Integrating TB in the Workplace Presentation by: Miss. D.M.Nokwe 15 th of October 2009 TB Directorate.

Integrating TB in the Workplace

Presentation by: Miss. D.M.Nokwe

15th of October 2009TB Directorate

Acknowledgements

National Department of Health URC(USAID) CSIR WSU Pro Health Risk NHLS PERCCI

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DOH Partners

Pro Health Risk ECIPA,Siyakha ,UDIPA WSU URC PERCCI Wellness task team

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Context South Africa has the 2nd highest TB burden in

Africa and 5th highest in the world Around 70% of new TB cases are HIV positive 2% of new TB cases and 7% of retreatment cases

have MDR-TB Majority of patients seek care in the private sector

and traditional health practitioners before presenting to the public sector

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Context (Continued) TB, TB/HIV and M(X)DR-TB has a high

burden of disease against a background of poverty and financial crisis

Eastern Cape is the second largest Province of South Africa which has a very high burden of TB (all pulmonary cases): Over 60 thousand new TB cases occurred in EC in 2008

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Context The Cure rates for Q1 of 2008 , 59,6% Defaulter rate is 9,2%. The province will complete

clearing the backlogs end November. These Outcomes are far from achieving the MDG’s , hence the engagement of the private sector

Disclosure at work is a problem due to fear of stigmatisation, discrimination and loss of employment resulting in high rates of treatment interruption and or defaulting

Poor access to services and lack of money for transport

Objectives Raise awareness about TB Improve Infection control Increase case finding Access to TB treatment Promote Treatment adherence and

compliance Standardize TB treatment to NTP

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Process VW in Uitenhage has a best practise model of TB in the

workplace. The Clinician and the Occupational nurse were trained

on TB, TB/HIV and STI management All the registers that are used by VW, are provided by

the department Drugs and NHLS, are the responsibility of the

department The department conducts quarterly reviews of the TB

Programme using the DRAT Tool

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Process The department and VW , conduct joint awareness

campaigns This programme is doing very well as they have

good outcomes, cure rate ranges between 98% to 100%.

The occupational nurse attend the district meeting in order to discuss such things as, referral Pathway, management of contacts and others.

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Process

Awareness campaigns has been conducted in 20 companies in the NMM

2 Companies have started with screening which was provided by DOH, e.g. Ford

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TB awareness and TB screening Ford motor company

Process The Directorate made a presentation to the executive

members of the House of Traditional Leaders Several meetings were held to discuss how the

Traditional Leaders are going to work with the Department of Health

The TB Directorate conducted training on TB, TB/HIV for 450 Traditional Leaders

The Executive members for IYA(Imbumba Yamakhosikazi Akomkhulu) were also trained on TB and TB/HIV

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Process Currently, both Traditional Leaders and IYA , are

leading awareness campaigns on TB , in their communities

The traditional Councils are used as treatment points, this helps to improve access to services

IYA developed a clear action plan on how they are going to implement the programme

The department has developed an M&E framework to monitor the plan

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Private General Practitioners The department of health has established Public

Private Mix with the General Practitioners at the Nelson Mandela Metro

The Private GP’s submitted a proposal to the TB Directorate as well as Walter Sisulu University , about the establishment of the PPM Project

The two proposals were not mutually exclusive, hence the department agreed on a tripartite arrangement

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Process (Continued) It was agreed that , the department of health will be the

custodian of the project and oversee implementation process

Walter Sisulu will provide academic support, operational Research and Evaluation at the end of the project

The Private Practitioners will be the implementing partners.

A memorandum of understanding and individual agreements were developed

There are Pre-requisits for starting the PPM

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Process

CSIR, conducted Risk Assessment to 6 GP Clinics 20 Doctors were trained on TB, TB/HIV &STI,

Infection Control, Clinical Management of M(X)DR-TB and PULSA plus(Practical Approach to Lung Health plus HIV&AIDS) and Recording and Reporting

10 GP’s have signed the individual agreements On the 8th of June 2009, implementation of the

project started. Currently, there are 46 patients managed by the GP’s

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Generic Package of care VCT with rapid HIV testing to all TB. Early diagnosis and treatment of TB in HIV+ Isoniazid Preventive Therapy (IPT) for HIV+ Cotrimoxazole Preventive Therapy (CPT) Effective Case Management, Tracing and

Management of Contacts Formalized referral systems

Process The department of health is providing drugs to the

GP’s Laboratory specimen sent to NHLS , but paid for by

the department GP’s have got all the records needed for the TB

management , including the notification book Ongoing training and GP recruitment Private hospital groups approached for

participation-with keen interest to participate

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Role of DOH Conduct sensitisation workshop with business

quarterly Conduct training on TB workplace policies. Conduct training of occupational health

practitioners on TB Conduct joint awareness campaigns in

commmunities Monitor and evaluate the implementation of

workplace TB programmes.

Roles of the stakeholders Conduct on going awareness campaign at the

workplace. Screening of suspects and periodic screening for other

employees. Workplace DOT programme, to improve adherence to

treatment Ensure implementation of infection control guidelines,

e.g. Availability of infection Control plan in the workplace to adree issues of Open Window Policy , Cough hygiene

Challenges

Mobility of patients-stigma Policy, Human Rights and ethics(XDR/MDR) Inadequate financial and human resources Management of contacts Employers, who do not understand , hospitalisation of

a patient for a long time especially M(X)DR-TB Infrastructure of some of the companies does not

comply to infection control measures.

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How they were addressed The GP’s and VW are using a referral letter that is

used by the department Continuous awareness campaigns Due to inadequate funding the department is also

supported by NGO’s in implementing these projects, like URC.

The department has encouraged the employer to communicate the Leave policy to the employees and ensure that policies addressing confidentiality and discrimination are available

How they were addressed

The department has supplied posters on cough hygiene, so as to remind the employees about Cough Etiquette.

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Lessons learnt There are more benefits than risks in the PPM Public and Private can work together in the fight

against TB , by improving access to services in the workplace

TB workplace programme helps in improving adherence (DOT) and reducing absenteeseem.

Sharing of resources for the benefit of the patient

Outstanding Risks and Issues Management and coordination Stakeholder relationships, expectations &

Change Management Funding and Sustainability Infection Control Exposure Risk NHLS & Drug Supply Case Management, Tracing , M(X)DR-TB

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Way forward Bridge the gap between, two worlds two cultures-

public -private Scaling –up of TB PPM services in private sector. Engagement of private providers in intervention for: Programmatic management of TB-M(X)DR-TB in

communities, –EPTB -TBHIV co-infection diagnosis and

treatment,

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CONCLUSION

STOP TB ... COMPLETE TREATMENT!!!

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THANK YOU

ENKOSI