Nontobeko Makhosonke works at a new facility that was opened in 2014. Because a lot of staff are new, the HAST Counsellors in the facility have found that they receive many different orders from many different directions which can be challenging. Nontobeko’s line manager, Jessica Mvelase, commends her for having the strength to politely refuse an order Nontobeko felt was not in the best interests of her client.
Nontobeko tested a client whose rapid test came back positive. The normal protocol is for a confirmatory test to be performed, but none were available at the facility. Blood was drawn for ELISA testing to check the result, but when the client returned to receive the results only the CD4 count was available. The ELISA result had gone astray.
A doctor ordered Nontobeko to perform the first ARV counselling session for the client. Since the client’s HIV status had not been confirmed, Nontobeko refused, stating she needed to have the client’s status confirmed. This was brave, but according to protocol. If the client was in fact HIV negative and during the counselling Nontobeko had incorrectly informed them that they were positive, it could have had severe consequences for the client’s life.
Sibusiso is a HIV/AIDS, TB and STI (HAST) Counsellor at Green Point Clinic in Cape Town. Recently her commitment to providing a service instead of judging her clients meant she was able to assist someone and prevent him from defaulting on his ARV treatment.
Her HAST Area Co-ordinator, Jessica Mvelase, relates the story:
“Sibusiso Masoko in Green Point CHC was able to assist a patient who was released from prison and had started ARV treatment there. When his ARVs were about to finish, the patient went from clinic to clinic begging to be accepted to continue his lifelong treatment. He was scared to attend a clinic in his own community as he had committed a crime there that landed him in prison and now was not accepted by community members and facilities where he went looking for help. He was refused when he told them that he had started his treatment in prison.
Sibusiso said that she left the patient’s criminal record for the law to deal with, and that she was there to provide a health service and not to judge.”
As the nurses could not provide the patient with his ARV medication that day, Sibusiso ensured that the nurses provided him with enough ARV pills to cover his requirements until he could come back to the facility to collect the rest of his medication.
Well done to Sibusiso for recognising that as health care workers our role is to provide health services in a nonjudgemental, friendly manner.
On the 30th March, TB/HIV Care and the Department of Correctional Services (DCS) held an event to highlight and share the successes achieved in the TB/HIV programme in Pollsmoor. The honourable Western Cape Minister of Health, Nomafrench Mbombo, participated in the event; helping to cut the ribbon on a brand new digital X-Ray machine which will assist in finding new cases of TB in prison
Other screening techniques, including the GeneXpert machine which was launched two years ago and can diagnose TB within two hours, have already borne fruit. TB case-finding in Pollsmoor doubled in one year; from 190 diagnosed in 2012 to 405 diagnosed in 2013.
Since then, 68 152 inmates have been screened for TB, 9922 have been tested with the GeneXpert tests and 701 started on TB treatment of whom 28 were started on multidrug resistant TB treatment. If one TB patient infects 20 others, then the rapid diagnosis and treatment of 701 cases of TB may have prevented 14 020 other TB infections in Pollsmoor.
This is of particular importance in the prison setting, where TB prevalence and the risk of transmission is high. Inmates are therefore one of the groups of people South Africa’s National Strategic Plan for HIV, STIs and TB 2012-2016 proposes targeting with interventions. Other groups include people whose immune system is compromised and people who live or work in areas where they are exposed to TB such as inmates and officials in correctional facilities, miners and those living within mining communities. The theme for World TB Day this year in South Africa is ‘Ending South Africa’s TB epidemic: accelerating our response in key populations’. The sub theme is “Find, treat and cure TB in hard-to-reach communities”.
The main aim of Monday’s event was to show how civil society can work in partnership with government to fight the spread of TB in correctional facilities. Through funding from the Global Fund to Fight AIDS, TB and Malaria (Global Fund), the Department of Correctional Services (DCS) and the Department of Health (DOH) in partnership with the National Health Laboratory Service (NHLS) and nongovernmental organisations such as TB/HIV Care Association (TB/HIV Care), Right to Care and the Aurum Institute have implemented a TB screening service in correctional facilities throughout the country.
TB/HIV Care is responsible for supporting 91 correctional facilities throughout the Western Cape, Eastern Cape and in two management areas of KwaZulu-Natal.