TB HIV/AIDS Services in South Africa

Project Activities and Achievements in South Africa, 2008

Skills development and capacity building: Under funding from USAID and PEPFAR, URC has trained over 2500 health care workers in TB and TB/HIV case management. In addition, URC developed multi-drug resistant strains (MDR) TB materials used to train more than 500 doctors and nurses. All MDR TB facilities are now utilizing standardized recording and reporting tools developed under funding from USAID. Newly developed infection control materials were used to train 45 program managers. As part of strengthening TB laboratory quality assurance, a supervisory tool has been developed in partnership with KwaZulu-Natal (KZN) National Health Laboratory Service and 26 managers have completed training on leadership and management for laboratories.

TB advocacy and communication: USAID funding provided for participation in the 1st National TB conference where more than 3000 delegates from more than 39 countries attended. Successful satellite symposia were held to advocate for the implementation of infection control as part of 3I’s. Key note speakers included the Centers for Disease Control and Prevention, Stop TB partners and the National Department of Health (NDoH). Key role players in the NDoH, provinces, municipalities, and the broadcast media participated in debating issues around communicating TB messages and the importance of partnerships with the media, communities and service providers. As part of World TB Day commemorations, informational pamphlets on MDR TB for communities which had been developed were distributed.

Strengthening TB/HIV integration: A successful national seminar on TB/HIV was held with key stakeholders in the country which included affected community members, researchers and academics, clinicians. and program managers at national and provincial levels. This has led to acceleration of implementation of isoniazid preventive therapy (IPT) and clearly defined roles and responsibilities for the TB and HIV programs in ensuring that TB programs provide HIV diagnosis and appropriate referral for HIV care for all TB/HIV co-infected individuals, HIV programs intensify TB case finding by screening and ensuring prompt treatment for those co-infected with HIV-TB and providing prophylaxis to those who are not infected with active TB.

Geographic coverage: URC, with USG funding, supports 659 facilities in 5 provinces, 11 districts and 30 sub districts. 179 facilities were supported through PEPFAR funds for TB/HIV integration. These USAID supported areas reached 83,311 TB cases, representing 25% of the national TB burden in 2007. At least 2500 of these cases were from non MoH sites in Mpumalanga, Limpopo and North West Provinces, mainly mining health facilities. The data from all supported facilities combined shows that HIV testing for TB patients has improved from 20% in 2006 to 60% in some areas, TB screening for HIV positive clients from 5% to 33% in some districts. This low screening uptake by HIV patients will be addressed in FY09 by implementing a TB screening tool in all HIV sections of primary health care facilities. TB treatment outcomes in supported provinces have improved compared to 2004 when TASC2 TB started. Changes in cure rates range from 5% to 20% in certain areas, default rates have gone down from 4% to 15% in others. In FY09 emphasis will be on strengthening DOTS, including TB in children and expanding community involvement in DOTS implementation, prevention of MDR TB and infection control.

An audit conducted in October 2007, revealed that the project was progressing well and meeting all targets in terms of the USAID requirements.

Successful implementation of laboratory quality improvements in KZN with development of a supervisory tool and re training of all microscopists.

Revision of national clinical management guidelines (NTCP and MDR TB) although these are still not officially approved, they are still utilized by clinicians in their draft form. Development of TB ACSM strategy and implementation plans. Development of TB in the workplace materials to expand public – private DOTS

Development of training materials and implementation of training for health care workers on drug resistant TB and infection control

Conducted infection control risk assessments and assisting MDR TB units to develop infection control plans

Improved program planning and implementation utilizing the collaborative approach to improve quality of TB/HIV programs