TF CARES initiatives aim to prevent TB transmission, to diagnosis TB and identify drug resistance earlier, and to strengthen TB and HIV care and treatment programs.
We provide clinical support and technical assistance to the Department of Health and to the physicians, nurses and staff at Church of Scotland Hospital. We also link clinical care and operational research to increase program effectiveness and to inform policy and practice.
Some of our initiatives include:
Strengthening and Integrating TB and HIV care
TF CARES provides technical assistance to the Department of Health in the areas of infection control, ongoing surveillance of MDR/XDR-TB, intensive case finding and community management of MDR-TB. These approaches, which we first demonstrated in Tugela Ferry, are now being adopted throughout the province.
In 2002 and 2003, TF CARES first demonstrated that TB and HIV care could be integrated with successful outcomes even in rural, low-resource areas. Following the XDR epidemic in 2005, our work in Tugela Ferry has served as a demonstration program for integration of care and treatment for MDR/XDR-TB and HIV co-infection. We have shown how testing, co-treatment, active case finding and community-based treatment are feasible approaches in rural areas.
Improving Diagnosis of MDR- and XDR-TB
TF CARES is developing and testing multiple strategies for a more rapid diagnosis of MDR/XDR-TB.
- We are testing the feasibility and effectiveness of the Microscopic Observation Drug Susceptibility (MODS) test at COSH. MODS is a simple and inexpensive procedure that uses existing lab equipment and yields results in one week.
- We are studying the efficacy of blood cultures and body fluids as a diagnostic tool for patients with suspected drug-resistant TB.
- We are also working to improve TB and drug-resistant TB diagnosis in children by strengthening specimen collection procedures and practice for blood, gastric aspirate, sputum and urine samples.
- In consultation with the National Health Laboratory Service, TF CARES and the Foundation for Innovative New Diagnostics are working on plans to decentralize laboratory facilities for rapid molecular and culture-based TB diagnosis by early 2011.
Intensive case finding
TF CARES has established intensive case finding programs in Church of Scotland hospital and other community settings in the Tugela Ferry area. Patients entering the hospital and clinics are routinely screened by ‘cough officers’ to identify TB suspects. TF CARES has also launched a TB and HIV screening program at congregate settings throughout the community. These include ‘pension pay points’ where monthly grants are distributed, schools, and taxi ranks. Close to 600 individuals have been screened to date and 9 percent have been found to be HIV infected and 3 percent have had active TB, including drug-resistant TB.
Improving infection control
Since the epidemic of MDR/XDR-TB is fueled by healthcare-related transmission, TF CARES has taken measures to address airborne infection control at COSH. We have helped to develop and implement infection control policies by working closely with the designated infection control nurses appointed by the Department of Health. This carefully monitored program has been associated with a decrease of MDR/XDR-TB on the COSH hospital wards.
- Ventilation has been improved in waiting rooms and the TB ward through an ‘open window policy’ and the installation of mechanical extractor fans.
- All patients in the ARV and other clinics and waiting rooms are screened for cough and other TB symptoms and those who are suspected of having TB are separated from others and evaluated.
- Staff risk has been reduced by the provision of N95 respirator masks for all staff, infection control education and training, and encouragement of HIV counseling and testing.
Community-based care of MDR-TB and HIV
TF CARES has developed and is testing one of Africa’s first community-based treatment programs for patients who are co-infected with MDR-TB and HIV, with the goal of improving treatment outcomes for MDR-TB and limiting the generation and transmission of XDR-TB.
In this program, nurses conduct daily home visits to give second-line anti-TB drugs by injection to their patients and observe doses of oral TB medications and ARVs. The nurses use a TF CARES-developed treatment literacy curriculum to teach patients and families the importance of medication adherence and how to prevent MDR-TB and HIV. Home visits provide close monitoring for any treatment-related adverse effects or disease progression.
We have shown that community-based treatment can yield successful outcomes for patients. This year we successfully demonstrated that MDR patients can be cured through community-based treatment
Our program design and educational materials have been adopted by other districts in the province and are being used in the design of a national program by the South African Department of Health.