Malawi wishes to eliminate tuberculosis (TB) by 2030. In this quest, endeavours such as preventing TB instead of putting more people on treatment are starting to be prioritised. As part of the policy reforms, the country has revised its Latent TB Infection (LTBI) Guidelines to include newer rifapentine-based TPT regimens and in line with the latest WHO Guidance. PEPFAR and Global Fund have been strong partners to support the government of Malawi in these efforts. The COP21 PEPFAR Strategic Directive Summary (SDS) confirmed that all 28 districts of Malawi will be rolling out TPT focusing mostly on 3HP. Civil society organizations also engaged in strategy procurement-related advocacy of 3HP with the Global Fund during the development of the new funding model (NFM).
Whilst the policy reform efforts are commendable, the rollout has, until recently, been slow. There has been no prioritization to invest in treatment literacy and Community-Led Monitoring (CLM).
On the rollout of the TPT/3HP; COWLHA, a critical community enabler working with women living with HIV, has been undertaking advocacy to support TB prevention and the scale-up of 3HP in some regions of Malawi. Noting that most of the women on isoniazid preventive therapy (IPT) do not adhere to the medicines due to a lack of proper information and guidance on the importance of TB prevention.
By way of creating demand for 3HP – which is the preferred TPT option from the community support group meetings that COWLHA leads; the organisation has trained over 50 women living with HIV, who are also mentors or peer supporters since 2019, on 3HP in Chiradzulu and Thyolo Districts. The women were trained on the importance of TB Prevention and the rifapentine-based regimens, 3HP, 1HP and 3HR, recommended within the guidelines for people and children living with HIV as well as household contacts. These trained mentors are now reaching out through a family-centred approach; including household contacts of people affected by TB as well as children. Within support groups and as trained expert clients, the women have also been following up on clients who struggle to adhere to the TPT/IPT treatment, which is what is available in the country.
Another area that COWLHA has been working in has been in Community-Led Monitoring (CLM). COWLHA is a member of the Civil Society Advocacy Forum (CSAF). In 2021, CLM conducted by the CSAF noted that interruptions to TPT at facilities due to shortages of INH and Vitamin B6 in some PEPFAR supported facilities. Post COP21 period, the CSAF has persistently engaged the Department of HIV (DHA) to ensure that this agenda remains relevant and that there is the resumption of 3HP.
COWLHA will continue to contribute towards the CLM process as this is a great tool to collect qualitative and quantitative data, which will provide evidence-based information, including from the recipients of care, to improve the HIV/TB services.
CLM will help COWLHA to identify real-time issues for advocacy on TPT, as currently, Malawi is facing storage and drug management challenges, which will continue to pose as the Achilles heel of successful 3HP implementation.
Written by: Harry Madukani
Organisation: The Coalition of Women Living with HIV and AIDS (COWLHA)
