TUAB054 – The Effect Of Diabetes Mellitus On Exposure To
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Trained Traditional Health
Practitioners can collaborate with
Biomedical Health Professionals to
improve TB & HIV case finding and
treatment success/ adherence:
The case of UMkhanyakude District in KwaZulu
Natal, SA
By:
Boniface Hlabano; Connie Osborne, Nonhlanhla Mthimkhulu, Vusi Ntuli
Amref Health Africa International Health Conference
25 November, 2014, Nairobi
OUTLINE OF PRESENTATION
Background & Introduction
Project Strategy &Tools
Results
Discussion-Conclusion
Challenges
Acknowledgements
Background: Framework for
THP practice in South Africa
• Traditional Health Practitioners Act, Act 22
of 2007.
• THP DIRECTORATE for African
Traditional Medicine at The National DOH.
• National THP COUNCIL (Interim) –
established by the Minister of Health to
regulate THP practice and representation
Background
• In South Africa, research shows that:
41% of TB patients would consult a THP prior to
biomedical diagnosis
84% of diagnosed TB patients would consider
choosing a THP as a treatment supervisor (DOTs
supporter)
88% of THPs trained in basic TB epidemiology
would genuinely refer patients for screening in
health facilities
92% of trained THPs are usually willing to act as
treatment supervisors for TB patients
(Wlikinson, D; Gcabashe, L & Lurie, M. International Journal of TB &
Lung Diseases Vol. 3(9) 835-842)
The Amref Health Africa
UMkhanyakude THP Project: 20112014
THPs Trained
Municipality-Sub-District
Males
Females
Total
Jozini
70
70
140
UMhlabuyalingana
71
82
153
Hlabisa
39
60
99
Mtubatuba
17
18
35
Big 5 False Bay
10
23
33
Total
207
253
460
45 Day Course-Structure
Basic HIV and AIDS information:10 days
VCT and general counselling skills: 5 days
TB and DOTs: 3 days
Introduction to orphans and vulnerable children Care (OVC):2 days
Home-based care: 10 days
ARV literacy: 3 days
Integrated management for child infection (IMCI): 3 days
Prevention of mother to child transmission (PMTCT),STIs: 3 days
Project management: 2 days
Financial management: 2 days
Leadership skills: 2 days
PROJECT TOOLS-Extract from the Manual
PROJECT TOOLS- Referral Form
PROJECT TOOLS- Patient Register
RESULTS (Year 3) n=130
90%
80%
70%
60%
50%
Baseline
40%
Endline
30%
20%
10%
0%
THPs who are complying with registration THPs with a working relationship with their THPs referring clients to the clinic for HIV/TB
policies
local clinic
screening
RESULTS (Year 3) n=130
80%
70%
60%
50%
40%
Baseline
Endline
30%
20%
10%
0%
THPs with proper waste disposal facilities
(dumps)
THPs with proper sanitation facilities
THPs with nutrition gardens
RESULTS
No. of Patients Referred for TB screening: year 3
RESULTS
No of Referred TB suspects confirmed as TB
cases
RESULTS
% Referred TB suspects confirmed as TB
cases (n=434)(vs 430)
RESULTS
No. Of Patients Referred for HIV Testing: year 3
900
801
800
700
600
500
410
400
300
264
200
84
100
102
0
Total Number of HIV Suspects
Referred for Testing by THPs
Male Children under 18
Female under 18
Male Adults
Female Adults
RESULTS
No. Of referred HIV suspects tested
HIV+
350
328
300
250
200
185
143
150
100
47
50
19
0
Total HIV suspects referred
and tested positive
Male Children under 18
Female Children under 18
Male Adults
Female Adults
RESULTS
% HIV+ patients receiving treatment
adherence support from THPs (n=328)
120.00%
105.00%
100.00%
96.00%
92.00%
80.00%
63.00%
60.00%
39.00%
40.00%
20.00%
0.00%
HIV+ patients receiving ARVs
Rx adherence support from
THPs
Male Children under 18
Female Children under 18
Male Adults
Female Adults
THP SERVICE QUALITY IMPROVEMENT
Protective clothing during patient consultation/examination
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THP SERVICE QUALITY IMPROVEMENT
Improvement in storage of medicines: Before & After
THP SERVICE QUALITY IMPROVEMENT
THP Consultation rooms: Before & After
UNINTENDED RESULTS
Empilweni Muti Forest-Environmental Conservation
DISCUSSION-CONCLUSION
When THPs are given up-to-date and accurate healthrelated information, they can make appropriate
changes in their working environment and abandon
potentially harmful practices and treatments.
The results from this model confirm that collaboration
between National TB Programs and community based
initiatives has a huge potential to improve early TB
case finding and treatment success. (The WHO, 2013:
Engage-TB strategy)
This collaboration strengthens better management
and integration of HIV/AIDS & STI and TB services
Such projects positively contribute to infection control
practices within the THP practice including improved
waste disposal and environmental conservation
CHALLENGES
Large variation amongst THPs associations
Weak central organization and coordination
Varying and conflicting theories of disease
causation between biomedical and THPs
THPs generally skeptical of DOH authority
Some health professionals have negative attitudes
towards traditional treatments (lack scientific rigor)
Poor access/supply of resources to improve
infection control (protective clothing)
Lack of a policy which for back referrals to THPs
by health professionals
Collaboration in Practice:
2013TB Day Commemorations-Jozini Sub District
24
ACKNOWLEDGEMENTS
CIDA-DFATD (Department of Foreign Affairs and
Trade Development)
AMREF Health Africa Canada
UMkhanyakude District Health Management
UMkhanyakude Traditional Authorities (Tribal
Councils)
Other Government Agencies and NGOs
The Traditional Health Practitioners Association
Kwa-Zulu Natal Office of The Premier
[email protected]; www.amref.org