A new tool to assist primary health care nurses managing TB &
“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
“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
“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
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: firstname.lastname@example.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.