Wellness Centers: Tracking, Adherence

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Wellness Centers Tracking, Adherence Social
Support of PLWHA in Eastern Cape, SA
International Center for AIDS Care and Treatment
Programs Annual Meeting, March 2006 Dar Es
Salaam, Tanzania

• B. Scott Worley
• 8 March, 2006

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Wellness Centers Programs

• St Patricks Holy Cross Hospitals (Northern
  Transkei)
• Co-located with ART clinics
• Managed through partnership with The Mothers
  Programmes
• 1 Site Coordinator Supervision of all programs
• 10 Field Care Givers (WC PHC clinic-based)
  Home visits patient tracking, clinic
  counseling, adherence monitoring
• 5 Peer Educators (WC-based) WC counseling, ward
  linkages, adherence monitoring
• PLWHA, ART, pMTCT support groups
• Nutritional counseling supplements
• Educational materials
• Community outreach, partnerships Advisory Board

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WC Program Challenges

• Initial development of structures systems
• Awareness clinical staff community
• Patient access WC location, FCG coverage
• Real nutritional support Food
• Monitoring of WC services
• Integration with clinical program

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Current integration issues

• Ensuring that client info collected by WC FCG and
  PE is available, accessible and useful for
  clinical staff
• How can client confidentiality best be ensured
  when community-based FCG with their own patient
  files are involved in the care-giving?
• How can it be ensured that WC clients seen are in
  fact the same as those seen in the VCT, pMTCT and
  ART programs?
• How can WC-clinic communication be improved in
  terms of needed patient tracking and
  communication of results?

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Monitoring Integration

• Patient files (FCG PE) contact,
  personal/family testing history, access to
  clinical services, health status at home,
  disclosure status, ART status, adherence/non-adher
  ence reasons, life stressors faced, follow-up
  issues
• Center reports (SC, monthly) total counseled
  at home at WC, pre-ART/ART, on ART who are
  not adherent and main reasons, degree of
  WC/clinic collaboration, qualitative descriptions
  of all WC monthly activities
• Formal meeting structure set up between ART, VCT,
  pMTCT WC management for program review and
  individual patient follow-up

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Example Jan 2006 Statistics
Reasons for non-adherence - ART side effects,
forgetfulness, felt better, sickness/nausea,
lack of family support, depression, unable to
access clinic, stock-outs Still need
clinical ART/pre-ART patients who access WC
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Umzimkulu Programs

• Much more decentralized model
• No physical Wellness Center
• Site Coordinator for Social Support programs
• Based in District DOH offices
• 13 FCG, covering 10 PHC clinics

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Site Coordinator Duties

• On-site supervision, monitoring reporting of
  FCG activities
• Integration of FCG into clinical care
• Assistance to PLWHA support groups
• Communication between hospital clinics (e.g.
  patient tracking, coordination of home visits)
• Participation in HAST ART Committee meetings
• Partnerships DOH, DSD, external NGOs, etc.
• Nutritional support/Food security programs

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