Getting youth engagement in 3HP Advocacy is not as easy as 1,2,3

Zimbabwe Young Positives (ZY+) network of young people affected and living with HIV. ZY+ works with well-established and functional community structures and systems. These structures include Community Health Advocates (CHAs), TB Champions, and Community Based Organizations (CBOs) peer educators; as well as support groups of young people living with HIV (YPLHIV), mentors and expert patients. All of these structures are involved in working on and expanding  Differentiated Service Delivery (DSD) models within Zimbabwe.

ZY+ has been working through these structures for the 3HP project. They are critical in influencing and advocating for the improvement of health-related issues. They are also the bridge between the efforts of the health facilities, the community and policymakers. They have been highly successful in disseminating health-related information to the community as well as linking the community to the health facility through their advocacy work

With the IMPAACT4TB project this year, ZY+ trained a cohort of youth on the importance of TB prevention. This included training them on the new rifapentine-based regimens which have been introduced in the Zimbabwe health system. While the benefits of the products were noted, the structure barriers were the most common feature raised. These include issues of dealing with the double stigma (self well as external community stigma) of dealing with dual epidemics HIV and TB, the fear that if they do contract TB, they may no longer have an opportunity to live their dreams. Other peers also raised questions about having to take more medication, when they had just been transferred to dolutegravir-based HIV. ”Today it’s TB, tomorrow it’s COVID-19, what is next?” asked one participant.

Even with these challenges, the ZY+ structures continue to work as focal points to provide additional psychosocial support to youth who are struggling with the concept of TB prevention. The models work in a two-way structure;

• TB Focal persons from these structures help cascade information through reports. ZY+ links these focal persons with the health facilities (this allows for the dissemination of information related to TPT uptake, challenges, gaps and recommendations).
• Health personnel are recommended to work closely with these focal persons because they help them pass on any health-related information to their community peers.

The IMPAACT4TB project assisted ZY+ set up two additional structures in the community in two facilities. The project has also managed to

• identify and train 15 youth TB Champions who assist in cascading information from facility and community
• create and sustain a client satisfaction survey tool for the project
• support young people through the creation of support groups specific to young people living with HIV affected by TB
• track and ensure continuity of TPT uptake amongst young people
• Created demand for sustainable supply of TB medication at local health facilities

We have a long way to go, but the TB Prevention seed has been planted and with short-course 3HP, ZY+ believes that youth will lead the prevention movement if we continue with our treatment literacy and community monitoring efforts.

Written by: Kelvin Makhura

Organisation: Zimbabwe Young Positives (ZY+)