Aurum Institute launches `Managing TB in a New Era of Diagnostics`

Theo Smart
Published: 16 July 2012

A new tool to assist primary health care nurses managing TB & TB-HIV

“Just this morning the Department of Health issued a directive stating that all nurses need to be trained in MDR-TB and that TB treatment is going to be decentralised,” said Lauren de Kock of the Aurum Institute in a skills building session at the 3rd South African TB Conference last month in Durban. “We have to make sure that our nurses are equipped, and that they have the tools in order to need to be able to do that — and I’m proud to say this tool will be able to help you do just that.”

The tool she was describing was the new Managing TB in a New Era of Diagnostics, developed by the Aurum Institute that would make the diagnosis and management of TB simple and easy to implement at primary health care facilities. The launch of the tool was marked by the interactive workshop Ms Dr Kock was leading, in order to train South African healthcare workers how to use it.

“We developed this tool because the TB situation in South Africa is dire — the stats aren’t getting any better. So we must not be doing something right,” she told the room filled mostly with nurses. And the tool wastes little time spelling out the challenges TB poses to the South African health system.

“At any given time in our community, only approximately 30% of cases of TB are detected and treated. During this time the disease is spread,” it says on the first page after the table of contents. No introduction, or lengthy preambles here. The authors get straight to the point.

“We’ve tried to make it as simple as possible, to use as few words as possible, in a question, answer format. We didn’t want to set out to write another textbook that would take a long time to read,” she said.

The text is very lean indeed. It moves quickly to diagnosis, noting the strengths and weaknesses of each diagnostic algorithm in previously treated patients, adults and children, and then onto treatment for both drug-susceptible and drug-resistant TB. It reviews management of TB in pregnancy, TB and HIV, and TB-HIV integration (by which they mean one-stop shops — not referrals).

The tool stresses the importance of recording and reporting since ‘if it’s not recorded, it,s not done,’ and provides examples of and instructions for filling out reporting tools, registers and other forms. It describes how to safely perform all the critical procedures for collection of sputum and other specimens. And it ends with guides on surveillance, clinical staging and a sample infection control plan for a PHC facility.

All of this is pulled together in one place and bound.

In addition to being used as a day-to-day management tool, Ms de Kock said “it can also be used for in-service training, and as a mentorship tool. And when you’re not there, you can leave them with a tool that will help them feel empowered.”

To illustrate this, participants were given case studies to work through with the tool to find answers to different clinical management questions, and asked to write down the page where the answer was found. They were promised prizes for finding the correct answer — which probably explained why no one told Ms de Kock and her colleagues, that they had mistakenly handed out the sheets with answers.

But once they were found out, and the answers were handed back in, the participants were indeed able to work through a number of complex real world clinical cases. Here and there, Ms de Kock would repeat important information a participant had shared.

“Remember, the guidelines have changed, please remember, every TB patient now qualifies for ARV treatment in South Africa,” she shouted.

At the end of the meeting, the participants were given back the sheets with the case study answers, so that they could later repeat this exercise and show others how to use the tool. “Go back to your clinics and please do in-service trainings,” said Ms de Kock. She also asked participants to provide them with feedback about the tool.

If we had one small criticism it might be that it is somewhat South Africa-centric

“Every single person who contributed to the tool is South African, working in South African clinics, in the South African context… and they can help other South African healthcare workers manage TB as well as HIV,” Ms de Kock said.  

But even so, we recommend it. Bearing in mind that policies and protocols vary from country to country, there is still much in this tool that people managing TB and TB-HIV anywhere should find useful. In fact, it is so well done, we think we can retire now!

The tool is free, and can be downloaded here. Printed copies can be obtained by emailing by contacting Aurum directly at: info@auruminstitute.org or by telephone: (010) 590 1300.

Ms de Kock concluded by telling participants to contact them if they wanted Aurum Institute to do trainings at their clinics; and said they were exploring the possibility of entering into a partnership that they hoped would enable them to roll out training country-wide.

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