On the Out-Patients Department (OPD), the front side of Mabvuku Poly Clinic, 25 kilometres east of the capital, Harare, two men and three women excitedly share how they have received effective TB preventive treatment and were ultimately prevented from developing the deadly disease.
“Once you begin the therapy, it becomes so easy, and I can now go to the market every day,” Taurai Chimuchenga, 33, explains to an HIV/AIDS peer educator, on the sidelines during the recent discussion. In the last three years, health centres in most communities had no equipment to accurately diagnose TB and limited stock of Isoniazid Preventive Therapy (IPT) and vitamin B. Chimuchenga and four others chatting at the OPD are among the 500 or so people reached by the newer TB preventive therapy (TPT).
Through a combination of improved tools and technologies for preventing and diagnosing TB, and a significant investment in TB research and development, people in Zimbabwe now have access to short-course rifapentine-based TPT and to more accurate, simple, and appropriate point-of-care TB diagnostic tests. As TB prevention and diagnostic tools have evolved, so have TPT/3HP demand creation and outreach programmes to people affected by TB. In the past 6 months, ZNNP+ HIV/AIDS peer educators have reached 500 infected and affected people.
Through door-to-door outreach and other forms of community engagement, including visits to health centres, these CHAs have reached out to affected communities and developed TPT sensitization sessions and interviews. The results have been amazing. Vendors like Chimuchenga, who was always at risk of TB, now have the right information about access to short-course TPT and how to access TB testing.
Some of these people, including children and youth, understand the TPT as the starting point of a TB cascade of care. Ideally, communities at risk of TB should receive regular screening and testing, followed by TPT, if appropriate.
“This is the highest standard of prevention and early diagnostic services for TB in the country”, says a doctor at one of the health centres in Harare. “Now many people are seeking health care when they begin experiencing symptoms and they no longer face stigma in doing so”, she added, noting that of those who are diagnosed, they receive the drug-susceptibility testing necessary to inform optimal treatment regimens.
With the advent of new and effective diagnostic tools, high rates of TPT initiation continue in communities, reducing the risk of developing active TB disease.
TB Preventive Therapy Brings Positive Health Dividends to Communities
“People are now talking about TB screening and testing, TB treatment or TB preventive therapy as positive health dividends for communities, especially those at risk of active TB disease. During a recent fact-finding mission in May 2021, at the Mabvuku Poly Clinic, a Member of the House of Senators noted that the dividend in many communities is more than just a contribution to TB diagnosis.
Additionally, from these results, health workers have been exposed to new TB diagnostic tools and diagnostic algorithms-but we need to increase and enhance these tools in the future.
In one of the districts, it has been noted that after the demand creation sessions by the Community Health Agents (CHAs), the recipients of care now understand the benefits of TPT. Some myths and misconceptions have been addressed leading to improved knowledge and acceptance of TPT. The recipients of care were in favour of 3HP which is shorter to complete and with fewer side effects. They were encouraged to accept the available Isoniazid as 3HP is not yet available in sufficient quantity for everyone to take, but once it is availed all who need it will be able to access it. Another success was how the Community Health Agents managed to reach out to adolescents and young people living with HIV with information on TPT. They are a bit harder to convince, but after some sessions with them, they understood the benefits of accessing TPT for the good of their health.
In this District, a positive result was the increase in TPT uptake and understanding of the importance of TPT. The health centres have reached between 85-90% uptake of TPT. For the uptake to increase, the CHAs also had a contribution alongside other players like the Ministry of Health and Child Care. There have also been no side effects reported by those who were on TPT, and this has had a positive impact on its uptake. Some recipients of care were supported through home visits to enhance completion rates and adherence. In some cases, CHAs have accompanied patients in their catchment areas to pick up their medicines, thus improving acceptability.
Stories compiled by Barbra Farashishiko, Eastern District Focal Person
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