Proper Management of Tuberculosis Reduces Mortality Rate Among Co-Infected Individuals

Proper Management of Tuberculosis Reduces Mortality Rate Among Co-Infected Individuals

PROPER MANAGEMENT OF TUBERCULOSIS REDUCES MORTALITY RATE AMONG THE KZN CITIZENS

1. INTRODUCTION

Nkandla Hospital is one of the Uthungulu District Hospitals which caters for a very vast extremely rural community. It has eleven PHC clinics in total. Mrs Maphanga, who is the nursing service manager and the operational managers of different sections are very enthusiastic and supportive in the health care improvement aspects.

Mrs V. N. Mbatha, URC health care improvement coordinator, works together with the Uthungulu Health District and supports Nkandla Hospital and its seven PHC clinics.

The health care improvement project started in July 2009, following the Quality Assurance Project which was started in year 2002 to 2005.

  1. PROGRAMMES COVERED

 PMTCT

 TB/HIV

 VCT/HCT

 BHC (Basic Health Care)

 HAART

When this project started, clients that were co-infected with TB/HIV were issued with cotrimoxazole prophylaxis if the CD4 count was above 200.

HIV counseling for newly TB diagnosed clients was very poor. The above quality gaps were discussed with the TB clinic staff. The department did have the policy form the DOH on CPT and that had to be revisited and well defined. Posters on cotrimoxazole prophylaxis were made available by URC to be distributed to facilities.

  1. GAPS IDENTIFIED
  • Staff attitude
  • Lack of supervision
  • Poor communication
  • Resistance to change
  • Poor compliance with standards and guidelines
  • Lack of knowledge and skills
  • Lack of in-service training
  • Frequent staff rotation.

Personnel at the TB clinic experienced confusion when they were requested to indicate in the remarks column of the TB register if the client was not ready to test for HIV. There was some resistance since generally that space is reserved for final patient outcome results.

  1. IMPROVEMENT INTERVENTIONS

- Support visits conducted twice a month and sometimes monthly if the schedule

is packed, to monitor progress.

- Feedback given to the TB clinic staff to communicate the findings and gaps

identified.

- Quality Assurance workshops have been conducted at the District Office and

URC Office, but due to transport crisis at institutions we then decided to

bring the workshops to the facilities for easy access by most personnel.

- Distribution of relevant posters on CPT, TB, etc. to facilities.

- TB/HIV collaborative management of clients.

- Distribution and discussion of graphs.

- Supervision of the TB management programme, checking on the records.

- Improvement in the interpersonal relationships.

The district programme coordinators were also informed of the HCI coordinators at facilities and any misconceptions experienced were corrected.

Data collection tools were issued to them as well reflecting the national indicators.

FIGURE: 1 - TB/HIV: Q3 2009 - Q1 2010

FIGURE 2 : % HIV Pos TB Patients initiated on CTP - Q3 2009 To Q2 2010

  1. NEW OUTCOMES
  • Attitudes of staff improved.
  • Staff became more motivated and improvement has been noted gradually i.e. there is more buying-in into the quality improvement.
  • All HIV positive TB patients are now initiated on cotrimoxazole as soon as they test positive regardless of the CD4 count results.
  • Newly diagnosed TB clients receive HIV counseling and indication is done where the client receives counseling but does not test and also when the client is registered for TB knowing his/her HIV status already.
  1. CHALLENGES
  • Staff turnover / rotation
  • Inadequate space
  • Staff development
  • Specimen turn-around-time for both microscopy and culture.
  • Shortage of staff.
  • Transport problem.
  • Delay in IPT initiation.
  • HCI and District TB coordinators not holding meetings together to discuss achievements and experienced challenges.

The HCI Project has played a major role in improving TB management and record keeping as people tend to work hard but fail to document the activities performed.

Improvement in the TB management will reduce the mortality rates especially among the most vulnerable co-infected individuals leading to a better life for South African citizens.

The goal STOP TB will therefore become realistic and achievable as long as health care workers are empowered and are motivated to improve and strive for quality care.

Therefore quality is not practiced in isolation but is rather incorporated in the same daily routine activities. Team work is the best cure.

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