1. Trained Traditional Health Practitioners can collaborate with Biomedical Health Professionals to improve TB & HIV case finding and treatment success/ adherence: The case of UMkhanyakude District in KwaZulu Natal, SA By: Boniface Hlabano; Connie Osborne, Nonhlanhla Mthimkhulu, Vusi Ntuli Amref Health Africa International Health Conference 25 November, 2014, Nairobi

2. OUTLINE OF PRESENTATION  Background & Introduction  Project Strategy &Tools  Results  Discussion-Conclusion  Challenges  Acknowledgements

3. Background: Framework for THP practice in South Africa Traditional Health Practitioners Act, Act 22 of 2007. THP DIRECTORATE for African Traditional Medicine at The National DOH. National THP COUNCIL (Interim) – established by the Minister of Health to regulate THP practice and representation

4. In South Africa, research shows that: 41% of TB patients would consult a THP prior to biomedical diagnosis 84% of diagnosed TB patients would consider choosing a THP as a treatment supervisor (DOTs supporter) 88% of THPs trained in basic TB epidemiology would genuinely refer patients for screening in health facilities 92% of trained THPs are usually willing to act as treatment supervisors for TB patients (Wlikinson, D; Gcabashe, L & Lurie, M. International Journal of TB & Lung Diseases Vol. 3(9) 835-842) Background

5. The Amref Health Africa UMkhanyakude THP Project: 2011- 2014 THPs Trained Municipality-Sub-DistrictMalesFemalesTotal Jozini70 140 UMhlabuyalingana7182153 Hlabisa396099 Mtubatuba171835 Big 5 False Bay102333 Total207253460

6. 45 Day Course-Structure  Basic HIV and AIDS information:10 days  VCT and general counselling skills: 5 days  TB and DOTs: 3 days  Introduction to orphans and vulnerable children Care (OVC):2 days  Home-based care: 10 days  ARV literacy: 3 days  Integrated management for child infection (IMCI): 3 days  Prevention of mother to child transmission (PMTCT),STIs: 3 days  Project management: 2 days  Financial management: 2 days  Leadership skills: 2 days

7. PROJECT TOOLS-Extract from the Manual

8. PROJECT TOOLS- Referral Form

9. PROJECT TOOLS- Patient Register

10. RESULTS (Year 3) n=130

12. RESULTS No. of Patients Referred for TB screening: year 3

13. RESULTS No of Referred TB suspects confirmed as TB cases

14. RESULTS % Referred TB suspects confirmed as TB cases (n=434)(vs 430)

15. RESULTS No. Of Patients Referred for HIV Testing: year 3

16. RESULTS No. Of referred HIV suspects tested HIV+

17. RESULTS % HIV+ patients receiving treatment adherence support from THPs (n=328)

18. THP SERVICE QUALITY IMPROVEMENT Protective clothing during patient consultation/examination 18

19. THP SERVICE QUALITY IMPROVEMENT Improvement in storage of medicines: Before & After

20. THP SERVICE QUALITY IMPROVEMENT THP Consultation rooms: Before & After

21. UNINTENDED RESULTS Empilweni Muti Forest-Environmental Conservation

22. DISCUSSION-CONCLUSION  When THPs are given up-to-date and accurate health- related information, they can make appropriate changes in their working environment and abandon potentially harmful practices and treatments.  The results from this model confirm that collaboration between National TB Programs and community based initiatives has a huge potential to improve early TB case finding and treatment success. (The WHO, 2013: Engage-TB strategy)  This collaboration strengthens better management and integration of HIV/AIDS & STI and TB services  Such projects positively contribute to infection control practices within the THP practice including improved waste disposal and environmental conservation

23. CHALLENGES  Large variation amongst THPs associations  Weak central organization and coordination  Varying and conflicting theories of disease causation between biomedical and THPs  THPs generally skeptical of DOH authority  Some health professionals have negative attitudes towards traditional treatments (lack scientific rigor)  Poor access/supply of resources to improve infection control (protective clothing)  Lack of a policy which for back referrals to THPs by health professionals

24. 24 Collaboration in Practice: 2013TB Day Commemorations-Jozini Sub District

25. ACKNOWLEDGEMENTS  CIDA-DFATD (Department of Foreign Affairs and Trade Development)  AMREF Health Africa Canada  UMkhanyakude District Health Management  UMkhanyakude Traditional Authorities (Tribal Councils)  Other Government Agencies and NGOs  The Traditional Health Practitioners Association  Kwa-Zulu Natal Office of The Premier

26. Boniface.Hlabano@Amref.OrgBoniface.Hlabano@Amref.Org; www.amref.orgwww.amref.org