Effectiveness of psychosocial support for MDR TB …msf-tb-symposium.org/files/5813/8892/9174/4.3_Maria_Idrissova... · Effectiveness of psychosocial support for MDR TB patients in

Effectiveness of psychosocial support for MDR TB patients in East Kazakhstan

USAID TB CAP project

USAID project TB CARE I

KNCV Representative Office in Central Asia

December 5 – 6, 2013, Dushanbe

Psychosocial support program for MDR TB patients

Project - «Management of MDR TB and social support»

Donor - USAID

Period- January 2009 – October 2010

Project site – East Kazakhstan region (EKO)

Psychosocial support program for MDR TB patients

Partners: National TB Center

Akimat of East Kazakhstan region

Oblast department for coordination of occupation and social programs in EKO

Oblast department of healthcare in EKO

Oblast TB dispensary

Territorial centers of social support

Project goal:

Develop a model of sustainable psychosocial support system for MDR TB patients to ensure completion of

treatment

Characteristics of MDR TB patients enrolled on psychosocial support program, March - December

2010

# MDR TB patients

enrolled on PSS

Gender Unemployed Home-less

Prison History Alcohol and/or Drug Use

M F

228 139 (61%)

89 (39%) 183 (80%) 3 (1%) 20 (8%) 24 (10%)

Psychosocial support program for MDR TB patients in EKO

strengthening the complex treatment and care by creating and maintaining

communication between medical workers and patients

Psychosocial support program

decrease treatment interruption or default

Improve adherence of MDR TB patients to treatment

PATIENT-ORIENTED APPROACH:

main elements

Clinical care Psychological support Socio-economical

support

HAVE TO:

•Be used for all patients •Be provided during the whole course of treatment

•Respond to patient needs •Have complex approach

PSYCHOSOCIAL SUPPORT

(multi-disciplinary team)

TB doctor Central Doctors Council on MDR TB Prison

system

COORDINATOR of patient support group

Final list of patients needed social support

Psychosocial support group: • Psychologist (individual work with patient and family members – counseling,

assessment of needs with visit at home )

• PSSG (development of individual patient plan for adherence of patient to treatment) • Psychologist: psychological support • Nurse of TB service: clinical care • Social worker: social support

MAIN STEPS OF PSS:

Interview (during first two weeks of hospitalization and

before transfer to ambulatory treatment)

Assessment of individual needs and risks for treatment interruption and default

Making list of patients needed support

Assessment of leaving conditions of patients

Development of individual plan for strengthening

adherence to treatment (will be corrected during treatment)

Psychosocial support based on patient-oriented approach(1)

Clinical care: DOT in DOT points, if needed - at home (disable

patients, women with children) Patronage of patients and family members by nurse

of OTBD Health education for patients and family members Tracing of patients who interrupted treatment

Close collaboration with psychologist and social workers of PSSG

Psychosocial support based on patient-oriented approach(2)

Psychological support:

Individual counseling of patients and family

members

Close collaboration with medical and social workers of PSSG

Psychosocial support based on patient-oriented approach (3)

Social support: Documentation for getting social support and other incentives (before

project start only 15% of patients knew about this possibilities)

Documenting (ID, housing, pension, registration)

Temporary housing on the period of treatment

Food and hygiene parcels

Free of charge kindergarten for patients’ children

Warm meal for children in school

Employment(making contacts with potential employers - mainly private business)

Psychosocial support, provided to 228 MDR TB patients, March – December 2010

Psycho-logical support

Food and hygiene parcels

Documen-tation

Disability Free of charge kinder-garden

Tempora-ry housing

Employ-ment

157 (69%) 85 (37%) 21 (9%) 48 (21%) 7 (3%) 3 (1%) 6 (3%)

Results of program(1)

Since January 2011 positions of social workers and psychologists have been included in the staffing list of TBDs

Indicator on social support for TB patients was included in the rating of

Akims at rajon level

Since February 2010 Akim of Semey city signed order on monthly social support for 120 MDRTB patients (5000/mth tenge) on ambulatory treatment till the end of treatment course

Budget on social support for TB patients in EKO increased more then 18

times in 2010 (till present) to compare with 2009

Results of program(2)

Patients got support and assistance from personnel (based on patients’ interview).

Patients trust to medical workers (based on patients’ interview) Treatment interruption at continuation of treatment decreased from 18%

(41) to 4% (9) !!!! Among beneficiaries of the program, 23% (44 of 190) of them

interrupted/defaulted treatment in the past– no teatment interruption! Patients better understand the importance of un-interrupted treatment Patients wanted to work in the PSSG

Total interviewed 190 MDR TB patients

35 in the TB hospital (18%)

155 upon ambulatory care (82%)

Question: Factors that, in the opinion of the patients,

influence on their successful treatment:

Medical 155 (81,5%)

Socio-economical 132 (70%)

Psychological 96 (50%)

Personal 32 (17%)

Treatment interruption in the MDR TB patients interviewed till the psycho-social support:

Yes 44 (23%),

No 146 (76%)

Question: Whether you missed the taking drugs after the PSS program started:

Yes 1 (0,5%)

No 189 (99,5%)

Thank you!

www.tbcare1.org | www.kncvtbc.org