To achieve our vision of being a leader in empowering communities to be healthy and free of TB and HIV, TB/HIV Care’s activities aim to prevent, find, and treat TB and HIV and to target our services where the need is greatest and the most impact can be made.

Prevent

Medical male circumcision
A medical male circumcision (MMC) is the removal of the foreskin from the head of the penis under clinical conditions. Research has shown that a man is 60% less likely to become HIV positive if he is medically circumcised. The procedure is therefore an important part of the South African Department of Health’s policy for preventing HIV. TB/HIV Care supports this policy by providing MMC services in certain areas in the Western Cape, Eastern Cape and KwaZulu-Natal.

TB/HIV Care offers two different methods of medical male circumcision to clients; surgical circumcision and circumcision by PrePex device. The procedure for each method is slightly different, but both methods require that the client returns for multiple check ups with a healthcare provider, and that the client takes care of their wound responsibly. All of TB/HIV Cares staff who perform the procedure are qualified medical personnel who have undergone standardized training. Detailed information about the procedure can be found here.
Since medical male circumcision is a choice, our teams need to provide information to men and women about the benefits of MMC in order to create demand for the service. For every 5 people who express an interest in the procedure, only about one actually arrives to take up the service so community mobilisers work hard to reach as many people as possible.

To find out where you can access a medical male circumcision through TB/HIV Care, consult this map.

Condom distribution and promotion
Condoms are still one of the most effective ways to prevent HIV as well many other sexually-transmitted infections. Distributing condoms, and explaining how to use them correctly, is an important part of all TB HIV Care’s programmes. During the course of a year our staff can distribute more than 10 million condoms. We also run campaigns promoting condoms during Valentine’s Day and produce materials to encourage and inform people about condoms.

Workplace health services
TB HIV Care’s workplace co-ordinator provides free TB- and HIV-related services to workplaces, whether large or small. When workers find out that a colleague has been diagnosed with TB or is HIV positive, they may react with fear and anxiety. TB/HIV Care’s workplace co-ordinator works with employees and employers to put these concerns to rest by providing them with clear information. Because all of us spend so much time at work, workplaces are very effective areas to communicate health messages. Employers are usually quick to see the benefit of having a healthy workforce.

Counselling and raising awareness
Although knowledge alone may not mean people adopt safer behaviours or abandon risky ones, counselling people on their options and finding out why they are making the choices they are, can assist in changing behaviours. During every HIV test, counsellors help their clients to create a risk reduction plan tailored to them and their HIV status. Raising awareness of health issues also happens during information sessions in workplaces and at community events, by invitation.

Find

Test and screen
The first step in providing care for people living with HIV and those with TB is to find them. For this reason, TB/HIV Care is committed to a highly successful testing and screening programme. TB/HIV Care’s strategy is to test and screen people where they are, whether this is at a clinic or a taxi rank, farm, high school or university. TB/HIV Care has both facility-based counsellors at health facilities like clinics and hospitals, and mobile wellness teams that can move around in the community. The mobile teams use customised caravans, vans and gazebos to ensure privacy for their counselling sessions wherever they may find themselves.

The HIV testing services that TB/HIV Care provides are no longer just about HIV, but offer a full range of wellness services. Whether the lay counsellors are based in a clinic or are in a van, they can offer counselling and HIV prevention messaging tailored to the clients’ HIV status. They also screen for TB and sexually-transmitted infections, high blood pressure and diabetes.
Our teams also focus increasingly on not only testing, but linking people who test HIV positive, or shows signs of any other disease, to appropriate care and treatment.

More than a million HIV tests have been conducted by TB/HIV Care’s teams!

Treat

Treatment support
Taking treatment can be a difficult journey. People living with TB take treatment for at least six months while those who are HIV positive or living with other chronic diseases, must take treatment for the rest of their lives. Having support can make the difference between continuing treatment or stopping. TB HIV Care provides this support through our community health workers; members of the local community who have been trained on home based care, TB and HIV and act as a link between the clinic and the client.

TB/HIV Care provides community-based treatment support to clients on TB treatment and/or antiretrovirals (ARVs) in the Western, Southern, Klipfontein Mitchells Plain and Khayelitsha substructures in the Cape Metro of the Western Cape.
Once a client agrees to be supported at home, they are assigned a community health worker (CHW) by health workers at their facility. The CHWs perform home assessments to establish the living conditions and health of the entire household in which the client lives. Thereafter the CCW will visit the client at home to perform pill counts to support the client in adhering to treatment, and to answer any questions they may have. CCWs will follow up with clients should they not attend clinic appointments. CCWs are also involved in general health promotion through delivering health messaging around other topics such as child immunization, breastfeeding, and maternal health.

A specialized form of this support is offered to clients with drug-resistant TB, because this form of TB requires up to 2 years of intensive treatment. Drug-resistant TB counselors provide specialised counselling and support groups to clients with DR-TB.

Social support
TB and HIV often affect the most vulnerable people in society. Providing medication alone is therefore often not enough to ensure people living with TB are cured or that those living with HIV remain healthy. TB HIV Care’s social work programme extends the care provided to people to address social issues such as unemployment, substance abuse, gender-based violence and many others.

TB/HIV Care’s social support team consists of 3 social workers and 5 social auxiliary workers. They provide services to patients at the Brooklyn Chest Hospital (a TB hospital) and communities in the Cape Metro of the Western Cape.
Both children and adults are treated at Brooklyn Chest Hospital. While there is a hospital school for older children, those under 6 were previously often confined to their cots for long periods of time without the necessary physical and mental stimulation. TB/HIV Care began an educare programme which provides enrichment activities critical to the children’s development.

The full list of services provided for children at Brooklyn Chest Hospital is as follows:

• Educare for children under school-going age
• Educare support for grade R children
• Counselling services for children and families
• Support groups for school-going age children
• Preparation for discharge from hospital for children and families
• Parent support groups and assistance with travel for visits
• Assistance with disabilities and grant applications
• School holiday programmes to provide stimulation between school terms

Adults at Brooklyn Chest Hospital are provided with counselling support to assist them through the long journey of adhering to drug-resistant TB treatment, which can take two years to complete.

Within the communities of the Cape Metro, the TB/HIV Care social support team works on promoting health and preventing HIV and TB through community outreaches and individual counselling sessions. If a client is experiencing challenges with a diagnosis or with staying on treatment, a clinic or one of TB/HIV Care’s mobile teams may refer the client to the social support team. The social workers can perform an assessment and assist with any psychosocial issues that may be affecting the client. Common challenges include fear of disclosing one’s status, depression, substance abuse, gender-based violence, and ignorance of how to apply for grants.

Target

HIV/ TB services for inmates
Inmates in correctional services around the world are at a higher risk of both TB and HIV. South Africa is no different. TB HIV Care has been supporting the Department of Correctional Services since 2009. We currently offer TB screening (including X-rays) and HIV testing and counselling to about 46% of all South African inmates. In addition we work with correctional services to strengthen the TB and HIV health services available in prison by, for example, training nurses to start eligible HIV positive inmates on antiretroviral treatment.

TB/HIV Care supports 94 correctional centres, which are located in the Eastern Cape, Western Cape and a small part of KwaZulu-Natal.
TB/HIV Care offers inmates TB screening as well as HIV counselling and testing services when they are admitted to a correctional centre, during biannual screening campaigns, and on release. Those inmates who show a symptom of TB are tested using GeneXpert technology. In addition to this, inmates are screened using mobile X-ray trucks which travel to correctional centres to offer the service. If an inmate’s X-ray result is abnormal, he or she will be tested for TB using the GeneXpert.

Inmates who test HIV positive are referred to correctional services health workers for initiation onto antiretroviral treatment (ART) while those who are confirmed to have active TB, are referred for TB treatment.

TB/HIV Care provides information on TB and HIV to inmates as part of HIV counselling and testing and through a peer education programme, where specific inmates are trained on TB and HIV and encouraged to share information with other inmates.

Existing Department of Correctional Services (DCS) health services are strengthened through clinical mentoring provided to DCS health workers by experienced nurse mentors as well as through training in continuous quality improvement methods. This helps to improve the quality and continuity of care of inmates. TB/HIV Care also works with other partners to assess and improve methods of controlling infection within centres.

HIV prevention for sex workers
Sex workers and their clients are at increased risk of HIV. However sex workers often have poor access to HIV prevention services or appropriate treatment, care and support. This project recognizes that health is a human right. Specialized, client-centered services are provided in mobile wellness clinics take HIV counseling and testing, screening for TB and sexually-transmitted infections, and other services onto the streets and into the places where sex workers can easily access them. The project also works to sensitize existing health care workers and systems to the needs and rights of sex workers so that those who are referred for further diagnosis and treatment are provided with support in a nonjudgmental environment.

Sex workers are identified as a ‘key population’ by South Africa’s National Strategic Plan on HIV, STIs and TB 2012-2016, meaning that addressing their health needs as a group is key to ending the HIV epidemic.
TB/HIV Care’s comprehensive mobile HIV prevention and wellness services are provided by teams that include a professional nurse, lay counselors and sex worker peers (those who are currently or were previously active in the sex work industry). This helps ensure that the services are relevant and friendly.

TB/HIV Care has been one of the pioneers in offering pre-exposure prophylaxis (PrEP) (the pill which if taken daily prevents HIV) to HIV negative sex workers as part of a government-led programme.

In addition, TB/HIV Care works with the Department of Health and its clinics and health facilities to sensitize health workers to the needs of sex workers and to improve pathways into local clinics and other support structures.

TB/HIV Care’s sex work project operates in eThekwini, the Cape Metro, OR Tambo, and Nelson Mandela Bay.

Step Up Project
The Step Up Project offers health services to people who inject drugs in Cape Town, Pretoria and Durban. Injecting drug users are one of the most vulnerable population groups when it comes to blood borne viruses. Our aim is to prevent or reduce HIV infections and other kinds of harm in the communities who use the Step Up Project’s services. This ‘harm reduction’ approach is widely accepted across the world as one that saves lives and the package of health services Step Up offers people who inject drugs is recommended by the World Health Organisation.

TB/HIV Care, in partnership with OUT LGBT Well-being (OUT), have begun implementing a demonstration project to provide a package of essential HIV and other wellness services recommended by the World Health Organisation to people who inject drugs (PWID). To date TB/HIV Care is the first organization to provide this package of services in South Africa.
The Step Up Project aims to develop recommendations for the South African context and elsewhere in the Southern African region for the scale-up of PWID HIV prevention and other health and wellness services. Peer-linked mobile outreach teams provide services to clients where they are. Along with the enhanced package of HIV/AIDS, STI, TB and other wellness services, the PWID project includes the provision of harm reduction packs, hygiene commodities and behavior change interventions tailored to injecting, overdose prevention and the sexual risks of PWID.

The PWID outreach teams, and many of those who use their services, are actively engaged in helping ‘clean up’ the areas where services are provided of used injecting equipment and are working with service users to increase the return of used injecting equipment for proper disposal by THCA’s experienced teams.

Tackling viral hepatitis
The WHO has set the target of eliminating viral hepatitis by 2030. South Africa has committed to attain this goal. This will require a concerted national effort, particularly among high-risk populations such as men who have sex with men, sex workers and people who use drugs. These high risk populations have historically been under-researched and underserved in the South African context.

We therefore expanded our focus to include viral hepatitis in 2015. Our work includes:

1. Implementation Research. TB HIV Care led the BMSF Viral Hepatitis Initiative (2015-2018) implemented in partnership with National Institute for Communicable Diseases (NICD), the University of Cape Town (www.uct.ac.za), Anova Health Institute (http://www.anovahealth.co.za/) and OUT Wellbeing (http://www.out.org.za/) building on existing service provision in seven cities. The Initiative provided HBV and HCV testing, referral and, where required, HBV vaccination services, to men who have sex with men, sex workers, and people who use drugs. Results highlighted highest prevalence of HCV among people who inject drugs. Links to results overview, key BMSF reports?].

The Initiative further:

• Provided staff and stakeholder capacity building.
• Developed referral networks. TB HIV Care has led the development of referral networks to relevant health facilities for people belonging to key populations who test positive for viral hepatitis.
• Generated open source information and education materials [link in here to IEC materials]
• Provided qualitative insights into challenges related to linkage to care. [link to abstract?]

2. Advocacy and results dissemination. TB HIV Care has taken a lead role in working with the National Department of Health to meet South Africa’s commitment to eliminating viral hepatitis. This has included disseminating research findings, providing expert input on key populations, and supporting policy development. Our work has fed into key national documents, including:

• South African National Hepatitis Guidelines [link]
• Hepatitis Action Plan [link]
• National Drug Master Plan [link]
• National Strategic Plan for HIV, TB and STIs [link]

3.Innovation. Future projects which seek to provide accessible, low threshold, in-community access to screening, diagnosis and treatment for people who inject drugs are in planning phases.