saworkshop pp addressing uebel

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!