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| Comment: Online discussion on TB HIV co-infection (6) |
2008-06-10 01:00:00 <STOP-TB> |
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Comment: Online discussion on TB HIV co-infection (6)
Dr Nii Nortey Hanson-Nortey, Ghana
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"IN TB CARE, PROPER TREATMENT COUNSELLING IS OFTEN TAKEN FOR GRANTED"
"PRESENTATION OF TB IN PLHIV IS LARGELY DIFFERENT FROM THAT IN NON-HIV INFECTED PERSON"
"TB CARE SERVICES ARE SEPARATE FROM HIV CARE CLINICS"
Dear Stop-TB members,
In Ghana the main challenges that people living with HIV (PLHIV) with active TB face include:
* A denial of the fact that these people really have TB among TB care providers. As we are all aware the presentation of TB in PLHIV is largely different from that in non-infected persons. Some physicians and prescribers are not familiar with the changes that occur on chest x-ray in sputum negative PLHIV. This affects how many people readily get TB treatment. Where a refusal occurs an HIV physician will have to go and discuss the case fully and where s/he is unable to do so then the PLHIV is sure not to get their TB treatment.
* In most facilities TB care services are separate from HIV care clinics. Each facility manages their logistics separately and has different reporting and accountability processes. This makes it difficult for care providers on each side to prescribe medications of the other programme directly. They must as such refer these clients to the other side to receive care. If in the process of referral the client is not given adequate information and counselling they end up not accessing the care on the other side.
* With regards to adherence it seems that most PLHIV who are put on anti-TB medications are adherent especially when they get good counselling prior to starting ART. This reflects in their general drug adherence. Where there is non-adherence a lot is inherent in the client who after taking medications for a while starts feeling well and so decides not to continue. And this can usually be traced to a weakness in the quality of adherence s/he received prior to starting ART. In TB care where counselling has been taken for granted defaulters are usually patients who did not receive adequate drug counselling prior to starting ART.
* Patient adherence to TB treatment has generally improved with the introduction by the TB programme of a treatment incentive package called the Enablers Package (includes breakfast meals, food packages and transportation where necessary) to motivate patients to go through their treatment and to achieve cure.
* Combined ARV and TB care is possible and is being practiced in Ghana. Combined care is possible at each level of care provision and must be tailored to suit the settings of the community and the health facilities serving patients in the community.
* Once a PLHIV settles into a ARV clinic they no longer need to be seen frequently and they can be seen daily at the TB clinic during the intensive phase of their treatment. Where they cannot make it daily to the TB clinic a treatment supporter (who may be a relative, trained community volunteer, NGO volunteer or a health worker) is assigned to the patient who is most likely to be the same one supporting the patient to take their ARVs. Where they have not started ARVs they are asked to select someone they would be comfortable with to support them during their treatment period. This treatment supporter supports and monitors them at home to take their TB medicines. Where they chose already trained community volunteers in the community these people support them to go through their treatment at home and link them up to the clinic both TB and ARV and periodically they attend the ARV clinics.
* Treatment for TB has been simplified with the introduction of 4-fixed dose combination drugs which has significantly reduced the pill burden for patients. This has contributed to patient adherence to treatment and allows patients the option to receive care in the clinic and at home supervised by the treatment supporter.
* Integration of TB and HIV services in Ghana is still a challenge though significant strides have been made in this direction.
* At the national level there is a TB/HIV Focal person who originally has an HIV background but is presently working with the TB programme directly and oversees the process of integration. Policy documents have been developed, disseminated and in use providing technical and clinical guidelines. Both programmes share a lot of information and plan programmes together to achieve the set indicators.
* At the implementation level there is a lot of effort to get health care providers to appreciate the collaboration needed to provide a one-stop shop approach to patients. In this manner care providers in ARV clinics diagnose and prescribe TB medications from their clinic and the patients collect these without having to see another care provider. In some places the same care providers see both TB and HIV patients on different days in the same clinic setting.
We are seeking to provide the best of care to our patients with even further integration.
Dr Nii Nortey Hanson-Nortey
Deputy Programme Manager
National TB Control Programme
Accra, Ghana
Email: nii.nortey@ghsmail.org
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[Mods note: A focused online discussion on TB and HIV co-infection was announced last month on SEA-AIDS eForum in Asia-Pacific. Above is a comment from a Stop-TB eForum member.
It will be vital to hear from those on the frontlines fighting TB and HIV in Asia and the Pacific to share their experiences on:
* What are the main challenges PLHIV with active TB face in accessing existing TB care services, and in adhering to treatment?
* Combined ARV and TB care and treatment: is it possible? If so, where? At homes or clinics?
* How closely integrated are TB and HIV treatment and/or prevention programmes in your country?
Be welcome to comment. Thanks]
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