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Red Alert On TB Infection Control In Clinics

– Results of TAC survey of 207 public clinics shows TB infection control still falling short.        – Government must urgently conduct an infection control audit of all public facilities

JOHANNESBURG, 19th MARCH 2018 – In the run up to World Tuberculosis (TB) Day on 24 March 2018, the Treatment Action Campaign (TAC) assessed the state of TB infection control in a number of clinics across South Africa. Of 207 facilities assessed, 145 were found to be in a “RED” state with very poor infection control measures in place.

In March 2017, TAC produced our first annual TB audit. Last year, 72% of the facilities (115 out of 158) were ranked “RED” compared to 71% (145 out of 207) this year. 9% of facilities (15 out of 158) scored “GREEN” last year, compared to a dismal 1% this year (2 out of 207).

TB remains the leading reported cause of death in South Africa with over 33 063 deaths (8.4% of natural deaths) in the country in 2015[1]. Based on the latest data in 2016, the rate of new cases of active TB in South Africa remains extremely high at around 438 000[2]. While total TB rates do appear to be slowly declining (down from 250 000 in 2015), multi-drug resistant TB (MDR-TB) and extreme drug resistant TB (XDR-TB) rates are increasing. The World Health Organization (WHO) estimated 19 000 cases in South Africa in 2016 up from 7 350 in 2007[3]. TB can be spread through the air when people with active TB disease cough or sneeze. However, various infection control measures can be taken to reduce the risk of TB transmission.

“Our clinics should be places we feel safe, where we know we can get decent healthcare services. They certainly should not be places we can get TB. The reality is that many clinics aren’t even doing the basics to prevent us getting TB as we wait to see a nurse. They are overcrowded. People are not screened for TB. Often staff don’t even offer a tissue to someone coughing,” says Sibongile Tshabalala, TAC National Chairperson.

TAC branches in Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, and Western Cape engaged in the audit during TB month, March 2018. The following questions were answered by TAC members from local branches linked to each facility assessed:

  1. Is there enough room in the waiting area?
  2. Are you seen within 30 minutes of arriving at the facility?
  3. Are the windows open?
  4. Are there posters telling you to cover your mouth when coughing or sneezing?
  5. Are people in the facility waiting area asked if they have TB symptoms?
  6. Are people who are coughing separated from those who are not?
  7. Are people who cough a lot or who may have TB given tissues or TB masks?

Based on the answers facilities were ranked RED (3+ questions answered “no”), ORANGE (1-2 questions answered “no”), or GREEN (0 questions answered “no”).

145 facilities were ranked “RED”, 56 facilities were ranked “ORANGE”, and only 2 facilities were ranked “GREEN”. 4 facilities were unable to be ranked due to incomplete data.

  • Facilities performed especially poorly in the length of waiting times, where over 90% of facilities (190 out of 207) failed to see people within 30 minutes of arriving, pointing to widespread human resource shortages across the clinics surveyed.
  • 57% of facilities (119 out of 207) did not screen people for TB symptoms who were waiting to be seen and 56% of facilities (115 out of 207) did not offer tissues or TB masks to those coughing. It is unknown if this is due to a lack of resources, time, or will.
  • 38% of facilities were found to be too small, and just under 70% of facilities did not (or could not) separate people who were coughing a lot from those who were not, pointing in part to infrastructural challenges that need to be addressed.

TAC commends the 2 clinics that were ranked GREEN – Goso Forest Clinic (EC) and Rhodes Clinic (EC). Our local branches linked to the 2 clinics will award them with certificates and urge them to continue ensuring effective TB infection control. However, if we wish to make progress against TB GREEN ratings should be the norm in the public healthcare system, not the exception.

An Excel sheet with the survey results (including provincial breakdown) can be accessed .

The problems highlighted in TB infection control through the audit are indicative of the wider crisis within the health system, where overstretched nurses at understaffed clinics lack the capacity and resources to engage effectively in infection control measures.

“While we stress that this is by no means a scientific survey and the results are not generalisable to the rest of the public healthcare system, it does suggest that infection control is a significant problem in many public sector health facilities. As a result, we demand that government carries out a full audit of all public buildings in South Africa, including schools, clinics, hospitals, correctional facilities and home affairs facilities, to assess whether sufficient TB infection control measures are in place,” says Tshabalala.

If the government is serious about tackling TB, then infection control must be made a priority this yearWe do not want to be raising the same issues this time next year – our 2019 audit must see a total turnaround of this situation.”

TAC branch, provincial and national leaders will be meeting with facility management, provincial and national health departments in the coming weeks to discuss the poor outcomes of our TB infection control survey.

All commitments and responses from these meetings will be published.

 

For more information and to arrange interviews contact:

Lotti Rutter | lotti.rutter@tac.org.za | 072 225 9675

 

Notes:

The full 2018 survey results can be found here: 

 

For a breakdown of TB infection control results per province please see the following overviews:

Eastern Cape overview: https://tac.org.za/files/tb-infection-control-eastern-cape-march-2018.pdf

Free State overview: https://tac.org.za/files/tb-infection-control-free-state-march-2018.pdf

Gauteng overview: https://tac.org.za/files/tb-infection-control-gauteng-march-2018.pdf

KwaZulu-Natal overview: https://tac.org.za/files/tb-infection-control-kzn-march-2018.pdf

Limpopo overview: https://tac.org.za/files/tb-infection-control-limpopo-march-2018.pdf

Mpumalanga overview: https://tac.org.za/files/tb-infection-control-mpumalanga-march-2018.pdf

Western Cape overview: https://tac.org.za/files/tb-infection-control-western-cape-march-2018.pdf

 

The 2017 infection control audit can be found here: https://tac.org.za/news/tb-infection-control-falls-short-many-clinics-tac-survey/

NOTE: Not all facilities surveyed in 2017 were repeated in the 2018 audit, and several additional facilities were included this year.

NOTE: Even though TB is the number one reported cause of death in South Africa according to official death notifications, many deaths attributed to TB and other causes are in people with HIV and HIV is thus underrepresented in death notifications. The Thembisa model of HIV in South Africa estimates that there are roughly 150 000 HIV-related deaths per year. A recent Medical Research Council report estimates around 150 000 HIV-related deaths in 2012. These estimates indicate that HIV is still the number one cause of death in South Africa.

 

A summary of results is available here: https://tac.org.za/files/results-summary-tb-infection-control.pdf

Province Is there enough room in the waiting area for everyone? Are you seen within 30 minutes Are the windows in the facility open? Are there posters telling you to cover your mouth when coughing or sneezing? Are people in the facility waiting area asked if they have TB symptoms? Are people who are coughing separated from those who are not? Are people who are coughing a lot or may have TB given TB masks or tissues?  RANK
Eastern Cape 17 20 1 5 15 15 18 Green – 2
Orange – 6
Red – 20
Free State 16 33 1 5 23 32 28 Green – 0
Orange – 3
Red – 31
Gauteng 10 24 4 6 11 17 17 Green – 0
Orange – 5
Red – 17
Unknown – 2
KwaZulu-Natal 11 23 1 1 8 14 9 Green – 0
Orange – 15
Red – 11
Unknown – 2
Limpopo 3 29 1 8 17 21 15 Green – 0
Orange – 11
Red – 20
Mpumalanga 15 35 1 9 26 20 27 Green – 0
Orange – 8
Red – 27
Western Cape 7 26 0 5 19 25 1 Green – 0
Orange – 8
Red – 19
National 79 190 9 39 119 144 115 Green – 2
Orange – 56
Red – 145
Unknown – 4

 

 

[1] National Strategic Plan on HIV, TB and STIs 2017 – 2022. SANAC. Available at: http://sanac.org.za/wp-content/uploads/2017/05/NSP_FullDocument_FINAL.pdf

CategoriesNews

Conference on Retroviruses and Opportunistic Infections (CROI) Conference

Advances in both clinical research and prevention science have led to a significant reduction in HIV transmission globally. UNAIDS ambitious goal of achieving “90-90-90” targets by 2020 calls for 90% of people living with HIV to know their status, 90% of those diagnosed to receive sustained ART and 90% of those on ART to have viral suppression. One or two strategies will not be effective in reducing the HIV/AIDS pandemic to the realization of the AIDS Response in the 2030 Agenda for Sustainable Development.

Women continue to be infected with HIV at alarmingly high rates especially in sub-Saharan Africa where women constitute nearly 60% of adults living with HIV/AIDS. A range of effective, affordable and widely available prevention products are needed because no single approach will meet all women’s needs or get the epidemic under control considering that prevention should always include a combination of biomedical, behavioral and structural strategies.

 

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WACI Health and other network partners at the Conference on Retroviruses and Opportunistic Infections Photo credit: WACI Health

 

The annual Conference on Retroviruses and Opportunistic Infections (CROI 2018) held between the 4th to the 7th of March 2018 at Hynes Convention Center in Boston, Massachusetts brought together top basic, translational, and clinical researchers from around the world to share the latest studies, important developments and best research methods against HIV/AIDS and related infectious diseases. The preliminary findings of HIV Open Label Extension (HOPE) and DREAM studies of the dapivirine vaginal ring were released showing 90% of women who used the ring at least some of the time had an estimated 50% reduction in the HIV acquisition.

The ring is designed to provide women with a discreet and long-acting HIV prevention option. The interim analyses of DREAM announced at CROI 2018 showed an increase in ring use over its parent Phase III study – more than 90% of women participants used the ring at least some of the time. Analyses also suggest that the overall HIV incidence rate among women in DREAM is 54% lower than would be expected without use of the dapivirine ring based on statistical modeling. This finding has important limitations due to the lack of a placebo comparison group in the open-label study (meaning that all participants know they are using the active product). Interim data from a parallel open-label study of the ring called HOPE, led by the US National Institutes of Health-funded Microbicide Trials Network (MTN), reported nearly identical results at CROI. “DREAM suggests so far that when women know that the dapivirine ring has helped lower HIV risk in clinical trials, they are more likely to use it and see higher levels of protection,” said Dr. Zeda Rosenberg, founding chief executive officer of IPM. “We are encouraged by these interim findings because more than 35 years into the epidemic, women still lack the range of practical options they need to protect themselves against HIV.”

We have made tremendous progress in the AIDS epidemic. However, this progress is not assured because of several factors among them declining funding. Governments and donors must continue to prioritize the allocation of funding for HIV programming, life-saving treatment, prevention, research and development for new health technologies which will inform an essential part of the solution to HIV.

New vaccines, microbicides, drugs, diagnostics, and other health technologies are needed in the face of many emerging threats for communities to have multiple tools that protect them especially those who are at highest risk of becoming infected with HIV for instance adolescent girls and young women. Multipurpose prevention technologies (MPTs) most of which are still experimental designed to address two or more sexual and reproductive health concerns simultaneously for example, combining protection against unintended pregnancy and sexually transmitted infections to be made available.

Ending HIV by 2030 requires collaboration across sectors, supportive policies that do not lock people out of care and support, health systems strengthening above all communities taking center stage and the commitment to not leave anyone behind – including adolescent girls and young women.

CategoriesNews

United Nations Commission on the Status of Women 62 session in New York

 

Rural women make up more than a quarter of the world’s population. In Africa, about 80% of the women population live in rural areas – agriculture is their major source of income. This reality was affirmed during the 62nd session of the United Nation Commission conference in New York which sought to examine the challenges and opportunities in achieving gender equality and the empowerment of rural women and girls. In her opening statement Dr Phumzile Mlambo-Ngcuka (Executive Director of UN Women) urged all participants to see this forum as a perfect opportunity for building alliances, focusing on acceleration and implementation of regional as well as global declarations to achieve gender equality and women empowerment.

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UN Women Executive Director Phumzile Mlambo-Ngcuka addressing a session hosted by Ilitha Labantu on challenges of rural women empowerment

Photo credit: Sibulele Sibhaca

Women and girls in rural areas still encounter difficulties including gender violence, high maternal mortality rates, child marriage, HIV/AIDS, FGM, conflict and natural disasters. Most are directly linked to gender inequality and structural barriers which causes power imbalances. These barriers are worsened when women are excluded from governance mechanism, leadership and decision-making or representation in local and national institutions which diminishes their voice. All these must be urgently addressed for Africa to realize its development aspirations in attaining the Sustainable Development Goals and Agenda 2063.

WACI Health together with other civil society in South Africa are making frantic efforts in advocating for political will in governments developing policies and programs to protect women such as the National Strategic Plan on Gender-based Violence (NSP GBV), bring gender justice, improve their health outcomes and end gender violence

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Minister of Women Bathabile Dlamini expressing that women should lead the struggle and shaping response in gender-based violence

Photo credit: Sibulele Sibhaca

Participants at CSW62 called on all stakeholders to address the limited access to quality social services, infrastructure, energy and labor saving technology, and tackle other inequalities.

 

To build in a bright future – invest in adolescent girls and young women!

There has never been a more critical time to invest in young people than now! With regards to health and development, young people have been overlooked and left behind many times. There are about 1.8 billion young people globally and nearly half of these are adolescent girls and young women.

Adolescent girls particularly those entering adulthood encounter numerous challenges including discrimination, gender violence, poor education and health outcomes, reduced opportunities and choices – their voices are often unheard. As for serious health risks, young women (15 to 24 years) are facing a triple threat. The highest risk of HIV infection is found within this group. In sub-Saharan Africa, young women account for 74% of new HIV infections. In addition to this, young women and girls have the lowest rates of HIV screening or testing and poor adherence to HIV treatment.

Investing in young girls and women indeed is a game changer. For example, this International Women’s Day celebrations WACI Health joined hands with other Kenyan civil society in calling for all stakeholders across multiple sectors to champion health of adolescent girls and young women by recognizing their issues as important, improving national programs and policies (tailoring Sustainable Development Goals and Global Strategy on Women’s, Children’s and Adolescents’ Health effectively) as well as increasing funding to ensure that young people survive, thrive and transform the world.

When educated, healthy, equipped with the right skills and opportunities; adolescent girls and young people hold the keys to unlocking many of the world’s pressing problems in poverty reduction, advancing gender equality, catalyzing national social and economic development, stopping HIV, maternal mortality and gender violence among many others – investing in the survival and success of the next generation.

As leaders of today and tomorrow, adolescent girls and young women can be a force for social change!

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