The incidence of tuberculosis in South Africa increased with 400% over the past 15 years.Approximately 1% of the population develops active TB disease each year and is the number one cause of all deaths in the country[i]. Current HIV/TB co-infection rates in South Africa exceed 70% with TB being the most common opportunistic infection among them. The main reasons for this high number of HIV/TB co-infection rates are late detection, poor treatment, and failure to retain TB patients on treatment. Drug-resistant forms of TB have increased significantly.
The Hospice Palliative Care Association and member hospices started the TB programme in response to Department of Health (DoH) request to assist in the care of TB patients. It was found that primary patients who were discharged by the TB hospitals did not all report to their nearest clinics of their own volition, and were being lost to follow up. Many of these patients lived far from their local clinic and daily trips to the clinic for treatment were unfeasible. It was also important to limit the exposure of other clinic patients to DR TB patients in the waiting rooms of clinics, which are often over-crowded, with sub-optimal infection control measures.
The programme started off with hospices being tasked with visiting discharged drug susceptible and drug resistant TB patients who were too ill or too remote to attend a clinic. Some patients presented themselves at hospices because they were too ill and required care. Lately, other Community Based Organisations (CBOs) have started participating in the programme. The purpose of these visits is to deliver and administer medications as well as provide palliative care and health education; to screen all contacts of index patients and refer to clinic for further tests when necessary; to refer all asymptomatic children for INH prophylaxis; to refer all asymptomatic HIV positive contacts for INH prophylaxis; to encourage testing of TB patients for HIV and for treatment support of those on antiretroviral or TB treatment; to educate on infection control in the home and in the community; to provide pain and symptom management; to provide holistic care to patients and families (psychosocial, nutrition); to assist clinics by tracing defaulters and contacts; to report to clinic and HPCA on the TB programme.
The result of the interventions by these CBOs, in the long run, will be decreased new transmissions as a result of the education given on infection control, early diagnosis and initiation of treatment, retention in care and improvement in treatment outcomes.It has been important to visit people in their homes and communities to enhance retention in care and infection control in these settings.
The programme has been very successful not only in managing the TB patients with increased cure rate and reduced loss to follow up of patients but also in creating collaborative networks between CBOs and DoH facilities. There has been improved infection control practices within households of patients and in the community and increased awareness of DR TB in households and communities.
We appreciate the involvement of member hospices and other CBOs, the dedication and professionalism of hospice staff and HPCA TB staff. We look forward to an ongoing partnership with government facilities to grow and sustain the programme across the districts and the provinces. If the programme is to be financially sustainable, this project must feature in all the province’s district health plans and their budgets.