Tuberculosis and PSI


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Tuberculosis and PSI

Jennie Quick, PSI

TB Working Group Showcase

CORE Group Spring Meeting, April 29, 2010

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Tuberculosis and PSI

  1. 1. Tuberculosis and PSI Jennie Quick, PSI April 29, 2010
  2. 2. Overview <ul><li>Who is PSI? </li></ul><ul><li>PSI’s approach to public health </li></ul><ul><li>What is social franchising? </li></ul><ul><li>PSI and TB </li></ul><ul><li>Next steps </li></ul>
  3. 3. Who is PSI? <ul><li>International non-profit </li></ul><ul><li>Incorporated in 1970 </li></ul><ul><li>More than 60 country offices </li></ul><ul><li>Based in Washington </li></ul><ul><li>World leader in social marketing and behavior change communication </li></ul>
  4. 4. Key Health Areas <ul><li>HIV/STI prevention </li></ul><ul><li>HIV Counseling and Testing (CT) </li></ul><ul><li>Reproductive Health </li></ul><ul><li>Malaria </li></ul><ul><li>Diarrheal Disease </li></ul><ul><li>Pneumonia </li></ul><ul><li>Tuberculosis </li></ul>
  5. 5. PSI and TB
  6. 6. What is social franchising? <ul><li>Franchise Responsibility: </li></ul><ul><li>Training </li></ul><ul><li>Quality Assurance </li></ul><ul><li>Monitoring and Evaluation </li></ul><ul><li>Drugs, Supplies and Consumables (as appropriate) </li></ul><ul><li>Communication, Branding and Demand Creation </li></ul><ul><li>Franchisee Responsibility: </li></ul><ul><li>Quality Service Provision (according to standards and protocols) </li></ul><ul><li>Implement Recommendations </li></ul><ul><li>Recording and Reporting </li></ul><ul><li>Participate in Network Activities </li></ul>Once established, a successful social franchise can be rapidly scaled-up with limited cost and expanded to include other health services.
  7. 7. Sun Quality Health - Myanmar <ul><li>Launched in 2004 </li></ul><ul><li>Passive case-finding model </li></ul><ul><li>Franchise of General Practitioners </li></ul><ul><li>in the private sector </li></ul><ul><li>Providers trained in TB symptomatic screening, diagnosis and treatment </li></ul><ul><li>Refer suspected TB cases to qualified labs </li></ul><ul><li>Treatment supporters provide follow-up to encourage adherence, trace clients who default on treatment and conduct contact tracing </li></ul><ul><li>PSI officers monitor quality assurance regularly </li></ul><ul><li>Demand creation through IPC and mass media </li></ul>
  8. 8. Results from Myanmar <ul><li>150 townships in 11 states </li></ul><ul><li>691 providers, 145 labs </li></ul><ul><li>116,849 clients tested for TB </li></ul><ul><li>53,890 registered TB cases </li></ul><ul><li>27,711 Category 1 cases </li></ul><ul><li>84% treatment success rate </li></ul><ul><li>10% contribution to national case detection rate </li></ul><ul><li>>55% of patients are from the lowest two socio-economic groups </li></ul>
  9. 9. GreenStar - Pakistan <ul><li>Launched in 2005 </li></ul><ul><li>Active case-finding by Community Health Officers </li></ul><ul><li>Door-to-door screening in high burden neighborhoods </li></ul><ul><li>Community-events for sputum collection </li></ul><ul><li>Private general practitioners trained in symptomatic screening, diagnosis and treatment </li></ul><ul><li>Referrals provided to qualified labs </li></ul><ul><li>Treatment supporters to encourage adherence, trace patients who default and to conduct contact tracing </li></ul><ul><li>QA visits from GreenStar project officers </li></ul>
  10. 10. Pakistan: GreenStar and TB <ul><li>1,080 providers, 49 labs </li></ul><ul><li>36,277 community-based treatment supporters trained </li></ul><ul><li>2,100,000 people reached </li></ul><ul><li>40,419 registered TB cases </li></ul><ul><li>89% treatment success rate </li></ul><ul><li>33-51% contribution to case detection rate in areas where it operates </li></ul>
  11. 11. TB Communications <ul><li>Where? </li></ul><ul><ul><li>Central Asia, India, Kenya, Laos, Myanmar and Romania </li></ul></ul><ul><li>What? </li></ul><ul><ul><li>TB (awareness, treatment seeking, adherence, etc.) </li></ul></ul><ul><ul><li>TB/HIV </li></ul></ul><ul><ul><li>Stigma </li></ul></ul>
  12. 12. PSI and TB/HIV <ul><li>Non-medical TB screening of HCT clients and referrals to laboratory diagnosis </li></ul><ul><ul><li>India, Mozambique, Myanmar, South Africa, Zambia, Zimbabwe </li></ul></ul>
  13. 13. South Africa: HIV/TB Integration <ul><li>Launched in 2006 </li></ul><ul><li>Mobile HIV counseling and testing (CT) for individuals from out-patient departments/TB wards </li></ul><ul><li>HIV-positive individuals referred back to clinic </li></ul><ul><li>July 2006 - Sept 2009, >7,000 patients tested for HIV </li></ul><ul><li>Among TB patients, 90% tested HIV-positive </li></ul><ul><li>80% of referrals tracked successfully </li></ul><ul><li>Telephone tracking ensures patients use referrals </li></ul>
  14. 14. Zimbabwe: HIV/TB Integration <ul><li>HCT Clinics perform symptomatic screening </li></ul><ul><li>Recently, clinics began offering sputum microscopy onsite </li></ul><ul><li>Individuals who are diagnosed with TB are referred to public health facilities for treatment </li></ul>
  15. 15. Next Steps <ul><li>Continued TB service delivery through existing franchises </li></ul><ul><ul><li>Scale-up of existing programs </li></ul></ul><ul><ul><li>Launch of new networks </li></ul></ul><ul><li>Support NTCPs and other partners in delivering evidence-based communications for TB and TB/HIV </li></ul><ul><li>Expand TB services offered within HCT clinics – including lab diagnostic services </li></ul><ul><li>Strengthen TB screening among PLWH by scaling up screening through HCT </li></ul><ul><li>Increase support to NTCPs to provide provider-initiated HIV counseling and testing to all TB suspects and patients </li></ul>
  16. 16. Thank you! <ul><li>For more information on PSI and TB </li></ul><ul><li>please contact: </li></ul><ul><li>Megan Elliott </li></ul><ul><li>[email_address] </li></ul>