Point of Care Clinics

Programme

TEBA Point of Care (POC) Clinics Project.

Background

Statistics show that mineworkers and their families are at high risk of exposure to TB and HIV/AIDS with an incidence rate of 2 500-3 000/100 000.

This figure is completely disproportionate in relation to the World Health Organization (WHO) threshold of 250/100 000.

Some of the factors that contribute to this exceptionally high incidence rate amongst the mining communities are high migration, broken family structures, and poor working and safety conditions.

In 2013, TEBA was appointed to establish Point of Care (POC) Clinics to alleviate this issue, with funding from the URCSA and support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control (CDC).

The TEBA POC Clinics Project was officially launched by the Minister of Health, Maseru, on 30 July 2013. The main aim of the project was to fast-track the identification of affected miners and ex-miners in Basotho communities in the districts of Maseru, Mafeteng and Leribe and to coordinate the administering of treatment to them.

Methodology and approach:

i. Optimising of resources

TEBA already had three established offices that served the mining communities in question with services like pre-employment health screening and the dispensing of deferred wages.

To leverage the existing resources, reach and exposure, the POC Clinics were set up at these offices. The facilities were purposefully created to ensure a seamless, one-stop and on-site service that could be rendered for six days a week.

ii. Tracking of cases

As all miners who have been recruited by TEBA over the years are officially registered on the system, TEBA had an extensive database that could be utilised to contact miners and ex-miners, and to encourage them to make use of the new facilities available. Numerous mining households were also personally visited, and the services were actively promoted amongst miners who visited any of the three TEBA offices where the POC Clinics were established.

iii. Education and awareness

All miners who visited the TEBA offices were exposed to TB and HIV education in the waiting areas, and dedicated care supporters assisted them with questionnaires to detect potential symptoms in a discreet manner.

iv. On-site counselling and testing

Miners who agreed to be tested for HIV and TB received professional group pre-test counselling. From there, they were channelled to dedicated Provider Initiated Testing and Counselling (PITC) points for individual testing.

Miners who wished to be tested for TB were guided to booths for collection of sputum samples for same-day collection and testing by GeneXpert. All sample collections and tests were conducted within the parameters of the relevant prescribed and approved medical protocols.

Patients who tested for HIV, as well as those with presumptive TB or a negative TB screen, also received post-test counselling.

v. Instant access to treatment

Miners who tested positive for TB and/or HIV were registered on the system and enrolled on fully coordinated treatment programmes.

TB patients received the necessary medicine and were scheduled for regular follow-up appointments to monitor progress, adjust their treatment where necessary and ensure that the treatment plans were successfully completed.

HIV-infected patients were scheduled for baseline investigations and enrolled for ongoing support and care, as well as antiretroviral (ART) therapy. They also received counselling at the start of each new phase of treatment.

Outcomes

The tangible impact of the TEBA POC Clinics Project as measured over a two-year period from 2013 to 2015 was as follows:

– A total of 182 776 miners, ex miners and their family members were screened for TB.

– 378 were diagnosed with TB, which included 23 Rifampicin-resistant cases.

– 80% of those who were diagnosed were initiated on TB treatment. 83% of the diagnosed 80% were made up of miners, 85% of ex miners and 75% of their family members.

– 80% of these total cases were treated successfully. This 80% was made up as follows: 73% miners, 81% ex miners and 88% family members.

– A total of 132 households of miners diagnosed with TB were personally visited by TEBA officials and representatives for further contact, tracing, and referral purposes.

– HIV testing and services were integrated with TB services, i.e. all HIV-positive patients were screened for TB.

Overall, the initiative was positively received by the mining communities, and additionally it created a demand for extending the services to ex-miners and mining households that were not part of the original target population.