iTeach

iTeach staff in South Africa

The Integration of TB in Education and Care for HIV/ AIDS (iTEACH) Program has been based at Edendale Hospital in KwaZulu-Natal, South Africa since 2005, and is actively engaged in initiatives to improve delivery of HIV and TB care and treatment in the public health sector.

This is accomplished by working in close partnership with the Umgungundlovu District and KwaZulu-Natal Department of Health, along with key stakeholders in the community.
iTeach’s primary areas of focus include:

• Training of HIV and TB Health Care Providers
• Anti-retroviral (ARV) Adherence
• HIV and TB Service Delivery
• Community Outreach & Mobilization
• U.S. Medical Resident Elective & Student/Volunteer Program

iTeach has been directly involved with decentralization of ARV treatment, bringing treatment from a centralized hospital to community clinics within the Edendale Hospital catchment area. Nurses deliver patient care at community clinics, as the majority of clinics do not have a doctor on staff. Since 2006, iTEACH has been helping to build capacity at the community clinics to strengthen HIV services and prepare them to manage patients on ARVs. Activities include site visits, in-service training on basics of HIV/AIDS, assistance with file and data management, instruction on the ureferral processes and basics of clinical management of patients on ARVs. Additionally, iTEACH has trained the all counselors at the seventeen fixed clinics (both district and municipal), to deliver the patient adherence-training course, which has significantly decreased the workload at the centralized hospital ARV program. These measures have
enabled clinics to prepare and refer patients for ARV initiation at the hospital, and in selected clinics, to take over management of uncomplicated patients who were initiated on ARVs at
Edendale.

In March 2007, iTEACH drafted a plan to provide ARVs to patients with advanced AIDS who were being admitted on the hospital medical wards In April 2007, utilizing two former HIV counselors called “Treatment Warriors”, the Edendale Inpatient ARV Treatment Program was launched and began fast-tracking patients who were so sick, they would be unlikely to survive to access ARVs through the existing government outpatient ARV program. By training a buddy instead of the sick patient and using ward doctors instead of ARV clinic doctors, the program avoided delays and enabling housestaff to gain ARV management experience. Warriors work closely with the doctors, affixing a short check-list to patient files that outlines the steps to follow, collecting lab results and assuring ARVs are ordered and received in the ward. Pill boxes are provided by the iTEACH warriors and bedside instruction is provided to both the patient and the designated treatment buddy and family. Frequent and regular communication with nursing staff is provided to assure patients receive ARVs as scheduled throughout their hospitalization. At the time of discharge, the Treatment Warriors schedule follow-up in the outpatient ARV clinic for ongoing care and management.

Additionally, iTeach has established a program to incorporate traditional healers in delivery of TB and HIV services. These trained trained healers enable extension of the care and support currently provided by the Department of Health. Importantly, this dispels the belief that one must choose between ARV treatment and traditional culture/beliefs/practices. Through formal involvement of traditional healers, it is expected that HIV testing and earlier access to treatment may be achieved (late access to treatment is a major cause of mortality) as well as improved and sustained treatment adherence.