The goal of the workshop is to define the best operational strategies and technical choices for the implementation of a decentralized model of care in rural settings affected by high HIV and (DR)-TB prevalence, taking Shiselweni region of Swaziland as a case in point.
Outline
Wednesday 28 October | Plenary Session
Venue: Session Room 1 – Left Wing
09:00-13:00 Opening Session
14:00-17:30 Intro Session 1: Health System
Thursday 29 October | Sessions
Venue: Session Room 7
09:00-13:00 Session 1: Health System
14:00-18:00 Session 1: Health System
Bridging Sessions
Venue: Session Room 10
09:00-13:00 Session 2: Clinical Management
14:00-18:00 Session 5: Laboratory
Venue: Session Room 9
09:00-13:00 Session 3: Infection Control
14:00-18:00 Session 6: Ethical issues
Venue: Session Room 8
09:00-13:00 Session 4: Health Information Systems
14:00-18:00 Session 7: Drug Supply
Friday 30 October | Closing Session
Venue: Session Room 1 – Left Wing
09:00-12:00 Closing Session
The facilitators of the morning sessions can be participants in the relevant afternoon sessions and vice versa. There is a limitation of 30 maximum participants per session.
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Wednesday 28 October | Plenary Session
Welcome Address and Keynote Speeches
Venue: Session Room 1 – Left Wing
HE Dr Barnabas Sibusiso Dlamini, Prime Minister, Kingdom of Swaziland (tbc),
Hon Benedict Xaba, Minister of Health, Kingdom of Swaziland,
Mr Aymeric Peguillan, Head of Mission, MSF Swaziland,
Dr Mario Raviglione, Director, STOP TB Department, WHO
Prof Alan Whiteside, Executive Director HEARD, University of Kwazulu-Natal, South Africa
Opening Session
Venue: Session Room 1 – Left Wing
Global epidemic situation
Dr Samson Kefas, TB Medical Officer, WHO Swaziland
National epidemic situation
Ms Rejoice Nkambule, Deputy Director of Health Services and Public Health, Swaziland
Workshop orientation
Venue: Session Room 1 – Left Wing
Sessions and objectives
Dr Felipe Garcia de la Vega, MD Peds DTCH, MSF Swaziland
14:00-17:30
Introduction to Session 1: Health Systems
Swaziland National Health System: Governance of HIV/TB programs, health workforce & financing, regional partnerships, health information system, drugs and supplies procurement, role of the civil society and local communities, policies on HIV/TB & DR-TB.
Venue: Session Room 1 – Left Wing
Chair: Dr Giuliano Gargioni, Stop TB Department, WHO
14:00 National TB Control Program and Swaziland National AIDS Program
Mr Themba Dlamini, Manager, National TB Control Program
Dr Velephi Okello, National ART Coordinator, SNAP
14:20 Swaziland National DST Survey, Preliminary Results
Dr Elisabeth Sanchez-Padilla, Epicentre, France
14:40 Discussion
15:00 Swaziland Network of People Living with HIV/AIDS,
Representative of SWANNEPHA
15:20 Influence of donors and implementing partners on changes of the health system in Swaziland – Representative of URC
15:40 Swaziland – Shiselweni region experience,
Dr Hermann Reuter, MSF Swaziland
16:00 Discussion
17:00 Wrap Up and Outline
Dr Peter G. Faussett, Professor of International Health, London School of Hygiene & Tropical Medicine
19:00 Regional debate on models of health care
Lesotho, Dr Hind Satti / South Africa KwaZulu Natal, Dr Bruce Margot / South Africa Khayelitsha, Dr Eric Gomaere
11:00-11:30 Coffee, 13:00-14:00 Lunch
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Thursday 29 October | Sessions
Session 1: Health Systems
What is currently the most appropriate public health model for addressing the regional crisis due to the combined DR-TB / HIV-AIDS epidemics?
Venue: Session Room 7
Time: 9:00-13:00 & 14:00-18:00
Chairs: Prof Anthony Harries, IUATLD (video link)
Prof Wim Van Damme, IMT, Antwerp, Belgium
Additional Presentation: Khayelitsha, South Africa MSF OCB project presentation
How to optimize the Swazi Health System, in order to reach out rural communities with HIV/TB services: case detection and patient flow for HIV and TB infections, provision of decentralized treatment, home-based management? How to adjust the Swazi health workforce to the needs of the current dual epidemic: core competencies, task shifting, training needs, legal frameworks? What are the roles and entitlements of community actors: community health workers, lay people and expert patients: PSEC, IEC, drug management? Policies for harmonization and support to TB-infected migrant workers in the South African region
11:00-11:30 Coffee, 13:00-14:00 Lunch
Session 2: Clinical Management of DR-TB
What are recommended standards for clinical management of DR-TB, keeping a balance between the urgency of mass treatment and the need to quality of care?
Venue: Session Room 10
Time: 9:00-13:00
Chair: Dr Michael Rich, Country Director, Partners in Health Rwanda
Minimal standards for infection control of tuberculosis to be put in place in Swaziland: health facility and community levels?
Criteria for periods of isolation and of residual infectivity
Monitoring the impact of IC measures
11:00-11:30 Coffee, 13:00-14:00 Lunch
Session 3: Infection Control
What are the minimal regional standards for infection control of tuberculosis in the health facilities and in the communities?
Venue: Session Room 9
Time: 9:00-13:00
Chair: Prof Saheen Methar, Head of Academic Unit for Infection Prevention and Control, Tygerberg Hospital & Stellenbosch University
Minimal standards for infection control of tuberculosis to be put in place in Swaziland: health facility and community levels?
Criteria for periods of isolation and of residual infectivity
Monitoring the impact of IC measures
Session 4: Health Information Systems
What are the best solutions to strengthen Health Information Systems in Swaziland and the best strategies to integrate data from different sources?
Venue: Session Room 8
Time: 9:00-13:00
Chair: Dr Denis Falzon, STOP TB Department, WHO
Individual follow-up of HIV-TB patients, epidemiological monitoring, and programme performance monitoring.
What are the existing standards in a decentralized setting (manual data recording vs. computer-based system)?
What are current strengths and weaknesses of HIS in Swaziland?
How to improve integration between: HIV clinical data, TB clinical data, laboratory data, and drug supply systems?
Data protection (legal and technical aspects)
11:00-11:30 Coffee, 13:00-14:00 Lunch
Session 5: Laboratory
What minimal laboratory resources at what level and what type should be put in place in Swaziland to deal with the epidemics?
Venue: Session Room 10
Time: 14:00-18:00
Chair: Dr Sabine Rüsch-Gerdes, National Reference Center for Mycobacteria, Borstel, Germany
What minimal laboratory/human resources should be put in place? At what level? What type? Reagent Management
What are recommended laboratory algorithms for the diagnostic of DR-TB in the Swazi context?
Current technologies and their local/regional availability? Regional networks? Quality control?
Future vision for diagnostics in Swaziland: Role of laboratory technologists, laboratory technicians and MD Biologists
11:00-11:30 Coffee, 13:00-14:00 Lunch
Session 6: Ethical Issues
What are the main Ethical dilemmas in the management of DR-TB patients in Southern Africa?
Venue: Session Room 9
Time: 14:00-18:00
Chair: Prof Jerome Amir Singh, Research Ethics Board, MSF International
Ethical issues posed by DR-TB: isolation, chronic defaulters, palliative care?
Regional experiences?
To what extent the recommended IC measures (session 3) ease ethical problem?
Current legal framework on forcible isolation in Swaziland?
Orientation on key ethical dilemmas: employer initiated or enforced HIV testing, cost of drugs, lack of access to treatment due to shortage of drugs and staff to administer them, and the responsibility of the state with regards to patients experiencing permanent side effects (deafness) or temporary but highly stigmatizing (psychosis) at community level
11:00-11:30 Coffee, 13:00-14:00 Lunch
Session 7: Drug Supply
How can uninterrupted supply of quality drugs be ensured at all levels of health care system?
Venue: Session Room 8
Time: 14:00-18:00
Chair: Dr Myriam Henkens, International Medical Coordinator, MSF
Ministry of Health Representative:
Ms Prudence Gwebu (TB Pharmacist, Swaziland)
What is the best design of a supply line management for HIV and (DR-TB) drugs in a decentralised setting like Swaziland? How to ensure quality monitoring?
11:00-11:30 Coffee, 13:00-14:00 Lunch
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Friday 30 October | Closing Session
Rapporteurs’ summaries – Final Wrap Up
Venue: Session Room 1 – Left Wing
9:00 Health Systems
Dr Zerihun Tefera & Dr Martha Bedelu
9:20 Clinical Management of DR-TB
Dr Hermann Reuter & Dr Dmytro Donchuk
9:40 Infection Control
Ms Ana de Souza
10:00 Health Information Systems
Dr Philippe Calain
10:20 Laboratory
Biol Maryvonne Lassovski & Dr Frauke Jochims
10:40 Ethical issues
Mr Nathan Ford & Ms Elaine Texeira
11:00 Drug Supply
Ms Juanita Cristina Theodora
11:30 Final Wrap Up – Concluding Remarks
Ms Rejoice Nkambule, Mr Bruno Jochum & Mr Aymeric Peguillan
End of the Workshop
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Practical details for the workshop
Venue: Esibayeni Lodge, Matsapha, P.O Box 1451, Manzini, Swaziland
Tel: +268 518 48 48
There will be free wireless internet access during the workshop for all participants
Médecins Sans Frontières/Doctors Without Borders (Switzerland)
Plot 392, Lukhalo Street, Dalriach East, Mbabane
Tel office: +268 404 83 07
Fax office: +268 404 78 84
International Consultative Workshop Coordination Team
Head of Swaziland Mission (Interim)
Mr Elias Pavlopoulos
Cell: +268 618 2622, Email: msfch-swaziland-workshop@geneva.msf.org
Workshop Coordinator
Dr Felipe Garcia de la Vega MD Peds DTCH
Cell: +268 6 111 864, Email: felipe.garcia@geneva.msf.org
Workshop Organiser
Ms Angela Vilakazi
Cell: +268 692 0387, Email: msf.mba.wshop@gmail.com
Members of the Organising Committee
Chair: Ms. Rejoice Nkambule
Deputy Director of Health Services and Public Health, Swaziland Ministry of Health
Mr Aymeric Péguillan
Head of Swaziland Mission, Médecins Sans Frontières Switzerland
Dr Velephi Okello
ART Coordinator, Swaziland National AIDS Programme (SNAP)
Dr Marianne Calnan
ART Case Manager, Swaziland National AIDS Programme (SNAP)
Mr Themba Dlamini
Programme manager, National TB Control Programme (NTCP)
Ms Gugu Shongwe
TB/HIV Coordinator, National TB Control Programme (NTCP)
Dr Kamal Mohammed
National TB Clinical Coordinator, NTCP Swaziland
Ms Sphiwe Ngwenya
TB Coordinator (Shiselweni), NTCP Swaziland
Dr Hosea Sukati
Head of the National Blood Program and National Clinical Laboratories
Mr Derick Khumalo
TB Laboratory Coordinator, National Blood Program and National Clinical Laboratories
Ms Prudence Gwebu
TB Pharmacist, Swaziland
Ms Thembi Dlamini
Coordinator, Treatment, Care and Support, National Emergency Response Council on HIV/AIDS (NERCHA)
Dr Samson Kefas
TB Medical Officer, STOP TB Department, WHO Swaziland
Dr Samson Malwa Huamba
MBCH B M. MED (Intern. Med) MPH, Country Director – University Research Co., LLC, Swaziland
Dr Yohannes Ghebreyesus
Drug Resistant TB Coordinator, University Research Co., LLC, Swaziland
