03 Heunis, Kigozi & Engelbrecht Sahara Conference 2009 Fin

Christo Heunis

Gladys Kigozi

Michelle Engelbrecht

Centre for Health Systems Research & DevelopmentUniversity of the Free State

Source: WHO 2009: 81-168

Source: WHO 2009: 81-168

Source: WHO 2009: 28

Source: DoH (2009)

34.8%-33.8%

LejweleputswaThabo Mofutsanyana

Free State

32.2-33.1%

31.1%-32.9%

Source: FSDoH (2009)

32.4%-44.6%

LejweleputswaThabo Mofutsanyana

Free State

37.9%-49.7%

43.1% -45.9%

Source: FSDoH (2009)

63.2%-67.3%

LejweleputswaThabo Mofutsanyana

Free State

63.8%-67.6%

60.3%-65.3%

� Mechanisms for collaboration between TB and HIV programmes

� Intensified TB case-finding among PLWHA

� IPT for PLWHA without active TB

� Improved infection control in health-care and congregate settings

� HIV testing for TB patients

� CPT for TB patients infected with HIV

� Identify factors impacting on uptake/non-uptake of HIV counselling and testing by TB patients from the perspectives of (1) patients, (2) professional and (3) community health workers

� Propose recommendations to increase uptake of HIV testing by TB patients

� Cross-sectional face-to-face interview survey: Feb-Mar 2008

� 61 PHC facilities offering: o TB serviceso HIV counselling and testing services

� Sampleo 600 TB patientso 81 professional health workerso 97 lay health workers

� Voluntary, informed consent

Variable n %

Female 310 51.7

Unemployed 513 85.5

Retreatment 232 38.7

Did (self-reportedly) not receive information on the link between TB and HIV/AIDS

214 35.7

LejweleputswaThabo

MofutsanyanaTotal (%)

Fixed clinics

Manager 4 1 5 (6.2%)

Manager/TB/HIV nurse 6 5 11 (13.6%)

Manager/TB nurse 2 4 6 (7.4%)

Manager/HIV nurse 1 3 4 (4.9%)

TB/HIV nurse 2 1 3 (3.7%)

TB nurse 3 3 6 (7.4%)

HIV nurse 4 4 8 (9.9%)

Mobile clinics

Nurse 5 5 10 (12.3%)

Hospitals

Nursing services

manager4 4 8 (9.9%)

Doctor 4 4 8 (9.9%)

TB nurse 3 2 5 (6.2%)

HIV nurse 2 2 4 (4.9%)

TB/HIV nurse 1 2 3 (3.7%)

Total 41 40 81 (100%)

n %

Lay counsellors 40 41.2

DOT supporters 57 58.8

Total 97 100

� Qualitative: simple content analysis

� Quantitative: uni-, bi-, multi-variate (logistic regression) analysis

* Significant at 5% level ; ** Significant at 1% level

VariableOdds ratio (95% CI)(unadjusted model)

Odds ratio (95% CI) (adjusted for all other factors)

Received TB-HIV informationRef: Not received

3.9 (2.7-5.6)** 4.1 (2.5-6.7)**

Know someone ill with HIV/AIDSRef: Not know

3.0 (2.0-4.3)** 3.5 (2.2-5.7)**

UnemployedRef: Employed

2.6 (1.6-4.1)** 2.3 (1.2-4.3)**

FemaleRef: Male

1.9 (1.3-2.7)** 2.2 (1.4-3.6)**

RetreatmentRef: New

1.8 (1.3-2.6)* 2.0 (1.3-3.3)*

� Shortage of nurses

� Insufficient training on TB/HIV

integration

� Inadequate space for counselling

� Lack of patient trust in lay counsellors

� Re-offer HIV counselling and testing at every

opportunity

� Supply TB-HIV (“the link”) information

� Motivation & support

� Availability of antiretroviral treatment

� TB patients’ fear of HIV, TB/HIV co-infection, death

� TB patients’ fear of anticipated

stigmatisation/discrimination should they test HIV-

positive

� Encouragement and motivation

� Intensifying education on the link between TB and HIV

� Motivating patients in the decision-making process

� Targeting especially males, newly diagnosed and employed patients

� Improving DOT supporters and counsellors’ training and skills

� Public Health Evaluation (PHE) protocol submission to CDC pending: quasi-experiment to implement and evaluate training interventions:

� Training of nurses and clinic managers to scale-up PITC of TB patients

� Training of lay counsellors to provide high quality HIV counselling services to TB patients

� Training of DOT supporters to continuously and more effectively encourage and motivate TB patients to take up HIV counselling and testing

� Funders:

� Department for International Development (DfID, UK)

� National Research Foundation

� University of the Free State

� Authorisation:

� Free State Department of Health

� Collaboration:

� Department of Sociology, University of Antwerp

� American International Health Alliance

� SUNY Downtown Medical Center

� Ethical clearance:

� Committee for Research Ethics, Faculty of the Humanities, University of the Free State

� Colleagues:

� A Pienaar, H Hlophe, M Machere

� Drs P Chikobvu, E Wouters, H van den Berg

� FSDoH. 2009. Tuberculosis statistical reports. http://www.fshealth.gov.za.

� NDoH. 2007. Tuberculosis Strategic Plan for South Africa, 2007-2011. Pretoria: NDoH.

� WHO. 2004. Interim policy on collaborative TB/HIV activities. Geneva: WHO.

� WHO. 2009. Global tuberculosis control 2009: epidemiology,

strategy, financing. Geneva: WHO.