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Putting communication back into tuberculosis care: implementing an interpersonal communication and counselling model to strengthen management of tuberculosis in South Africa

EP-01-108-31

Public Health Practice

Conclusions

Background and challenges to implementation Results/Impact

KwaZulu-Natal province in South Africa records the highest incidences oftuberculosis (TB), drug-resistant TB (DR-TB) and HIV in South Africa as wellas a high rate of patients who are lost to follow up. The USAID TB South AfricaProject developed and implemented an interpersonal communication andcounselling (IPC/C) package to strengthen capacities of healthcareprofessionals to support patients to adhere to treatment in uMkhanyakudedistrict, KwaZulu-Natal.

The model’s approach includes training healthcare providers to improvecommunication with patients. The objective of IPC/C training is to empowerhealthcare workers to be able to communicate with patients effectively so thatthey are able to support patients to adhere to treatment.

The perception and practicality model of understanding adherence is a keycomponent of IPC/C training. Health workers are trained to help break patients’perceptions about TB so that they can be supported throughout the treatmentjourney until cure.

Training was presented through a standardised module that favours role-play.Groups were allocated scenarios covering the following thematic areas:• A person with both TB and HIV who uses recreational drugs and has been lost

to follow up multiple times• A family is in dire need of all support imaginable. No one in the family is

employed and there is no food in the house. TB treatment is not on the list ofpriorities.

• A patient who does not believe they have TB and who chooses to use onlytraditional medicine.

• How to prioritise patients for IPC/C - this was done to assist the healthcareworkers in assessing and identifying patient needs for IPC/C

The role play exercises were evaluated through observation of thecommunication behaviour checklist which assesses counselling practice as partof peer mentoring. The tool assesses positive verbal and non-verbal language,psychosocial and medical assessment, treatment education and discussion ofpsychosocial factors that might impact adherence and treatment goals. Aftereach role play feedback was provided and discussed in the bigger group.

A total of 42 healthcare providers from seven healthcare facilities benefittedfrom intensive capacity building and mentoring sessions over three months.Following training, 52 patients were counselled by trained care providers duringa two-week period using the checklist. Peer-to-peer observation to assess thequality of counselling provided, were conducted for 17 of the 52 patients whoconsented to the exercise. The peer mentor provided feedback to healthcareproviders after the assessments.

It was found that patients were given enough information related to TBtreatment during counselling sessions, but there were gaps in discussing andrecording medical history and psychosocial factors that may affect adherenceto both TB and HIV treatment.

Zamani Dlamini, Princess Mabota-Rapholo, Gregory Jagwer, Refiloe MatjiUniversity Research Co., LLC

Peer observation and mentoring are key to ensuring that treatment communication and adherence counselling is standardised in areas where TB, DR-TB and HIV burdensare high and patients’ treatment regimens include many drugs taken over long periods. It is important to observe routine counselling sessions to improve practice andquality of TB care. Following the IPC/C training and mentoring initiative, 12 patients that were lost to follow up from both TB and HIV programmes were returned to careand re-initiated on treatment. Classroom training alone does not yield better results in IPC/C, onsite mentoring and coaching remains a priority in the implementation ofIPC/C. The implementation of IPC/C training and mentoring in uMkhanyakude has shown that it improves patient-healthcare worker relations as well as patient care andadherence.

Patient counselling session at Somkhele clinic in uMkhanyakude

42

52

1712

0

10

20

30

40

50

60

No. of HCW trained No. of patientscounselled

No. of counsellingsessions

No. of patients returnedto care

IPC/C implementation results in uMkhanyakude

Left: Informational posters developed to educate healthcare providers on how to help patients to adhere to treatment.