We cannot hope to end the AIDS epidemic without addressing TB.
The Sustainable Development Goals (SDGs) for 2030 were adopted by the United Nations in 2015. One of the targets is to end the global TB epidemic. The WHO End TB Strategy, approved by the World Health Assembly in 2014, calls for a 90% reduction in TB deaths and an 80% reduction in the TB incidence rate by 2030, compared with 2015.” WHO, Global TB report 2016
As part of Anova’s commitment and support for the above, we have dedicated teams in each of our supported districts implementing various strategies to ensure these goals are achieved.
HIV related complications are one of the leading causes of death in TB patients, to this end, our Health System Strengthening work has ensured that in the facilities we support:
- Routine TB screening is provided for all clients regardless of HIV status. This is because HIV-negative people are also at risk of developing TB. To prevent transmission of TB in the community, one has to identify those infected with TB so as to put them on treatment and make them non-infectious
- All TB patients offered HIV testing services
- TB patients are cared for by trained and competent clinicians trained and mentored by Anova teams
- TB/HIV infected patients are started on ART by trained and competent clinicians mentored on TB/HIV management by Anova teams
- Isoniazid Preventative Therapy (IPT) is offered for all HIV-positive adults & children who do not have TB symptoms; to protect them against developing TB
Anova facilitates tuberculosis (TB) training for all Department of Health (DoH) staff categories to ensure patients with TB are cared for and managed in line with the Department’s TB management guidelines. In addition to encouraging untreated people with TB to take treatment, Anova’s current priority includes caring for people who present with TB symptoms by facilitating further investigations.
The facilitation includes support for routine TB screening offered to all people regardless of their HIV status and for those diagnosed with TB, HIV counselling and testing is offered. Anova is also engaged in capacity building for community health workers working in the ward based outreach teams (WBOTs) primary healthcare re-engineering programme, from the DoH. The aim is to enable the CHWs to screen community members for TB and refer symptomatic clients from community to the health facility, as well as provide treatment support for those on TB treatment.
Anova is supporting the implementation of the six ‘Is’ of TB-HIV management at primary healthcare facilities, which involve Isoniazid preventative therapy, infection control, intensified case finding, initiation of ART in TB/HIV co-infected clients, initiation of co-trimoxazole prophylaxis in TB/HIV co-infected clients, integration of TB/HIV services. This is being accomplished through training, ongoing mentoring, and the development and provision of job aids and patient information material in Gauteng. In Mopani the team has introduced TB screening stamps in all hospitals as a tool to improve TB case identification and management. They are also conducting Infection Control training and have conducted Infection control risk assessments at all Primary health care facilities. Anova nurse mentors conduct monthly audits of the TB registers to identify the gaps and provide focused mentorship and in-service training.
Over the last five years Anova has dedicated much of its focus to integrating TB-HIV services with nurse-initiated management of antiretroviral treatment (NIMART) at TB sites. This allows for TB-HIV clients to get ‘one-stop’ HIV and TB treatment, as opposed to having to visit different areas of the clinic, staffed by different nurses, on different days. This has allowed for quicker identification of TB cases, early initiation of ART among TB/HIV infected people, and better treatment adherence. Thus far 80% of Anova-supported clinics in Johannesburg are providing ART within TB service points. In Mopani 100% of Anova-supported clinics have integrated HIV and TB care and Anova Nurse mentors also conduct monthly audits of the TB files to ensure all co-infected clients are initiated on ART.
Recognising that monitoring and evaluating data on TB treatment and care is vital in strengthening health services, Anova is assisting both Districts in improving the quality and utilisation of TB-related data through participation in HAST data reviews and TB data validation at facility and sub-district level. Anova in Mopani also conducted a review of TB deaths in all seven hospitals which has assisted the DoH make strategic decisions regarding the TB programme.
Anova is supporting the national roll-out of the electronic TB register at primary healthcare level in Mopani and Gauteng supported sub-districts to ensure real-time capturing of treatment and care details of patients co-infected with TB and HIV. This will enable clinicians to track patients’ HIV/TB treatment response, identify those who missed their clinic appointments and enable programme people to monitor patients’ clinical outcomes.
With the continued improvement in TB diagnostics, results of TB investigations like GXP®; are available as early as 24hrs later. It is imperative that people with TB are started on treatment as soon as possible to reduce the incidence of new infections. Because of this, one of Anova’s current priorities is supporting the linkage to care for people with TB who are not yet on treatment as well as those with TB symptoms who need to be investigated further. This is done through facility based linkage officers who telephonically contact patients diagnosed with TB from laboratory investigations and encourage the patients to visit the clinic early to start TB treatment. This telephonic contacting of patients is also done for those already on TB treatment but have missed their clinic appointment. It is important for those on treatment to finish their course of treatment to be cured of TB, prevent transmission of TB to others and to prevent development of drug-resistant TB.