Zimbabwe PHC clinics cascade TB-HIV care successfully: The story of Phakama Clinic

Phakama Clinic is one of the 23 urban clinics supported since 2012 through The Union’s TB CARE project in 17 urban areas of Zimbabwe. Located in a high-density suburb of the City of Gwanda, provincial capital of Matabeleland South Province, Phakama Clinic is the only one participating in the project that is run by the local authority.

Since August 2013, Phakama Clinic has been accredited as an antiretroviral treatment (ART) initiating and follow-up site for its catchment population of more than 20,000 people. It currently provides follow-up ART for 966 patients who were transferred from Gwanda General Hospital and 107 patients who started their treatment at the clinic.

Full range of TB-HIV services offered at the clinic

Phakama clinic offers a full range of collaborative TB-HIV activities recommended by The World Health Organization, including TB screening, diagnosis and treatment; intensified TB case finding for patients in HIV care or on ART; provider-initiated testing and counselling  (PITC) for HIV for family members; cotrimoxazole preventive treatment (CPT) and ART to all HIV-positive patients who are eligible.

Special services and resources

• Sputum exam turnaround time is less than 24 hours: Prompt TB diagnosis is aided by the use of a motorcycle courier, funded by TB CARE, to transport sputum to the laboratory at the general hospital for smear microscopy or XpertMTB/RIF examination. A microscopy laboratory is also being established onsite at the clinic.

• Cellular phone prompts:  The clinic staff is provided with cellular phones to contact patients who need to start TB treatment and also to follow up with those who miss scheduled appointments. This has helped to prevent patients from defaulting on their treatment.

• Solar power back-up: A solar-powered back-up power system, installed with support from The Union, helps to ensure that the clinic has an uninterrupted power supply for both patient care needs and  communication. 

• Patient education resources:  Patient education is essential to TB-HIV care, and the clinic has audio-visual equipment for this purposes, as well as printed materials.

• Internet connectivity: A computer connected to the Internet expedites communication.

Well-trained staff, with focus on nurses, leads to good results

The clinic staff has been trained in TB and HIV case management, as well as opportunistic Infection and antiretroviral treatment (OI/ART) management.  Nurses were mentored at a well-established clinic in Bulawayo, giving them hands-on experience in a primary health care setting.  

With infection control (IC) a top priority, the clinic has an IC committee, focal person and IC plan designed to protect both patients and staff. TB-HIV review meetings are held monthly; and data compiled and analysed quarterly is used as a basis for local decision making under the supervision of district, province and national staff.

Key results for Phakama Clinic

• 1036 patients were taken on for ART follow-up in the first six months after its accreditation

• TB case detection increased from 15 in 3rd quarter 2012 to 75 in 3rd quarter 2013

• Patients being treated for TB increased 67%

• Between September 2012 and September 2013

-- 97% of TB patients accepted PITC
-- 99% of HIV-positive TB patients commenced CPT
-- 83% of HIV-positive patients commenced ART

Source: The Union