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
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!
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