Amplifying Voices to Scale-up Short-course Preventive Therapy for TB in Zimbabwe

Over the last year, the Zimbabwe Network of People Living with HIV (ZNNP+) and Jointed Hands Welfare Organisation (JHWO) have prioritized community outreach to increase demand and uptake of TB Preventative Therapy (TPT) for people living with HIV (PLHIV). This includes work in Harare and Midlands Provinces to monitor the accessibility, availability, and acceptability of TPT services, and resulted in two significant improvements: TB/HIV policy alignment so that TPT can be incorporated into existing community differentiated service delivery models, and increased demand for TPT, driven by community awareness of how TPT benefits PLHIV.

These outreach efforts have shown a growing consensus among PLHIV that the introduction of TPT into existing differentiated service delivery models—such as the Community ART Refill Groups—would reduce TB-related mortality among PLHIV and that the programs are well-positioned to monitor TPT adherence.

To accomplish these objectives, ZNNP+ and JWHO leveraged existing alliances with the Ministry of Health while simultaneously working with programs and systems that served the communities, including differentiated service delivery structures such as community health advocates, community-based organizations, peer educators, as well as support groups of PLHIV, mentor mothers, and the well-established expert patient model. All of these models embrace community involvement in advocating for improving the uptake of TPT and other health services while strengthening the ties between the communities and the health facilities that serve them.

One of the CARG groups sharing their ARVs and IPT after the group focal person collected the supply from their health facility

After demand for TPT increased in their communities, PLHIV acknowledged that differentiated service delivery approaches in HIV outreach like  Community ART Refill Group, adherence groups and support groups can improve TPT adherence monitoring amongst PLHIV and that distribution of TPT medicines can be done using these models. Directly observed therapy (weekly doses) of 3HP can also be conducted through differentiated service delivery.

Similarly, TB screening can be done at the community level using some of the DSDs models like Community ART Refill Group (CARG) and Family ART Refill Group, and people with TB symptoms can be referred to health facilities for better treatment management at an earlier time. 

Meaningful involvement of communities and working closely with their supporting systems improves the uptake of health services. TPT can be integrated in differentiated service delivery models to enhance treatment adherence and completion rates. Strengthening these community systems and integrating TPT into differentiated service delivery models will only become more important as Zimbabwe seeks to scale-up TPT while confronting Covid-19.

One of our expert patients, Daniso Phiri, was at Rutsanana Clinic leading a health education program on TB prevention on 23rd of March 2020, during the early days of Covid-19 in Zimbabwe. The clinic provided masks for expert patients to prevent Covid-19 transmission. Later, services provided by expert patients were suspended following the lockdown, quarantine, and social distancing measures in the face of the pandemic. More focus and attention was given to the Covid-19 response, crippling other essential TB/HIV related services like TB screening, TPT initiation, and contact tracing.

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