July 2004
( Conference Preview )

Implementation of DOTS at community level

Challenges of integrating DOTS in an urban setting

What the Papers Say!

DfID urged to improve Aids programmes

ARVs Require Discipline

It would be useful to ImpActAIDS if we could get feedback from the following sessions.

Implementation of DOTS at community level
By: R Kaluta, Mwape, W Mwape, J C Mfula
Community Based TB organisation -CBTO, Lusaka, Zambia

Introduction: A community based treatment unit is spearheading the implementation of DOTS with family and community involvement in the care of TB/AIDS patients by training treatment supporters living closer to the patients and family members. Treatment supporters can be anyone who is willing, trained, responsible, acceptable to the patient and accountable to the TB control services. Community based DOTS implementation is the surest way of ensuring the provision of adequate care and support to persons infected with tuberculosis .
Objective: To improve detection and cure rate through early diagnosis and effective treatment compliance using DOTS strategy with the help of TB treatment supporters.
Strategy: treatment supporters supervise treatment at community level to ensure a standard and effective implementation. This is enhanced by the following activities: Health Education,mobilization and sensitisation of the community on the need to supervise treatment. Training of treatment supporters on data recording / reporting and use of forms.
Method: TB suspects are refered to the diagnostic center by the treatment supporter for smear examination, once diagnosed with TB, a treatment supporter living closer to a patient is assigned to supervise treatment, record and report. Since January 1998 to November 2003, the project had 4,436 new TB patients of which 2,143 were sputum positive.
Result:
- Cure rate from 40% before DOTS to 79.6% with DOTS.
- Completion rate from 55% before DOTS to 80% with DOTS.
- Defaulter rate from 20% before DOTS to 3% with DOTS
- Increased number of people attending clinics at early stage of disease
Conclusion: Family supporters can actively improve detection rate, provide support and encouragement to patient under treatment and trace those who fail to attend clinic. With appropriate training family members can take drugs to patients thereby making it easier for patients to complete treatment.

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Challenges of integrating TB DOTS in an urban setting , at a stand-alone voluntary counselling and testing (VCT) center in Kampala, Uganda
By: R Habineza, B Mugisha, S Namono, O Mbabazi, J Mubangizi, S Wangalwa, L Hitimana
AIDS Information Centre, Kampala, Uganda

Background: AIDS information center (AIC) Uganda, an Organization that offers VCT and related services since 1990, started TB DOTS program in February 2003. To promote Active TB treatment adherence, clients were counseled and given an option to identify Treatment Supporter (TS). Clients were then reviewed every two weeks for the first two months and later monthly. The proportion of clients who identified TS, clients who completed treatment, their treatment outcomes and challenges in identifying and working with TS are described here.
Method: We reviewed AIC data from February 2003 to December 2003. Data was entered in Epi-2000 and analysed.
Results: In the described period, 182 urban dwelling clients were diagnosed with active TB. Of these clients, 95(52%) were treated at AIC and the rest were referred to health centers of their choice. Reasons for referral included long distance and clinical state, which required hospitalization. Out of those treated at AIC, 8(8.4%)preferred to administer drugs by themselves whereas 87(91.6%) identified TS. Out of those who preferred to self- administer drugs; 2(25%) defaulted, 3(37.5%) transferred to hospital and 3(37.5%) were still on treatment. Out of the 87 clients with TS; 8(9.2%) died, 1(1.1%) defaulted, 7(8%) transferred, 20(23%) had completed treatment while the rest were still on DOTS. Challenges encountered included; linking TS to AIC health workers, some TS initially accepted but later withdrew without informing AIC service providers and other TS expected payments. Most of the TS identified were family members.
Conclusion: Implementation of TB DOTS is feasible at a stand-alone urban VCT center. Our results show that most clients were able to identify TS despite being in an urban setting. Treatment supporters are useful for continuous support of clients on TB treatment. Counseling and guidance is necessary for co-infected patients to complete TB treatment. This being an ongoing program, we shall have more data by June 2004

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DfID urged to improve Aids programmes

The Department for International Development is not effectively monitoring the effectiveness of its policies to tackle the spread of HIV/Aids, a report has warned.

According to the National Audit Office, DfID also faces difficulties in making best use of expertise and knowledge on the disease.

However, the department was praised for its broad-based approach, its flexibility and its role in supporting research.

The report says that DfID's HIV/Aids strategy "compares well" with the approaches developed by like-minded donors.

"It provides a starting point for country staff to develop programmes suited to local circumstances," said the report.

"But it could have provided further guidance on the relative merits of different approaches, responding to demand from country teams for guidance on the most difficult issues – such as the merits of funding anti-retroviral drug treatments.

"DfID plans to produce a new strategy in July this year which it intends will address these and other issues."

Analysis
The international development department spent between £103 million and £169 million on bi-lateral HIV/Aids programmes in 2002/03.

"Effective development interventions require good analysis of the context and potential responses prior to project implementation," added the report.

"The autonomy afforded to country teams has enabled DfID to adopt a flexible approach to HIV/Aids programming."

But it added that "plans often did not link the approach proposed with resourcing and expected impacts".

"The HIV/Aids epidemic has a devastating effect on the lives of poor people in developing countries," said NAO chief Sir John Bourn.

"The Department for International Development has a clear commitment to respond to HIV/Aids.

"The department should put in place management systems sufficiently robust to ensure that people affected by HIV/Aids gain the greatest possible benefit from the increasing resources allocated to the epidemic."

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ARVs Require Discipline
Posted to the web June 28, 2004

Kampala

PRESIDENT YOWERI Museveni has warned against taking anti-retroviral drugs without consulting a doctor.

The President's word of caution should be taken seriously. The Ministry of Health has just launched an initiative aimed at making sure that every AIDS patient who needs anti-retroviral drugs will receive them. This initiative has raised the hopes of Ugandans living with HIV/AIDS, and also met approval from around the world.

However, utmost discipline is required to achieve the desired results. Not everyone who has HIV will immediately need ARVs. Only trained medical personnel can tell a patient when it is time to begin. These drugs are taken life-long and they have side effects, so there is no need rushing into them before the recommended time.

When on treatment, a patient has to stick to the right dose, and take the drugs according to the recommended timetable since misusing ARVs can lead to unnecessary suffering.

Even with the right dose, a person who takes ARVs has to be closely monitored by doctors to ensure that they are improving, and also to make sure they do not suffer excessively from the side effects. Through such monitoring a doctor can make a decision to change the drug combination when necessary.


The challenge for health workers, therefore, is to ensure that they educate the public massively about these drugs, using all available channels. Health workers should also ensure that every patient is adequately counselled. Often medical personnel, particularly in public health facilities, do not adequately communicate with patients, citing time constraints.

This has to change. If the scheme is to work well, medics have to create time for patients who take ARVs.

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Mulago to burn 7.5m condoms

By Attractor Kamahoro

MILLIONS of Engabu condoms in Mulago Hospital warehouse have been declared obsolete and will be transported to Bombo where they will be burnt.

The hospital’s deputy director, Dr Gideon Kikampikaho, said the consignment was part of a donation from the Sexually Transmitted Infections (STI) project of the ministry of health.

Kikampikaho said condoms were normally distributed through the hospital’s STD and Family Planning clinics but some donations were beyond the hospital’s requirements.

As to why the condoms were not distributed through other hospital departments or donated to smaller health centres outside Mulago hospital before they expired, Kikampikaho said beaurocracy did not permit the hospital to do so.
“We are the end users, not distributors,” he said.

He admitted that it was a big waste since many people were in need of the condoms elsewhere, but said that he had just written to donors asking them to donate what is manageable and also consider giving such donations to other institutions as well.

Some 7.5 million condoms are to go up in flames soon.

An offer of close to five million condoms from another organisation was recently rejected by Mulago allegedly due to lack of capacity to handle them.
Three years ago some six million condoms expired at Mulago and were also burnt.

Condoms of the Engabu brand are imported by the Ministry of Health for distribution free of charge countrywide.

Published on: Monday, 28th June, 2004

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