Transcript Title of slide show

WORKING TOGETHER TO
ERADICATE TB:REACH THE 3
MILLION:A TB TEST, TREATMENT
& CURE FOR ALL
Joint Round Table: HSRC, UCT &
SU
PSYCHOSOCIAL ASPECTS OF TB
Professor Pamela Naidoo
Population Health, Health Systems & Innovation
(PHHSI): Human Sciences Research Council (HSRC),
South Africa, & Extraordinary Professor at the University of
the Western Cape (UWC)
[email protected]
HSRC, 02 June 2014
INTRODUCTION
• Presentations at the round table provide a ‘holistic’
perspective of TB: framed by a Bio-Psycho-Social
Model
• Fellow speakers focus primarily on the biomedical
aspects of TB
• This presentation will hone in on the psychosocial
aspects of TB
• By the end of the round table we should have
demonstrated how the biological, psychological and
socio-economic factors associated with an
infectious disease such as TB, are inter-related
INTRODUCTION cont…
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HISTORICAL CONTEXT
Prior to mid-1800s TB was almost unknown in SA
Since then there’s been a steady increase in TB
prevalence
Historically poor living & working conditions of miners set
the stage for rapid TB transmission in SA
Route of transmission can be traced from the migratory
patterns of mine workers to rural communities
Additionally, poor socio-economic & environmental
conditions during apartheid ‘facilitated’ the spread of TB
INTRODUCTION cont…
• Socio-economic determinants of TB are well-known:
over-crowding, poverty (& associated poor nutritional
status), lack of health resources including lack of access
to health care
Read: Paul Farmer’s work which provides an excellent
understanding of the socio-economic determinant’s-TB
• It’s estimated that about 1% of the SA population
develops TB every year
• SA has a high TB/HIV rate making up 25% of all TBHIV co-infections in the world
• Given this: Social & Human Sciences need to play
a role in eradicating TB and improving cure rates
PSYCHOSOCIAL FACTORS:
MEDIATING DISEASE OUTCOME
• There has been prolific biomedical research on TB
relating to disease pathways & effective medicines that
can cure the disease
• The role of Socio-Economic factors in TB disease onset
is also relatively well known
• GAP: What has been understudied and underestimated
is the role of psycho-social factors in mediating TB
disease outcome (including TB cure & HR-QoL of those
infected and those with TB/HIV co-morbidity)
PSYCHOSOCIAL FACTORS:
MEDIATING DISEASE OUTCOME
• There are many psychological (individual level) & social
factors (environmental, household, work and community
levels) that influence TB disease outcome
• This presentation will focus broadly on 2 of these factors:
(1) Knowledge and Awareness
(2) Common Mental Disorders, Substance
Abuse and TB
• Will present some findings based on studies (namely,
SANHANES I & SBI:TB) conducted at the HSRC
PSYCHOSOCIAL FACTORS:
MEDIATING DISEASE OUTCOME
Knowledge and Awareness
• Appropriate knowledge & awareness of TB, as well the
fact that TB is curable even in the face of HIV remain
vital messages required for effective TB control in SA
• These messages are important when TB patients decide
to use health services, seek a diagnosis & adhere to
treatment
• TB knowledge & awareness of TB as an infectious
disease forms the basis for people taking protective
measures to avoid becoming infected
PSYCHOSOCIAL FACTORS:
MEDIATING DISEASE OUTCOME
• SANHANES 1- Population based household survey sample 15 years & older (Shisana, Labadarios et al.,
2013) found:
*Majority of participants (91.4%, n=14 739)
perceived TB to be a very serious disease
*Know TB can be cured (92.2%, n=14 903)
*Only 3.3% (n=15 140) had knowledge of 6 or
more signs & symptoms of TB
*Only 22.3% (n=14 664) were concerned about TB
presence in HIV + people
*30% of =/>55years did not know whether people
with TB should take an HIV test
TB KNOWLEDGE OF PARTICIPANTS
15 YEARS AND OLDER
PSYCHOSOCIAL FACTORS:
MEDIATING DISEASE OUTCOME
Common Mental Disorders, Substance Abuse and TB
• CMDs: cluster of psychiatric disorders which include
depression and anxiety. At least one third of all
individuals seen in public primary care health facilities in
low & middle income countries (LMICs) suffer from
CMDs which are not recognized nor treated
• Co-morbidity of CMDs & TB in LMICs range from 30% to
70%
• Alcohol & Substance Abuse: co-existing prevalence of
TB & alcohol use disorders range from 4% to 62%
PSYCHOSOCIAL FACTORS:
MEDIATING DISEASE OUTCOME
• Screening and Brief Interventions: TB (SBI:TB)conducted in a cluster of public primary clinic based
adult sample across 3 provinces in SA (Peltzer, Naidoo
et al., 2012, 2013). Adult sample, n=3107
Baseline data from SBI: TB study revealed the ffg
prevalence figures for participants on anti-TB drugs:
*Psychological distress (26.3%)
*PTSD symptoms (29.6%)
*Males who met the criteria for hazardous
drinking on the AUDIT (22.5%)
*Women who met the criteria for hazardous
drinking on the AUDIT (9.5%)
PSYCHOSOCIAL FACTORS:
MEDIATING DISEASE OUTCOME
*Current tobacco use in the past month (27.6%)
*Anti-TB treatment non-adherence rate (24.5%
missed meds at least once over past 10
days)
*Anti-TB/ARV non-adherence rates (11.8%
missed meds at least once in the last 7 days)
CONCLUSION
• In order to address the socio-economic
determinants of TB on-going structural
adjustments need to be made for which political
will is necessary
• In order to address the psycho-social mediators of
TB disease the following is needed:
*Health literacy campaigns at targeted
groups of individuals
*Screening & treatment for CMDs, alcohol
& substance use disorders at health care facilities
as part of the integrated services offered
CONCLUSION cont…
*Monitor the quadruple burden of ‘disease’,
namely
TB, HIV, Depression (CMDs), Alcohol &
Substance Use Disorders
*Use a sound M&E system to assess the impact of
screening and treating for CMDs/Alcohol & Substance
use Disorders whilst simultaneously using the ant-TB
DOTS strategy recommended by WHO
THANK YOU