TBHIVART care Swaziland John Walley, Prof Intn Public Health, Nuffield Centre IHD, LIHS, Leeds - PowerPoint PPT Presentation

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TBHIVART care Swaziland John Walley, Prof Intn Public Health, Nuffield Centre IHD, LIHS, Leeds

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... Centre & Community care. The King. Woman with AIDS. The main ... GSH district hospital, Lubombo , a rural a district of 250,000. The hospital then & now ... – PowerPoint PPT presentation

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Title: TBHIVART care Swaziland John Walley, Prof Intn Public Health, Nuffield Centre IHD, LIHS, Leeds


1
TB-HIV-ART care SwazilandJohn Walley, Prof Intn
Public Health, Nuffield Centre IHD, LIHS, Leeds
  • Hospital,
  • Health Centre Community care

The King Woman with AIDS
2
The main diseases
GSH district hospital, Lubombo , a rural a
district of 250,000
  • The main problems include
  • Most patients HIV related
  • Plus the usual MCH, malnutrition, epilepsy etc.

3
The hospital then now
  • Previously - not tested HIV,
  • TB patients - 2 months in hospital
  • Wards full, patients on floor beds
  • Transmission TB to HIVve
  • Discharged
  • Often defaulted
  • Drug resistance
  • Many died.

Now HCT all in patients Chronic cough sputum
TB screening
4
The community TB, HIV-ART team
  • Elija, middle, TB
  • Sweetness, bottom right, ART care.
  • Initiate treatment
  • Refer follow up care at H Centre

5
Comm-based TB, HIV-ART epilepsyHospital, now
in H Centres
  • Identify TB etc. chronic cough screening
  • Educate patient, start Treatment
  • Register, supervise, follow-up care
  • at local H Centre
  • If late attendance, tracing
  • by Adherence officer on a motorcycle
  • Epilepsy, similar to above.

6
The health centre role
  • Monthly review TB etc. patient.
  • Record TB (HIV-ART, chronic care card).
  • Link with community health workers and family
    supporter

7
Community Health Worker role
  • TB Treatment Supporter
  • CHW or family members. - yellow home TB card

8
Trial - Adherence to TB HIV/ART Hosp vs. HC
  • Trial - effective community based TB care either
    community/ family treatment support.
  • ART Trial compared H.Centre HIV/ ART care with
    the usual hospital ART care
  • Health centre better satisfaction, adherence, and
    lower death rates
  • Makes possible to start more patients at hospital
    TB HIV-ART

9
3 Is R D
  • In hospital
  • In H Centres
  • Increased case finding TB,
  • Infection control and
  • Isoniazid preventative therapy.

10
TB- HIV Integration
  • TB half, HIV half of building
  • Infection control guidelines
  • TB screen of HIV
  • HCT for TB patients
  • PMTCT

Old waiting room
New TB-HIV unit
11
MDR, XDR
  • MDR, XDR present
  • Shelter box tent
  • Implementing MDR project
  • Also Pakistan as Comm-based model

12
COMDIS R D approachComplex interventions
(MRC)Develop, pilot, refine, support scale-up
  • Design to be sustainable and replicable within
    the system
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