Reducing the Impact of Drug-Resistant Tuberculosis through Patient-centred Education and Counselling (PEC)
Image: The TB PALS team and Lead Counsellors, (left to right): Aniba Koivaku, Nazzy Ruhi, Maryanne Hapolo (Lead Counsellor), Allan Kuma (Lead Counsellor),Lucy Dai, Theresia Haihuie (Lead Counsellor), Iru Tofinga, Jenny Bodolo, Desmond Sampson
Burnet’s aim is to accelerate change through interventions that are informed and driven by the local stakeholders and community. We have a major focus on building local health worker capacity and strengthening systems to sustain the response.
A key example of this is through the way we are engaging and empowering the TB affected community in Daru, Papua New Guinea, through a pilot model of patient education and counselling (PEC) that trains and mentors a team of peer-counsellors or “TB-PALS” (People Affected by, Living with, or having Survived TB) to provide education and counselling to people taking treatment for TB disease and infection, and their families.
This team uses a patient-centred approach to provide psycho-emotional support, facilitate adherence to treatment and promote well-being.
The model of care integrates with facility and community-based delivery systems for both drug-sensitive (DS-TB) and drug-resistant (DR-TB) care and prevention that the Burnet Reducing the Impact of Drug-Resistant TB (RID-TB) project supports.
Image: Peer Counsellors are based at the community treatment sites and provide in home counselling and education when requested
The pilot model of PEC care initially focused on DR-TB due to the complexity (side effects, length) of this disease and increased impact of social and emotional issues for patients.
It soon became clear that there was also a strong need for education and support for people on treatment for DS-TB and the families of children taking treatment for latent TB infection, and in response the project spread its services across these areas.
Care is provided through standardised education and counselling sessions provided at key points during the treatment journey, supplemented by tailored individual support where required (eg. Treatment interruption follow up, home visits, medication supply counselling).
Additional support is also provided through:
Family education and counselling offered to each person on treatment
Referrals to clinical staff and external services where required
Health education talks provided at busy locations throughout the hospital grounds and at treatment sites
Facilitation of peer group discussions in the hospital wards and treatment sites to encourage sharing of lived experience and support amongst people on treatment.
Regular child focused activities at the treatment sites and large scale child patient events every quarter
Regular peer group activities for young adults on treatment, including a Photovoice program held in early 2019
Tools and resources for use in provision of counselling and education have been created, trialled and adjusted based on feedback from counsellors and people on treatment.
Current tools and resources include:
Guidelines for DR-TB, DS-TB and Preventive Therapy standard session counselling
Flipcharts for DR-TB, DS-TB, Preventive Therapy (Sleeping TB), Bedaquiline and general health education
Checklist for Supply Request Counselling
Handout on infection and disease provided in the first session of counselling
Visual aids for explaining infection, disease and the impact of treatment
Child-friendly tools: a board game and story book
Flipcharts in use
Board game helping children understand treatment
Visual aids- boxes showing lungs with TB infection and disease
The tools and resources are currently undergoing an update. For further information or to obtain a copy of any of the above please contact [email protected]
Patient surveys regarding the counselling and education services have resulted in high satisfaction rates, demonstrating the appreciation felt by people on TB treatment for the support provided by the project team.
Feedback from people on treatment and their families, combined with the high treatment completion rate in Daru, show that the project is abiding by its aim of reducing the impact of social and emotional issues on TB patients and their families.
Reduction of the barriers to treatment will ultimately contribute to a reduction in TB transmission in Daru.
Image: Feedback from patients and their families has guided continual adaption and improvement of the project services
Members of the Western Province TB team, supported by the RID TB project, demonstrate the ‘tippy tap’, an innovative, low cost and hands-free solution for hand hygiene in settings without running water. First developed in Zimbabwe in the 1970s, ‘tippy taps’ have been used in similar settings around the world and have recently been implemented by the team in Daru as an important preventative strategy in the fight against COVID-19.
This website was developed with the generous support of a donor.
Burnet Institute (Australia) is located on the traditional land of the Boon Wurrung people and we offer our respects to their Elders past and present. We recognise and respect the continuation of cultural, spiritual and educational practices of Aboriginal and Torres Strait Islander peoples of this land.
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