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Tb 2009 Project Proposal

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Tb 2009 Project Proposal Powered By Docstoc
					Integration of HIV/TB Services Project in the Breed Valley Sub district of the
                 Cape Wine lands: Worcester, South Africa



1. Geographic Location of the Project




   Lindsay-Michelle Meyer
   Project Coordinator – Ukwanda Centre for Rural Health
   Fax: +2721 931 4220
   e-mail:      lindsaym@sun.ac.za

2. Executive Summary
   The Integration of HIV/TB Services is a well recognized need in tuberculosis (TB)
   endemic areas, where TB is the most common opportunistic infection and most
   frequent cause of death among HIV-infected patients. We identified this as an
   important gap in providing an effective health service to a community with whom the
   undergraduate and post graduate students of the Faculty of Health Science interact
   when they undergo training on the rural platform. The aim is to provide a
   comprehensive service to patients attending the Antiretroviral (ARV) clinic who are co-
   infected with Mycobacterium tuberculosis. This is a daunting challenge that requires
   pragmatic solutions, to improve treatment access and barriers to care for co-infected
   patients without endangering the health of HIV patients without TB. Since TB is
   transmitted via the respiratory route this risk requires careful consideration.
   By training health care workers at various ARV clinics in the Boland region in the
   management of TB should improve the diagnostic and therapeutic care of TB infected
   patients. The essential outcome of this project will be that all patients on highly active
   Antiretroviral Therapy (HAART), or attending the ARV clinic, will receive their TB
   treatment at the ARV clinic, as well as being notified and registered at the ARV clinic.
   The diagnosis of suspected TB will be made at the ARV clinic thus the project will
   improve the collaboration between TB & HIV/Aids Services.
   Ukwanda, the Centre for Rural Health is in the unique position to assist our long
   standing partner in Health Services by implementing this innovative project with the
   medium term aim to establish this at the ARV Clinics in the region. The long term aim
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   is to mainstream this project. At this same time, this allows the Rural Clinical School
   Initiative of the Faculty of Health Sciences, to articulate community engagement in a
   critical area of health.

3. Program Goals and Objectives
   With reference the proposal submitted the main goal and Objectives remains:

   To ensure comprehensive, effective care for the patients attending – providing TB
   services within the clinic
   Objective 1
   To improve the diagnostic and therapeutic care of TB-infected patients
   attending the Worcester ARV Clinic through:
   •   TRAINING all Health Care Workers (HCW) in the WORCESTER ARV clinic in the
       management of TB; as well as >90% of Nursing staff working in the referring TB
       clinics of the Breede Valley. This should happen before the integrated clinic
       becomes operational – within three months of the project Launch. The training
       course will run over 4 weekly sessions; a post-course evaluation will be done, with a
       >75% success rate to be obtained by the participants. A standardized PGWC
       Protocol and Training Manual will be used (already exists within the Region).
   •   CLINICAL CARE: All patients attending the Worcester ARV clinic will be screened
       for TB and a confirmation, or exclusion, of active TB disease will be made within 6
       weeks. Those patients who are co-infected, will take >90% of the doses within their
       TB Treatment regimen.
   Objective 2 = to improve collaboration between TB & HIV/AIDS Services
       •   To increase the number of patients initiated on HAART, as seen by an increase
           in the number of new patients referred to the WORCESTER ARV Clinic – at
           least 15 adults/month and 5 children/month to be commenced on HAART
           (PGWC Targets for WORCESTER ARV Clinic).
       •   Fewer opportunistic infections in HIV+ persons as seen by a Decrease in
           number of TB cases in persons on HAART.




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4. Methodology
  The project’s clients will be the HIV+ patients attending the WORCESTER ARV Clinic;
  adults and children.


  Project activities
  The essential outcome of this project will be that all patients on HAART, or attending
  the ARV clinic, will receive their TB treatment at the ARV clinic, as well as being
  notified and registered at the ARV clinic. The diagnosis of suspected TB will be made at
  the ARV clinic.
     The Key Activities include:
     •   Training of HCWs in the ARV and TB clinics – all levels of staff – counsellors,
         pharmacy staff, nurses and doctors; as well as the Project Team.
     •   Training of new home-based care workers and the up skilling of existing
         home-based care workers in various communities in and around Worcester
         including Avian Park.
     •   Implementation of treatment and diagnostic services
     •   Review of key indicators to determine if project is meeting targets.




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5. Evaluation
  Specific Indicator Protocol reference sheets have been designed to track the indicators
  specific to this Project which include:
  TRAINING:
  (A) More than 90% of HCW in the referring TB clinics, and all staff at the ARV Clinic,
      trained in both NTCP and ARV Protocols
  (B) All staff attaining >75% on post-course evaluation test
  (C) Increase in the number of patients on HAART, receiving TB treatment at the
      Integrated ARV Clinic
  The Project Clerk will be responsible for completing the electronic TB register, as well
  as the gathering of all other indicators – as described above.
  The Project Manager will compile a monthly report of these indicators, which will be
  distributed electronically to all key stakeholders and Clinic Team members.


6. Project Progress
  06 June 2009 to 30 September 2009

  Project Background:
  The progress of the project must be viewed within the context of the location TB HIV
  Integrated project in the Community Health Centre of Worcester and the ARV clinic.

   Description                       Period                        Totals
   1. The total number of            06 June 2009 to 30            143
      patients to visit the ARV      September 2009
      Clinic at the Worcester
      Regional hospital
  2. The total number of             As above                      15
      patients to visit the TB/HIV                                 This is 10.49% of the total
      project                                                      of the patients attending
                                                                   the ARV clinic
  Description and breakdown

  Clinical Statistics:
  Patient Totals       15
  •      5 - new patients
  •      4 - patients referred from Zwelithemba & De Doorns
  •      6 - patients on CHC 40 records but attending the ARV Clinic
  Sputum Test conducted

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•      17 new cases
•      7 cases were referrals

Launch
The Project was officially launched on 07 August 2009 at the Worcester Regional
Hospital. This project was publically endorsed by Dr Lizette Phillips Director of the
Boland Regional Department of Health and oversees the Breede Valley Sub district.


Staff Component:
The local project coordinator was appointed 01 June 2009
The Councillor /administrative clerk was appointed later

Training:
Currently the local project coordinator is exploring existing training in the region to
determine the training needs for the sustainability of the project and those involved.
Networks are being built with those who are planning and involved with similar
projects outside of the region.




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