Pavlodar: Adopting the accompaniment model of TB care

	Patient in Hospital at Home Program.

Tuberculosis (TB) patients in Pavlodar--a city in northeastern Kazakhstan--now have access to a new model of care.

With guidance from PIH-Kazakhstan (PIH-KZ), the Pavlodar TB Dispensary successfully launched a “Hospital at Home” program this fall, providing patients with treatment and social support in their homes. Obstacles such as distance, transportation costs, and physically inaccessible treatment facilities limit many patients’ ability to regularly attend clinics and receive medication. This program thus specifically targets TB patients who face barriers to accessing care: the elderly, pregnant women, geographically isolated patients, and patients who suffer from socio-economic problems such as poverty and alcoholism. By bringing medication and support directly to patients, this program aims to bolster adherence rates and consequently increase patients’ chances for complete recovery.

Each day, nurses and drivers deliver medication and food packages to patients, monitor side effects, and provide additional social support. Once a week, a TB doctor joins the “Hospital at Home” staff to provide check-ups. All of which is made possible from the support of the regional government and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. 

The program enrolls approximately 25 patients at a time.

The “Hospital at Home” program is based on PIH’s existing Sputnik project in Tomsk, Russia. Earlier this year, the Kazakh staff observed the Tomsk system of ambulatory care, patient accompaniment, and psychosocial support. Pavlodar TB doctors customized the program to fit their region’s needs.

In Tomsk, the Sputnik project has raised adherence rates from 40 percent to 94 percent. PIH-KZ is hoping to see similar positive results as the Pavlodar program matures. Plans are already underway to launch a similar program in Karaganda, KZ.

PIH began the Kazakhstan program about a year ago to work with the Kazakh government to help address an epidemic of multidrug-resistant tuberculosis.