Preventing the Transmission of TB in the Ethembeni HIV Clinic

Preventing the Transmission of TB in the Ethembeni HIV Clinic

The Southern African Catholic Bishops Conference (SACBC) through the Centocow Development Programme (CPD) with funds from PEPFAR provides support to the St Apollinaris Hospital for its HIV care and treatment programme. St Apollinaris is the public hospital that serves the Sisonke health district, in the Ingwe municipality. Sisonke, one of the ten most impoverished areas in South Africa, serves a rural population of 192, 145 at the very epicenter of the HIV epidemic in the Kwa-Zulu Natal Province. Sisonke is also the health district with the highest number of reported cases of TB, 1387 per 100,000 (http://www.hst.org.za/publications/district-health-barometer-201011).

Through PEPFAR and in partnership with the St Apollinaris Hospital, the SACBC helped establish and support the Ethembeni HIV Clinic and the Philani TB clinic. The SACBC provided technical support,  vehicles , equipment, training, implementation of the government’s tier.net electronic patient data system, and staff salaries, including “TB Warriors,” staff who served as liaisons between the HIV clinic and the TB clinic and wards to promote coordination and integration of HIV and TB services. The SACBC also purchased three park homes to house the clinics on government hospital grounds. The consulting rooms were small and the waiting areas crowded with patients and the family members who accompanied them. With little air flow in these enclosed treatment and waiting areas, there was concern that TB would be spread from one patient to another.

In order to reduce TB transmission in the patient waiting areas, the SACBC initiated four activities: (1) provided support for outreach clinics to increase the impoverished rural patients’ access to service and reduce patient numbers at St Apollinaris Hospital clinics;  (2) sponsored St Apollinaris staff to CDC trainings on TB infection control; (3) assisted St Apollinaris HIV and TB clinics to develop and implement TB infection control plans; and (4) with financial and technical support from CDC, contracted an engineering company with specific knowledge of TB infection control measures to renovate the consulting areas to improve air flow and to construct open air waiting areas. The activities were evaluated by six-weekly on-site visits by SACBC staff to the facilities; and by an extensive evaluation at the request of the St Apollinaris CEO to evaluate the implementation of the HIV/TB services. This included interviews with key staff, managers, and community outreach workers, and focal group meetings with patients in the community.

As a result of the CDC sponsored training in TB infection control, staff at the St Apollinaris district hospital have implemented TB infection control measures, such as opening windows in consulting rooms; prioritizing patients with cough, and displaying posters on cough etiquette. In addition, the SACBC renovated the pharmacy, had extractor fans installed in the park homes; provided a large generator; and constructed open-air waiting areas . In addition, many patients who live in areas where outreach clinics have been established have better access to care and are less exposed to the risk of becoming infected in crowded clinics.

The SACBC with technical support from CDC and financial support from PEPFAR has improved the infrastructure of the St Apollinaris Hospital, a government hospital that serves Sisonke, one of the most impoverished districts in the country and one with of the highest numbers of recorded TB cases.

Ruth Stark
Senior Technical Advisor