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Thandeka Moyo
THE City of Bulawayo was one of the first local authorities to implement a patient-centred approach which incorporates family members in the planning, delivery and evaluation of healthcare.

In the countrywide fight against Tuberculosis (TB) which according to statistics claimed 1.5 million lives in 2014 globally, the approach has helped improve the treatment success rate.

One major aim of the approach was to provide HIV testing services to HIV positive TB patients’ family members and to link positive TB patients to HIV treatment, care and support.

Dr Charles Sandy, Ministry of Health and Child Care Aids and TB Programmes deputy director said the model of healthcare was designed to involve family as TB patients are sent back to their families after they are discharged. “Great milestones have been achieved since the adoption of the programme. Zimbabwe recorded a TB case detection rate of 70 percent, a treatment success rate of 82 percent and a case notification rate of 210 over 100 000. This was made possible by a number of factors which came into play as a result of the programme,” said Dr Sandy.

“The ministry has renovated and equipped 226 microscopy sites throughout the country. Patient and family centred care is an approach to health care that shapes policies, programmes, facility design, and staff day-to-day interactions. It leads to better health outcomes and wiser allocation of resources, and greater patient and family satisfaction.”

Bulawayo City Council senior public relations officer Mrs Nesisa Mpofu said the approach dubbed the “One Stop Shop” TB-HIV initiative was being implemented at all the city’s 19 clinics.

“The aim of the approach is to integrate TB and HIV care in order to improve the quality of life among TB patients infected with HIV,” said Mrs Mpofu.

“So far, access to HIV testing has improved as ART uptake increased as evidenced by 90 percent of HIV positive TB patients initiated on ART compared to 47 percent before the approach. We have also recorded an increased access to health care for index patient’s family e.g. screening for TB, HIV and other illnesses and this has greatly improved adherence to treatment as shown by reduction in default rate which includes people who are lost to follow up,” said Mrs Mpofu.

According to Mrs Mpofu, the approach has made communication with patients easier as health personnel now use cellphones courtesy of the International Union Against Tuberculosis B and lung disease.

“Health workers call the patients to relay any information to do with the patients’ illness/treatment. They can, for example, call the patients to remind them that they are overdue for treatment, to come for tests or to see the doctor. The approach was initiated in 2007 at Magwegwe and Emakhandeni clinics and family support for the patient became easier to access and disclosure problems were reduced.

Sabelo Moyo* who at one time was admitted to the Thorngrove Hospital for Infectious Diseases said his family used to treat him with disgust before they were taught about TB during their hospital visits.

“When I finally opened up to my family that I had TB, they concluded I was going to die soon. They were happy when I got admitted as they felt I was now a health hazard to the toddlers we stay with,” said Moyo.

“However, tables turned when one day during their visit, a nurse asked them a few questions about their knowledge of TB. From that day they saw my situation in different light and when they agreed to test for TB, I was convinced they had accepted my condition.”

Moyo said his family now freely discusses TB and HIV and that they even share their knowledge with distant relatives who had misconceptions about the disease.

“The clinic helped me get TB treatment and after some time, I started taking ART as I am also living with HIV. I feel that nurses are more accessible now as I am free to express myself even when I am mistreated.”

“When I was finally discharged, my wife and siblings started treating me differently and I believe it was because the nurses had taken time to involve my family in the road to recovery,” said Moyo.

Another patient from Nkayi who is still taking TB medication said the integrated TB-HIV care model helped him bond with his family.

“I used to stay in South Africa where I started my TB treatment. When I came back home, I dreaded opening up about TB and ended up defaulting until I got very sick and had to be admitted,” said Nkanyiso Thebe.

“The nurses however made opening up easy and in no time, I managed to reveal that I had been diagnosed with TB while I was still in South Africa. My family liked the discussions around TB that were initiated by health officlas at the clinic,” he said.

Thebe said the model had helped him interact freely with nurses whom he thought were hard to reach.

Dr Sandy said the approach is grounded in mutually beneficial partnerships among health care providers and patients.

“Patient and family-centred practitioners recognise the vital role that families play in ensuring the health and well-being of patients of all ages. They acknowledge that emotional, social, and developmental support are integral components of health care,” he said.

“It also fosters participation as patients and families are encouraged and supported in participating in care and decision-making at the level they choose.”

Dr Sandy said families play an important role in supporting the treatment of one diagnosed with TB.

“When a patient is put on treatment, they are eventually sent back to their families on a treatment model called Direct Observed Treatment (DOT). Here a family or community is oriented to watch the patient take their treatment daily and report on any reactions to treatment. The patient does not get detached from their families and their roles in their families and communities considering the length of TB treatment (6-8months).”

The integrated TB-HIV care model is now being implemented at most health facilities throughout the country as the health delivery system endeavours to deliver quality service to all citizens.

“We adopted the approach because of the advantages it offers to the patient unlike in the past where programmes only concentrated on just treating the patient and forgot about what was happening to them when they leave hospital. When patients are discharged from hospital they go back to their communities hence the need to also involve the communities in which they live.”

Dr Sandy urged everyone to go for early diagnosis should they exhibit any signs and symptoms of the disease such as coughing, loss of weight, night sweats among others.

“We also encourage regular screening for the following risk groups; HIV positive, diabetics, smokers, miners, health care workers. Once diagnosed with TB, we encourage close contacts of the TB patient to come for screening to prevent the spread of the disease. For patients on treatment we encourage adherence to medication. TB is curable.”

Dr Christopher Zishiri from The Union said the approach had helped reach out to TB patients who were struggling with ART treatment.

“The union is currently receiving USAID funding through the Challenge TB grant to support the Ministry of Health and Child Care in the national response against TB and HIV in Zimbabwe,” said Dr Zishiri.

“We noted that ART uptake was very low among TB patients despite the fact that seven out of every 10 people with active TB are HIV positive in Zimbabwe. In addition, TB remains the commonest opportunistic infection and major cause of death in people living with HIV.”

Dr Zishiri said TB services were an important entry point for HIV diagnosis and care.

“These services also offer an opportunity to manage both diseases simultaneously at least for the anti-TB treatment. By end of September this year, 46 primary health facilities will be implementing the model of care in all 10 provinces in Zimbabwe,” he said.

Dr Zishiri said more resources were needed to roll out the programme countrywide.

“Health care personnel need to be trained as well and some sites need renovation to allow for one stop shop approach.” — @thamamoe