13. TB/HIV Care Workplace Programme Educate employers and employees on TB and HIV Link workplaces to community based HCT programme for HIV testing and TB/STI screening and referral Coordinate workplace adherence support for working TB and ART patients

14. Community Based HCT (CBHCT)

15. Workplace – Wellness Day

16. Community Care Workers (CCWs) – Western Cape

17. CCWs – Sisonke

18. CCW Package - HIV Prevent – Distribute condoms – Promote: decreased exposure, HCT, PCR, disclosure/acceptance, circumcision, safe feeding Find – Provide HCT Treat – Remind clients to attend scheduled visits (6 monthly CD4, annual Pap) – Adherence support (pill counts, support groups) for CPT, ART

19. CCW Package - TB Prevent – Trace child contacts and refer for IPT – Promote: infection control (cover cough, open windows), know TB symptoms and seek care Find – Screen for TB symptoms – Refer or collect sputum from symptomatics and provide results Treat – Remind clients to attend scheduled visits (2/3 month and 5/7 month smears) – Adherence support for TB treament, IPT

20. How Business can work in partnership to help stem the tide Identify and meet with local NGO Work together to prevent, find and treat TB/DRTB and HIV – In the workplace – In the communities where workers live And join with NGOs in…

21. Advocacy

22. Moving Forward in Partnership to Fight TB/DR-TB and HIV THANKS!

23. Acknowledgements Funders – CDC PEPFAR – Departments of Health and Social Development – Community Chest – Lotteries – ABSA, Alan and Gill Gray Trust, Bargaining Council for the Building Industry, BOE, EL Darter Charitable Trust, Jet Lee Will Trust, Joan St Leger Lindbergh Charitable Trust, C&E Harding Trust Management team and staff of TB/HIV Care Communities that we serve People infected and affected by HIV and TB