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Enhancing TB/HIV Care: Strategic Approaches for Target Populations in South Africa

Dr. Eric Goemaere, Regional TB/HIV Advisor for MSF South Africa, discusses effective programmatic adjustments tailored for specific target populations facing TB and HIV challenges. This talk emphasizes increasing coverage and CD4 thresholds, developing patient-friendly regimens, and supporting self-management strategies. Through targeted outreach and community-based interventions, particularly for adolescents and adult males, the presentation highlights the importance of innovative care models and peer educator-led support systems. The goal is to improve long-term patient retention and virological suppression post-initiation of ART.

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Enhancing TB/HIV Care: Strategic Approaches for Target Populations in South Africa

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  1. Plugging the Leaky Cascade:Programmatic adjustments forspecific target populations Dr Eric Goemaere Regional TB/HIV Advisor MSF South Africa

  2. The low hanging fruits Increased coverage/Higher Cd4 threshold Patient friendly regimen Testing Patient self management Staging/ Eligibility Long Term survival Post –initiation ART Triage and fast track PHC decentralised care, nurse based CHW supported

  3. Specific targets, specific strategiesAdult males 43 % of male testingat site C are lessthan 25 yrs

  4. Recruiting eligible males: have a look at TB clinic Source : Fuchia bulletin (OCB) N= 54.679 Source: Town II TB clinic, Khayelitsha= 188

  5. Factors Influencing Retention in Care after Starting Antiretroviral Therapy in a Rural South African Programme. Boyles TH, Wilkinson LS, and all, 2011 PLoS Median CD4 count = 218 Baseline retention on pre-ART in SA ( CD4 monitoring within 12 months ): 31-45%

  6. Comprehensive care for pre-ART Weekly peer educator led HIV Care Group (Pre-ART+ART) • Effective referral system btw HIV care group and clinic • Accessible CD4/VL results to peer educator • Provision of ART/Cotri/IPT refills to HIV care group • M&E system at community level – simple mobile options? referrals • group support and education • CD4 count monitoring • weight + symptom screening • pregnancy referrals • ART prep/ counselling • Bactrim dispense CD4 <500 • IPT refills • pap smear monitoring • nutrition • defaulter tracing

  7. Specific targets, specific strategiesAdolescents Denial Stigma /parental judgment Peer pressure Outreach testing Reduce time/number prep sessions Mixing positive and negative ones Not Peer supporter <> counselor 1:1 guidance across all initial step Intensive emotional support

  8. ART for youth and adolescents in Khayelitsha, IAS poster THPE 0170 Van Cutsem G 1, 2 , Knight L 1, Abrahams M 1, Kerschberger B 1, Malavazzi C 1, Ford N 1, Boulle A 2 Kaplan-Meier: Virological failure by age group 0.40 0.30 0.20 0.10 0.00 0 6 12 18 24 30 36 42 48 Months on ART 10-24 >=25 • Virological suppres.@24mths • children 80.4 % • Adolescents:87.0 % • Youth : 74.5 % • Adults : 88.2 % ( p <0.001) • Remaining in care at 24 mths: • Children 95.4 % <> Adolescents 81.6 % ( p=0.007) • Youth 78.7 % <> Adults : 83.3% ( p=0.008)

  9. Multivariate analysis -> AHR for LTFU in migrants at one year 6.69 ( 3.18-14.09) Helen Bygrave1*, Katharina Kranzer2, Katherine Hilderbrand3,4, Jonathan Whittal3, Guillaume Jouquet1,Eric Goemaere3, Nathalie Vlahakis1, Laura Trivin˜o1, Lipontso Makakole5, Nathan Ford3,4, Plos One , October 2010 | Volume 5 | Issue 10 | e13198

  10. Mobile clinic one stop shop for the HIV/TB co-infected patient • HCT, POC CD4 at mobile points • Each visit, patient asked about travel plan and documented • Health passports + alternative treatment points • Temporary Transfer Out (TTFO): = plans to return (circular migration) • 3 months ARV supply + tail protection • If not intention to return, self addressed stamped envelope signed by receiving sites

  11. Acknowledgments • MSF teams in South Africa, Lesotho and Zimbabwe • South African Medical Unit & CAME • Gilles Van Cutsem , GuiseppeDemola, Daniela Garone, Katherine Hilderbrand, Nathan Ford • Staff and patients who are driving these new ideas Dedicated to Babalwa

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