PERSPECTIVES FROM THE FIELDPERSPECTIVES FROM THE FIELD
DR LYDIA MUNGHERERA
TASO (The Aids Support Organisation) UGANDA
REVERSING THE TIDE OF TBREVERSING THE TIDE OF TB
IntroductionIntroduction
The HIV pandemic presents a massive challenge to the control of TB all levels.
TB is one of the most common causes of morbidity in people living with HIV/AIDS.
By the end of 2000, about 11.5 million HIV infected people were co-infected with TB.
Uganda is one of the world’s 22 high burdened countries with TB.
Uganda has an estimated annual risk of infection of 3% equivalent to 150-165 new smear positive cases per 100,000 populations per year or 300-330 total TB cases per 100,000 per year.
Background of TASOBackground of TASO
TASO was founded in 1987 by a group of 16 volunteers spearheaded by Noreen Kaleeba and her husband the late Christopher Kaleeba (R.I.P)
The vision was to take care and support people living with HIV/AIDS so that they can live and die in dignity
TASO SERVICESTASO SERVICES
• HIV/AIDS counselling• Medical care• Social support• Capacity building• Advocacy and networking• Community mobilisation,education and
senstisation• Regionalisation• Programme support and evaluation
Role of Taso Drama GroupsRole of Taso Drama Groups TASO drama groups
are made of positive members who go out and sensitize the community about the epidemic and common opportunistic infections like TB
Medical careMedical care
The medical department has activities to promote medical care like:
• Center and outreach clinics• TB follow up• Home based care• Support and supervision to community
nurses
Training at TASO CentresTraining at TASO Centres
Training takes place at the centers to give staff and community volunteers more knowledge of how to care and support people living with HIV/AIDS and TB
TB Care and supportTB Care and support
TB care and support is proper management of a TB client both at the facility and in the community.
It is aimed at prevention of spread to the community and complete cure of the infected.
It involves screening,counselling,drug initiation and follow up.
Screening of HIV is done at the same center and patients are treated for both diseases
COMPONENTSCOMPONENTS
PREVENTIVE MEASURESTB health education talks during
community gatherings at the center and outreaches.
Individual health education during triage,consultation,dispensing
Follow up and monitoring
COMPONENTSCOMPONENTS
PROPER MANAGEMENTEarly identification and screeningTreatment initiation as per National TB
Leprosy Program (NTLP) guidelinesRelevant TB counselling and Accurate
recording
CB DOTS MODELCB DOTS MODEL
DEFINITION: Community Based Direct Observed
Treatment Shortcourse is supervised tablet swallowing in the community
PEOPLE INVOLVED IN THE COMMUNITY:1. clients and care givers2. AIDS community workers (ACWs)3. Community nurses4. Home care team who report to the TB nurses
DOTS FOLLOW UPDOTS FOLLOW UP Identification of homes for periodic home visits
depending on severity,appointment compliance,prognosis and workload.
House hold health education on hygiene, nutrition, prevention, stigmatisation and adherence.
Identification of a treatment supporter for DOTS initiation.
Support and supervision of caregivers DOTS and community nurses CB DOTS.
Field Officers who monitor adherence to ARVs complement the follow up of TB treatment in the community
ROLE of Community Health ROLE of Community Health WorkersWorkers
Community mobilization for TB and HIV Coordinate TB care and support activities Support update of the unit TB register Ensure a continuous drug stock Do TB follow-up for repeat sputum smears Ascertain correct discharge from treatment
ACHIEVEMENTS ACHIEVEMENTS
Reduction in the TB epidemic and reduced mortality of Aids patients
Follow up has helped with adherence to treatment
Raised community awareness Reduction of morbidity and mortality TB and HIV programmes have begun to
complement each other Involvement of people living with the two
diseases as peer educators
CHALLENGESCHALLENGES Inadequate TB/HIV programs in government
health facilities “Pill Burden” of TB/HIV makes it difficult for
patients to adhere Absence of drugs for MDR and proper
diagnostic tools in most health centers Interaction between ARVs and anti-TB drugs Stigma in families and in the community Lack of skilled manpower Scattered populations make it difficult to
identify homes where TB patients are living
Unique Obstacles to Rural Unique Obstacles to Rural TB/HIV CareTB/HIV Care
• Minimal existing health infrastructure and personnel – very limited access to lab testing
• Dispersed population with limited access to transportation
• Extreme poverty with minimal access to electricity, sanitation, clean water
• Potential difficulty with adherence, potential for development of viral resistance
WAY FORWARDWAY FORWARDStrengthen the collaboration of TB and
HIV/AIDS services at all levelsProfessional skills-refresher workshopsReduce stigma amongst health workersImprove community mobilization skillsCreating partnerships with other
stakeholdersSearch for new diagnostics and drugs
which make adherence easier for patients
ACKNOWLEGMENTACKNOWLEGMENT
I would like to acknowledge all the staff of TASO in the community and at the
centers. I especially want to acknowledge the TB nurses and field officers for follow
up of patients on treatment.
I want to thank the TB Alliance for recognizing the need for community involvement and inviting me to this meeting
