Presentation Transcript
Providing HIV care for Health Workers: Providing HIV care for Health Workers Dr Kerry Uebel
McCord Hospital
Durban
7th October2006
Outline: Outline The HIV crisis amongst HCWs in SA
Staff HIV care at McCord Hospital
The challenges
The crisis without: The crisis without Over whelming numbers of critically ill young people dying of AIDS in wards
Critical staff shortages
Struggling health systems
Lack of political leadership
BURNOUT
The crisis within: The crisis within HIV prevalence in HCWs in KZN 17% 2001
Death rates in SA women in 20s and 30s has more than tripled 1997-2004
Stigma
FEAR, DENIAL and HOPELESSNESS
Accessing HIV care for HCWs: Accessing HIV care for HCWs Burnout
Fear denial and hopelessness
PLUS
Lack of confidentiality
Huge barriers to HCWs accessing HIV care for themselves
Accessing HIV care for HCWs : Accessing HIV care for HCWs Urgent necessity
Specific planning and provision
AIDs care in the community will fail without an HIV Care programme for HCWs
McCord Hospital Staff HIV care: McCord Hospital Staff HIV care 180 bed community hospital
Government subsidised
540 staff members (~170 pupil nurses)
Large HIV clinic (~2000 on HAART)
McCord Hospital Staff HIV care: McCord Hospital Staff HIV care Assumed prevalence 20%
~110 HIV positive staff
~80 aware of status & CD4 (ideal conditions)
~25-30 CD4 <200 at any time needing ARVs. This group will develop AIDS, be unable to work for some months and die if not treated in 6-18 mths(5% of workforce)
McCord Hospital Staff HIV care: McCord Hospital Staff HIV care Located in staff clinic
General practice
On site
Free (No hospital medical aid)
Acute and Chronic care
TB care
HAART was added to the scope of practice in Nov 2001
McCord Hospital Staff HIV care: McCord Hospital Staff HIV care Confidential
NOT an HIV clinic
All HIV related bloods are coded
All HIV related bloods are taken by doctor
Pre and post test counselling by doctor
HIV and CD4 results are not kept in file
ARV adherence counselling by doctor during consultations (flexible and convenient)
McCord Hospital Staff HIV care: McCord Hospital Staff HIV care Comprehensive
TB and HIV meds at one clinic
Normalises HIV care (like Diabetic and Hypertensive Meds)
One stop care
Already have relationship with doctor
Don’t have to join the ARV queue
Don’t have to take time off work to access care
McCord Hospital Staff HIV care: McCord Hospital Staff HIV care VCT
PRE 2002 6-11 per year
2002 38 tested
2004 56 tested
2005 118 tested
McCord Hospital Staff HIV care: McCord Hospital Staff HIV care 45 staff members ever started
8 left the hospital
7 deaths on ARVs
6 with known adherence problems
1 stopped therapy at 3mths voluntarily
4 PMTCT only
25 currently on ARVs
1 staff child 3 years
1 currently on PMTCT
McCord Hospital Staff HIV care: McCord Hospital Staff HIV care 7 Deaths on ARVs
2 presented too late (CD4<20 & both very ill with TB)
2 defaulted (1 seizure, 1 Dissem TB)
1 multiple pulmonary emboli
1 NRTI associated lactic acidosis
1 MDR TB
Challenges: Challenges TB and HIV
Stigma
External stigma
Internal stigma
Lack of information
Absenteeism Mortality
Programmatic
TB and HIV: TB and HIV TB incidence in HCWs at McCord ~2,600 per 100,000 per year
3 times the rate in KZN at present
~ 20 of those needing HAART also had TB
Management of TB and HIV is complicated and should be handled by one experienced physician
TB prophylaxis important
External stigma: External stigma Usually seen as disadvantage of in-house HIV programmes
BUT an in-house programme can be a positive means of breaking down the gossip fear and silence
Colleagues are seen to get better and everyone knows where to go if they or their friends are sick
Internal stigma: Internal stigma A “paralysing dread of confronting HIV..(that results in)…inaction, postponement, delay, denial and death”
Edwin Cameron May 2005
Normalise this disease
Remove the barriers
Combating stigma: Combating stigma Raise awareness of stigma and disclosure issues
Involvement of PLWAs (including HCWLWAs!) in talking with staff
What barriers?: What barriers? Insisting on pretest counselling with HIV counsellors
“the diagnosis ..is treated as exceptional, and is hedged around with fuss, palaver and hullabaloo”
Insisting staff be referred to other hospitals because of confidentiality
Insisting staff follow strict protocols on adherence modules
Refusing to let VCT be done with codes
What barriers?: What barriers? Breaking up care between different clinics
Staff clinic, HIV counsellor, ARV clinic, TB clinic
Information: Information Study by Wits Health consortium underway
No reports of any other programmes to address HIV in HCWs
Thanks: Thanks The staff at McCord Hospital
What a priviledge to work amongst you all!