25 June 2014 - Khayelitsha, South Africa - Khayelitsha, a township in the Western Cape, South Africa, is home to approximately 500,000 residents and has some of the highest rates of HIV and tuberculosis globally. In response to the growing burden of drug-resistant tuberculosis (DR-TB) in Khayelitsha, Medecins Sans Frontieres (MSF), in collaboration with the City of Cape Town Health and the Provincial Government of the Western Cape, began piloting a decentralized model of care for DR-TB in 2007. The patient-centered, community-based model was thereafter implemented in 10 primary health care clinics (PHC) within the sub-district, and is now managed in its entirety by the local Department of Health. In 2011, various aspects of this decentralized model were adopted and implemented across other sub-districts in Cape Town as well as other provinces in South Africa.
One essential component of the decentralized programme is patient support; the strength of counseling and adherence support for DR-TB patients is equally as important to the clinical care they receive on their long treatment journey. MSF recently partnered with City of Cape Town DR-TB management to develop a DR-TB counselling toolkit to summarize the standardized counseling sessions a patient receives a specific time points throughout their treatment. The toolkit was designed in accordance with the South African National Drug Resistant TB Management Guidelines (2011), which recommend DR-TB specific counselling to promote adherence to difficult treatment regimens, to encourage retention in care, and to increase the likelihood of successful treatment outcomes.
The counseling toolkit is a comprehensive guide which provides patients with support throughout their treatment duration; it aims to encourage patients to take ownership of their treatment through adherence strategies and a problem solving approach. Specific counseling session plans have been included in the toolkit that provide structured scripts of simple, essential key points to be conveyed to patients in order to eliminate confusion and to clarify the messages presented. In addition to sessions provided at the start of treatment, there are sessions that specifically address treatment interruption, the diagnosis of XDR-TB, and treatment failure/palliative care. In order to monitor the counseling sessions to ensure quality assurance, a competency assessment for counselor managers has been included in the toolkit. Although there can be challenges anticipated in the implementation of this patient support model, such as the human resource needs for skilled counsellors and appropriate supervision, staged implementation of individual counseling sessions has the potential to retain patients in care and improve treatment outcomes.
The counselling toolkit was recently presented at the 4th Annual South African Tuberculosis Conference held in Durban, South Africa from June 10-13, 2014. It won an award for clinical excellence as the best oral presentation at the conference. The toolkit can assist DR-TB treatment programmes with the patient support component of decentralization of care to primary care level; it not only provides standardized counselling messages, but it ensures quality of service delivery and promotes improved treatment outcomes. The toolkit serves as a means for collaboration between DR-TB clinicians, nurses, and counsellors who provide patient care and support, and promotes the DR-TB counselor as a critical member of any team providing care to patients with DR-TB.
Source: Stop TB Partnership