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Towards consensus?

This text discusses the collaborative efforts and impact of consensus-building in various levels of healthcare services, including clinics, government and NGO services, and district management, to improve HIV and TB care. The text highlights the importance of collaboration in promoting case-finding and case-holding, reducing stigma, capacity building, and improving morale among healthcare staff. It also emphasizes the need for quality assurance, communication, and coordination among different stakeholders. Overall, the text emphasizes the need for comprehensive and integrated care for HIV and TB patients.

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Towards consensus?

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  1. Towards consensus?

  2. Collaboration and discussion has been stimulated at many levels • Clinic services • Government and NGO services • District management • National departments • International agencies

  3. Health care staff feel encouraged • Morale • Reduces stigma • Capacity building • Impact on family and community too

  4. DOTS may be strengthened • Encourages political commitment • Promotes case-finding in clinics and communities • Promotes case-holding in home based care • Improves morale in clinics • Links to community for defaulter prevention

  5. Models of service provision • Based around promotion of HIV testing • Spectrum from stand-alone NGO to government clinic service • Referral systems are a challenge

  6. VCT • Demand exists and is increased by mobilisation, media etc. • Quality assurance • Counsellor support • Evaluation tools feasible and useful • Regulations and systems around testing

  7. Care and prevention are not separate • Quality care encourages both patients and staff • VCT promotes prevention • Plenty of opportunities for other prevention - condoms, STI screening or referral

  8. Experience with HIV care expanding • Shape of package of care will depend on local context - policies, services, resources etc. • Capacity to confront HIV care • Relevant to ARV delivery too

  9. Intensified case-finding • HIV positive individuals have significant prevalence of unrecognised TB • Most TB is not found through VCT services • Diagnostic efficiency of general health systems should be strengthened • Operations research needed to study other approaches to ensure more cases found in other settings

  10. Adherence to isoniazid needs to be improved • Demand needs to be stimulated • Small marginal cost • In presence of VCT provision of IPT costs about $25 for each person completing a full course. Around $125 to prevent a case of TB (allowing for one secondary case). • Research on secondary prophylaxis needed

  11. Symptom screening seems sufficient prior to isoniazid • IPT popular with counsellors • Few side effects

  12. Cotrimoxazole easier to administer while patients on TB treatment • Continuing research needed on longer term follow up and possible alternatives • Outcome of randomised studies will be important to guide policy further

  13. Communication and coordination • District health team ownership • Regular meetings of all partners

  14. TB/HIV collaboration assists health systems strengthening • Supervision • Training • Management systems –Technical training, on the Job training, Project management/Budgeting and organograms • Monitoring and evaluation • Planning cycles • Clear definition of roles

  15. Essentials • Policy • Protocols • Training • Technical Mentorship • Monitoring & Evaluation • Communication links/Referral • Appoint Counsellors • Situational Analysis • Strengthened collaboration • Management • Logistics • Infrastructure

  16. Measuring Impact of support • M&E process • Freq of meetings • minutes & action points • Reviews/ Outcomes, VCT;TB;HIV care; prophylaxis;STI; HIV prevention • Resource deployment ..human, financial & material

  17. Some recurring themes • Human resources limited • Can’t rely on long term volunteers • Counselling capacity • Material resources limited • Community capacity needs to be harnessed to share the burden of TB/HIV • NGOs, HBC, Churches • Good situation analysis to identify resources • Organic nature of services available

  18. Quality assurance • VCT evaluations useful • Laboratory and rapid test quality must be assured • Quality of care

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