JUNE 2010

About ICAP

ICAP was founded in 2004 at Columbia University’s Mailman School of Public Health. Now a global leader in HIV/AIDS services, ICAP supports work with more than 1,200 health care facilities in 14 countries in Africa. More than 962,000 people have received ICAP-supported HIV services, including antiretroviral treatment for more than 480,000 individuals.

For more information about ICAP, visit here.
For more information about ICAP leadership, visit here.

Sponsored by Doris Duke Charitable Foundation, Bill and Melinda Gates Foundation, William and Flora Hewlett Foundation, Robert Wood Johnson Foundation, Henry J. Kaiser Family Foundation, Stephen Lewis Foundation, John D. and Catherine T. MacArthur Foundation, National Institutes of Health, David and Lucille Packard Foundation, Rockefeller Foundation, and Starr Foundation.


© 2010 ICAP

Contributors include Prue Clark, Grace Garnvwa, Anton La Grange, Tshiwela Neluheni, and Leah Westra.

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LINKING TB AND HIV CARE IN SOUTH AFRICA

 

The first 18 months of Tumi’s life have been tough. Born with HIV, Tumi lives with his mother in a small home in Zwide, in South Africa’s Eastern Cape Province. Tumi has been under routine care at an ICAP-supported pediatric clinic, where he receives HIV medication as well as routine assessments for growth and development. When Tumi was brought to the clinic recently with a cough, he was also diagnosed with tuberculosis (TB).

All things considered, Tumi is lucky. His TB was promptly diagnosed. As part of TB/HIV integration efforts, the clinical staff where he gets his care had been trained to routinely check patients for symptoms of TB. At 60 South Africa healthcare facilities supported by ICAP, staff have undergone such training and are now regularly asking patients questions related to TB during visits.

Although Tumi receives care at an HIV clinic, the staff are trained to administer the relevant questions and conduct the necessary tests to diagnose TB. After making the diagnosis, they refer patients to a nearby TB clinic for appropriate treatment. Approximately one-third of HIV-positive individuals are co-infected with TB. Coordinating care for patients who might have both conditions is a huge step towards improving patients’ overall wellbeing.

Dr. Sabine Verkuijl, ICAP-South Africa’s technical advisor on TB/HIV integration, has been working to overcome several challenges in coupling the services. She notes that traditionally, records from each clinic have been kept separate, so “a nurse treating a patient for TB knows nothing about the patient’s HIV status and vice versa.”

A uniform method of recording patient data, and a system to track patients’ clinical progress and social support needs was developed. ICAP worked with the Eastern Cape Department of Health, the Eastern Cape Regional Training Centre, and several organizations to develop a comprehensive HIV adult clinical record (ACR). A unique feature is that this clinical record includes questions that relate to information on TB screening, diagnosis, and treatment, as well as HIV care and treatment. The ACR was evaluated and favorably reviewed in April 2010, and an electronic version is now being piloted in several health facilities in the city of East London.

Dr. Verkuijl has also focused on TB infection control, another component of ICAP’s TB/HIV work. Infection control is the prevention of the transmission of TB from one patient to other patients or health care workers. She has pioneered an infection control program where staff identify patients who arrive with TB symptoms and then fast-track them through the necessary assessments. Those with TB are started promptly on treatment. This process minimizes the time that someone with undiagnosed TB spends with others at the clinic who might catch the illness. It also helps curb the transmission of TB from the patient to others in their household and community.

In South Africa, this work helps address a critical health crisis. A staggering 19 percent of the population is estimated to be HIV-positive. The rates of tuberculosis are equally alarming. According to the World Health Organization’s Global TB Report, South Africa has a severe TB prevalence rate, affecting 692 out of 100,000 South Africans. Tuberculosis particularly affects those with suppressed immune systems, and is easily spread in among those who, like Tumi, live in overcrowded conditions.

Since ICAP began its efforts to help integrate TB and HIV services in South Africa, nearly 10,000 HIV patients have been screened for tuberculosis. Roughly 60 percent of new patients in HIV clinics are being screened for TB through a simple symptom checklist. The goal of the program is to reach 90 percent of all patients. Across all ICAP-supported programs to date, more than 196,000 HIV-positive patients have been screened for TB using the symptom questionnaire.

In December 2009, South Africa’s President Jacob Zuma expressed support for a major policy shift that he indicated would result in a “new era” for HIV in the country. Among his new policies is a plan to bring TB and HIV/AIDS treatment “under one roof.” Coinfected patients will receive free antiretroviral therapy if their CD4 counts are below 350 cells/mm3. These new policies have been enthusiastically welcomed by patients and providers alike.

FROM THE FIELD

New Peer Education Manuals Available

To share lessons learned from its Peer Educator programs, ICAP recently developed generic Peer Educator materials, which can be adapted by organizations and implementing partners wishing to start or scale-up their own Peer Education programs. ICAP’s Peer Education curriculum (which includes trainer and participant manuals) is available, along with an implementation manual that can guide program planning, implementation, and monitoring. The materials can be accessed free of charge HERE»

ICAP, along with Ministries of Health and other local partners, is currently implementing Peer Educator programs in several sub-Saharan African countries. Peer educators, themselves living with HIV and enrolled in care and treatment, support people living with HIV and their families by providing education and practical adherence and psychosocial support. They also follow up with clients in the community who miss appointments. Peer education programs support greater and meaningful involvement of people living with HIV in service delivery and help tackle the human resource demands of HIV care by supporting task-shifting to trained lay counselors.

ICAP Supports Training of Pharmacist Assistants

ICAP supported the renovation of a training room and information center at the Port Elizabeth Hospital Complex in South Africa. The Center will be utilized for the training for pharmacist assistants and as a resource for relevant medical information. This allows the pharmacy department to use modern technology in the training of pharmacy personnel. Since 2007, ICAP has funded the training of 16 pharmacist assistant candidates.

"ICAP stands up for our rights."

In Kaduna State, Nigeria, Mrs. Adama Sambo, better known as AD Mama, is a peer health educator and a Home Based Care (HBC) volunteer. See her profile on ICAP’s Virtual Quilt.