Focus: Community based strategies to confront epidemics of tuberculosis, HIV/AIDS and drug resistant tuberculosis
Affiliation: Philanjalo, KwaZuluNatal Department of Health, Yale Schools of Medicine and Public Health, University of Kwazulu Natal
Contacts:
The training site is in Tugela Ferry, located in the Umzinyathi District of KwaZulu Natal province, a traditional Zulu area and the third poorest district in South Africa. Philanjalo is a local South African NGO founded by Dr. Anthony Moll in 1998 to address the rapidly growing epidemic of HIV/AIDS. Yale joined Philanjalo and the KZN Department of Health (DOH) and University of KwaZulu Natal in 2002 to strengthen and integrate HIV and TB care and treatment at this site. In 2005, we uncovered the third and disastrous epidemic of extensively drug resistant (XDR) TB. These convergent epidemics have been characterized by rapid and high mortality rates, overwhelmed TB and HIV health care systems, ongoing health care and community transmission and epidemic propagation, all associated with extreme poverty, weak infrastructures, inadequate prevention strategies, late presentation to care, limited TB diagnostics and treatment options.
In response, we have worked collaboratively to characterize the convergent epidemics and have developed and implemented a comprehensive strategy of innovative integrated HIV and TB health care and community based strategies combined with operational research to strengthen clinical and public health programs, reduce the associated high rates of morbidity and mortality and decrease incidence and transmission of HIV and drug susceptible and drug resistant TB. We have rapidly demonstrated acceptance, feasibility and utility and have successfully advocated for widespread scale up and dissemination of these strategies, including the first national community-based MDR TB treatment program and first integrated HIV and TB intensive case finding (ICF) program in rural South Africa. Current priorities include scale-up of isoniazid preventive therapy, implementing point of care technologies, integrating community-based screening for HIV and TB with noncommunicable diseases, screening high risk populations, and incorporating new HIV prevention tools.