perspectives from the field dr lydia mungherera taso (the aids support organisation) uganda...

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  • PERSPECTIVES FROM THE FIELDDR LYDIA MUNGHERERATASO (The Aids Support Organisation) UGANDA REVERSING THE TIDE OF TB

  • IntroductionThe 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 worlds 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 TASOTASO 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 SERVICESHIV/AIDS counsellingMedical careSocial supportCapacity buildingAdvocacy and networkingCommunity mobilisation,education and senstisationRegionalisationProgramme support and evaluation

  • Role of Taso Drama GroupsTASO drama groups are made of positive members who go out and sensitize the community about the epidemic and common opportunistic infections like TB

  • Medical careThe medical department has activities to promote medical care like:Center and outreach clinicsTB follow upHome based careSupport and supervision to community nurses

  • Training at TASO CentresTraining 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 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

  • COMPONENTSPREVENTIVE MEASURESTB health education talks during community gatherings at the center and outreaches.Individual health education during triage,consultation,dispensing Follow up and monitoring

  • COMPONENTSPROPER MANAGEMENTEarly identification and screeningTreatment initiation as per National TB Leprosy Program (NTLP) guidelinesRelevant TB counselling and Accurate recording

  • CB DOTS MODELDEFINITION:Community Based Direct Observed Treatment Shortcourse is supervised tablet swallowing in the community

    PEOPLE INVOLVED IN THE COMMUNITY:clients and care giversAIDS community workers (ACWs)Community nursesHome care team who report to the TB nurses

  • DOTS FOLLOW UPIdentification 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 WorkersCommunity mobilization for TB and HIVCoordinate TB care and support activitiesSupport update of the unit TB registerEnsure a continuous drug stockDo TB follow-up for repeat sputum smearsAscertain correct discharge from treatment

  • ACHIEVEMENTS Reduction in the TB epidemic and reduced mortality of Aids patientsFollow up has helped with adherence to treatmentRaised community awarenessReduction of morbidity and mortalityTB and HIV programmes have begun to complement each otherInvolvement of people living with the two diseases as peer educators

  • CHALLENGESInadequate TB/HIV programs in government health facilitiesPill Burden of TB/HIV makes it difficult for patients to adhereAbsence of drugs for MDR and proper diagnostic tools in most health centersInteraction between ARVs and anti-TB drugsStigma in families and in the communityLack of skilled manpowerScattered populations make it difficult to identify homes where TB patients are living

  • Unique Obstacles to Rural TB/HIV CareMinimal existing health infrastructure and personnel very limited access to lab testingDispersed population with limited access to transportationExtreme poverty with minimal access to electricity, sanitation, clean waterPotential difficulty with adherence, potential for development of viral resistance

  • WAY 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

  • ACKNOWLEGMENT

    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