In Malawi, Facilitators of Community Transformation (FACT) and Coalition of Women Living with HIV and AIDS (COWLHA) have collaborated with the IMPAACT4TB consortium, via KNCV Tuberculosis Foundation, the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) and the World Health Organization (WHO), to increase the engagement of members of parliament (MPs), women living with HIV (WLHIV), people living with HIV (PLHIV) and TB civil society networks in scaling-up TPT across the country.
This initiative, driven by policy and community-level interventions, has helped increase demand for the implementation of comprehensive TB Preventative Therapy (TPT) services in the country. Both FACT and COWLHA have continued their advocacy during this COVID-19 period. In response to the scaling-down of HIV and TB services in the last two months, they have advocated for increased collaboration between the national TB and HIV programmes, calling for the incorporation of TPT into existing differentiated service delivery models.
At the policy level, the partners have produced a TB/TPT financing landscape memo, which highlights the existing gaps in TPT budgets as well as the need for increased funding to expand TPT services. Working closely with the national tuberculosis program (NTP), they have pledged to advocate for reduced prices of 3HP and also pushed for the inclusion of newer TPT regimens in the updated Malawi TPT policy guidelines.
Finally, their work has targeted donors, securing funding to expand TPT in the PEPFAR-supported districts, resulting in an additional seven districts for 3HP scale up. The March 2020 PEPFAR Strategic Directive Summary confirmed that “all 28 districts will be rolling out TPT—mostly 3HP—in COP20.” As part of the Global Fund funding request writing team (TB module), FACT advocated for the conditional funds to be allocated to the procurement of 3HP treatments.
At the community level, interventions have focused on WLHIV as well as on TB civil society networks. Seventy-seven women were reached from all of the project districts with information about the critical role that women play in monitoring the implementation of 3HP among the general population and, in particular, among childhood contacts.
A significant number of women consulted by this initiative attributed the high rates of treatment incompletion to the side effects of INH and its long treatment duration. This is a situation that complicates their experiences with health providers. For WLHIV, taking INH causes skin rashes, severe headaches, and exhaustion, and other side effects that prevent them from continuing their normal work and leads to their discontinuing treatment. These challenges have highlighted the need for short-course alternative regimens with fewer side effects, such as 3HP.
