Trained Traditional Health
Practitioners can collaborate with
Biomedical Health Professionals to
improve TB & HIV case finding and
treatment success/ adherence:
The case of UMkhanyakude District in KwaZulu
Natal, SA
By:
Boniface Hlabano; Connie Osborne, Nonhlanhla Mthimkhulu, Vusi Ntuli
Amref Health Africa International Health Conference
25 November, 2014, Nairobi
OUTLINE OF PRESENTATION
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Background & Introduction
Project Strategy &Tools
Results
Discussion-Conclusion
Challenges
Acknowledgements
Background: Framework for
THP practice in South Africa
• Traditional Health Practitioners Act, Act 22
of 2007.
• THP DIRECTORATE for African
Traditional Medicine at The National DOH.
• National THP COUNCIL (Interim) –
established by the Minister of Health to
regulate THP practice and representation
Background
• In South Africa, research shows that:
 41% of TB patients would consult a THP prior to
biomedical diagnosis
 84% of diagnosed TB patients would consider
choosing a THP as a treatment supervisor (DOTs
supporter)
 88% of THPs trained in basic TB epidemiology
would genuinely refer patients for screening in
health facilities
 92% of trained THPs are usually willing to act as
treatment supervisors for TB patients
(Wlikinson, D; Gcabashe, L & Lurie, M. International Journal of TB &
Lung Diseases Vol. 3(9) 835-842)
The Amref Health Africa
UMkhanyakude THP Project: 20112014
THPs Trained
Municipality-Sub-District
Males
Females
Total
Jozini
70
70
140
UMhlabuyalingana
71
82
153
Hlabisa
39
60
99
Mtubatuba
17
18
35
Big 5 False Bay
10
23
33
Total
207
253
460
45 Day Course-Structure
 Basic HIV and AIDS information:10 days
 VCT and general counselling skills: 5 days
 TB and DOTs: 3 days
 Introduction to orphans and vulnerable children Care (OVC):2 days
 Home-based care: 10 days
 ARV literacy: 3 days
 Integrated management for child infection (IMCI): 3 days
 Prevention of mother to child transmission (PMTCT),STIs: 3 days
 Project management: 2 days
 Financial management: 2 days
 Leadership skills: 2 days
PROJECT TOOLS-Extract from the Manual
PROJECT TOOLS- Referral Form
PROJECT TOOLS- Patient Register
RESULTS (Year 3) n=130
90%
80%
70%
60%
50%
Baseline
40%
Endline
30%
20%
10%
0%
THPs who are complying with registration THPs with a working relationship with their THPs referring clients to the clinic for HIV/TB
policies
local clinic
screening
RESULTS (Year 3) n=130
80%
70%
60%
50%
40%
Baseline
Endline
30%
20%
10%
0%
THPs with proper waste disposal facilities
(dumps)
THPs with proper sanitation facilities
THPs with nutrition gardens
RESULTS
No. of Patients Referred for TB screening: year 3
RESULTS
No of Referred TB suspects confirmed as TB
cases
RESULTS
% Referred TB suspects confirmed as TB
cases (n=434)(vs 430)
RESULTS
No. Of Patients Referred for HIV Testing: year 3
900
801
800
700
600
500
410
400
300
264
200
84
100
102
0
Total Number of HIV Suspects
Referred for Testing by THPs
Male Children under 18
Female under 18
Male Adults
Female Adults
RESULTS
No. Of referred HIV suspects tested
HIV+
350
328
300
250
200
185
143
150
100
47
50
19
0
Total HIV suspects referred
and tested positive
Male Children under 18
Female Children under 18
Male Adults
Female Adults
RESULTS
% HIV+ patients receiving treatment
adherence support from THPs (n=328)
120.00%
105.00%
100.00%
96.00%
92.00%
80.00%
63.00%
60.00%
39.00%
40.00%
20.00%
0.00%
HIV+ patients receiving ARVs
Rx adherence support from
THPs
Male Children under 18
Female Children under 18
Male Adults
Female Adults
THP SERVICE QUALITY IMPROVEMENT
Protective clothing during patient consultation/examination
18
THP SERVICE QUALITY IMPROVEMENT
Improvement in storage of medicines: Before & After
THP SERVICE QUALITY IMPROVEMENT
THP Consultation rooms: Before & After
UNINTENDED RESULTS
Empilweni Muti Forest-Environmental Conservation
DISCUSSION-CONCLUSION
When THPs are given up-to-date and accurate healthrelated information, they can make appropriate
changes in their working environment and abandon
potentially harmful practices and treatments.
The results from this model confirm that collaboration
between National TB Programs and community based
initiatives has a huge potential to improve early TB
case finding and treatment success. (The WHO, 2013:
Engage-TB strategy)
This collaboration strengthens better management
and integration of HIV/AIDS & STI and TB services
Such projects positively contribute to infection control
practices within the THP practice including improved
waste disposal and environmental conservation
CHALLENGES
 Large variation amongst THPs associations
 Weak central organization and coordination
 Varying and conflicting theories of disease
causation between biomedical and THPs
 THPs generally skeptical of DOH authority
 Some health professionals have negative attitudes
towards traditional treatments (lack scientific rigor)
 Poor access/supply of resources to improve
infection control (protective clothing)
 Lack of a policy which for back referrals to THPs
by health professionals
Collaboration in Practice:
2013TB Day Commemorations-Jozini Sub District
24
ACKNOWLEDGEMENTS
CIDA-DFATD (Department of Foreign Affairs and
Trade Development)
AMREF Health Africa Canada
UMkhanyakude District Health Management
UMkhanyakude Traditional Authorities (Tribal
Councils)
Other Government Agencies and NGOs
The Traditional Health Practitioners Association
Kwa-Zulu Natal Office of The Premier
Boniface.Hlabano@Amref.Org; www.amref.org