Transferring knowledge and skills to frontline medical personnel fighting the HIV & TB epidemics in rural South Africa
Authors: Tulio de Oliveira, Justen Manasa, Richard Lessells
A very successful workshop and book launch was hosted at the Ghost Mountain Inn, Mkuze, on the 7th and 8th of March 2013. In total, 52 clinicians, senior nurses and pharmacists attended from the five district hospitals within the uMkhanyakude District of northern KwaZulu-Natal. Also present were HIV and TB specialists from Africa Centre, CAPRISA, King Edward Hospital at UKZN, and Botswana. The event was organized in order to facilitate the discussion of common clinical management challenges related to the management of HIV and TB drug resistance and treatment failure within a rural district with a huge dual burden of HIV and TB.
The workshop was also organized in order to launch the HIV & TB Drug Resistance & Clinical Management Case Book, which has just been published by the Medical Research Council (MRC). In total, 250 copies of the book were given free-of-charge to the five hospitals to be distributed to clinicians, nurses and pharmacists involved in managing HIV & TB cases at the hospitals and primary health care clinics. The book is a compilation of informative clinical cases from South Africa that together highlight some of the major challenges that clinicians face in the management of HIV and TB drug resistance and that also illustrate some of the important lessons to be learnt in trying to limit the spread of drug resistance in our programmes and communities.
Amongst the top challenges of the HIV & TB epidemics are issues related to patient adherence to their antiretroviral and anti-TB drug regimens and the absence of reliable tools to measure adherence. The factors that contribute to suboptimal adherence were explored in group discussion sessions and the importance of thinking beyond patient factors and thinking more broadly about health system factors and community factors was emphasized. The complexities of the management of co-infections, especially when it comes to multidrug-resistant and extensively drug-resistant TB (pulmonary and extra-pulmonary) and HIV with high-level resistance to the standard first-line regimens, were also discussed. All these challenges were explored in the context of primary health care clinics and district hospitals where there are still critical shortages of human resources and limited access to advanced diagnostic and monitoring facilities.
Dr Hervey Vaughan-Williams, District Family Physician at the uMkhanyakude Health District Office, said 'I think it was a great success on a number of levels, not least the number of District staff attracted to attend... Gatherings such as these are valuable both for District staff education and bonding between institutions, which is invaluable in times of stress or crisis, as well as enriching the working environment.'
One of the main aims of the workshop and the book was to create awareness and understanding of the issues related to the management of HIV and TB drug resistance, given the increasingly complex case mix facing frontline health care workers in South Africa with the rapid scale-up of antiretroviral therapy and the ongoing epidemic of drug-resistant TB. The book has been edited by Dr. Theresa Rossouw (an HIV specialist from University of Pretoria), Dr. Richard Lessells (an HIV and TB specialist from UKZN's Africa Centre for Health and Population Studies) and Dr. Tulio de Oliveira (a virologist and bioinformatician also from Africa Centre).
The book was published under an open source license and is thus freely available in print and also in electronic form at the Southern African Treatment Resistance Network (SATuRN) website (http://www.bioafrica.net/cases.php>. The free distribution of the book was made possible through the generous support of the European Commission, CDC and Wellcome Trust. The workshop and book launch was organized by the Africa Centre for Health and Population Studies at UKZN and SATuRN in collaboration with the uMkhanyakude Health District Office.
The Dean of Health Sciences at the University of Pretoria has also organized a formal book launch on the 15th March 2013. This book launch will host the ambassador of the European Union to South Africa, the head of the TB program at the CDC in South Africa, the director of the Africa Centre and Deans and directors of units of the University of Pretoria.