What Works for Women and Girls

A mathematical model based on TB transmission patterns in Tugela Ferry district and atChurch of Scotland Hospital in the Kwa Zulu Natal district in South Africa, was createdto simulate TB transmission in high TB/HIV prevalent settings. If no new infectioncontrol interventions were introduced, about 1300 new cases of XDR-TB were predictedto occur by the end of 2012, more than half of which would likely be noscocomiallytransmitted or transmitted within health care settings. The model showed that masksalone would prevent 10% of new transmission in an overall epidemic, but could preventa large proportion of XDR-TB cases among hospital staff. The combination of mask andreduced hospitalization with a shift to outpatient treatment could prevent nearly onethirdof XDR-TB cases. Approximately 48% of XDR-TB cases could be averted by theend of 2012, if a combination of mask, reduced hospitalization with shift to outpatienttreatment, improved ventilation, rapid drug resistance testing, HIV treatment and TBisolation facilities for highly infectious patients were implemented (Basu et al., 2007).(Gray III) (TB, South Africa)19. Implementing service-related changes based on needs assessments can result in improvementsin HIV services.Surveys using the same standardized questionnaire given to 250 patients on one day in2005 and 400 patients on one day in 2007 found that improvements made based onthe 2005 survey resulted in significantly reduced waiting time for patients in Uganda(no sex disaggregated data). Nurse visits, rather than assessments by clinicians wereinstituted for minor complaints. Group counseling was instituted. A pharmacy onlyrefill program was initiated for patients on ART for at least 12 months, who were asymptomaticwith good adherence levels and CD4 counts above 200, with patients seeinga doctor or nurse very three months and monthly pharmacy visits. The median timespent at the clinic decreased from 157 minutes in 2005 (ranging from 22 minutes to426 minutes to 124 minutes (15 minutes to 314 minutes) (Castelnuovo et al., 2009).(Gray III) (health facilities, treatment, counseling, Uganda)382 CHAPTER 13 STRUCTURING HEALTH SERVICES TO MEET WOMEN’S NEEDS