People with advanced HIV infection are vulnerable to infections and malignancies that are called ‘opportunistic infections’ because they take advantage of the opportunity offered by a weakened immune system.
One of these is tuberculosis (TB), which is the leading cause of death among HIV infected people in Africa.
It is vital for people with HIV to have treatment if they have active TB. This will cure them and prevent transmission to others.
Against this background, the TB Focal Point (TBFP) has been established next to the Themba Lethu Clinic at Helen Joseph Hospital. TBFP is a centre dedicated to effective diagnosis, investigation, and treatment of TB and simultaneous investigation for HIV co-infection.
TBFP is a product of a close collaboration between Right to Care and the Gauteng Department of Health.
A dedicated team of health professionals staffs the centre. The team comprises a public health specialist, two professional nurses, two nursing assistants, one health educator, and four counsellors.
The facility has been refurbished and boasts the latest technology aimed at improving diagnosis of TB. Moreover, ultra-violet lights have been installed across both facilities, for infection control purposes.
Because it is next to Themba Lethu Clinic, TBFP allows easy access to all HIV related services needed by patients.
At Helen Joseph Hospital about 90% of the patients admitted to the medical wards are HIV and TB co-infected. Close to 60% are smear negative and as a result difficult to diagnose using the standard sputum smear tests.
The introduction of a sputum induction facility within TBFP has provided a breakthrough. This facility provides a negative pressure system (air is sucked out), which is ideal for removing bacteria and making it safer to cough and produce sputum for analysis in a closed room. This facility has reduced by 10% the number of patients who cannot produce sputum, leading to improved testing rates.
In 2008, TBFP had the privilege of being among the sites accredited to pilot the HAIN test. This is a PCR (polymerase chain reaction) test used for the rapid diagnosis of multi-drug resistant TB (MDR-TB). This test has reduced the waiting period from an average of six weeks to about 72 hours to confirm MDR-TB diagnosis with 100% specificity and 99% sensitivity.
A stringent system has been developed to refer patients once discharged to the various clinics in the area, linked to a follow-up system. Through this, it is hoped the benefits will be reflected in improved health outcomes (reduced defaulter rates and improved cures rates).
Right to Care’s plans for focal points include working closely with the primary health care clinics it supports. Focal points will be piloted at clinics at Witkoppen, Crosby, Westbury, Diepsloot, and Randburg.