Lucy Chesire, TB Advocacy Advisor for ACTION (Advocacy to Control TB Internationally) in Kenya, shared details of the TBREACH project, an initiative of the Stop TB Partnership with funding from the Canadian International Development Agency (CIDA), which started off last September. The goal of the project is to enhance early and full TB case detection among selected high risk groups. The project focuses on reaching slum dwellers and people living with HIV, particularly those with limited access to health services, i.e. the poor. The project done in partnership with KAPTLD (Kenya Association for the Prevention of Tuberculosis and Lung Diseases), covers one city and three towns in Kenya, (Kisumu, Nairobi, Thika and Nakuru). These towns have continued to show increased burden of TB over the years
“One of the objectives is to enhance TB case finding and care among HIV infected people by engaging current and former TB/HIV patients in peer to peer screening approaches,” Chesire explained. For the project, 220 TB community volunteers, all former TB patients, have been recruited, as well as 55 community health workers (CHW). Of the 55 CHWs, 22 are persons living with HIV who have been through TB/HIV co-infection in the past. They will engage in door to door campaigns, community mobilization during screening camps, treatment support, referral of suspects and health education: the volunteers carry out case detection work at least three times a week, the health workers work at least four days a week. All get a monthly stipend.
“This approach enables us to reach those patients who many of times have not been able to come to the health care facilities despite presenting the signs and symptoms related to TB,” Chesire says in an interview with CNS. “For example, if a facility is detecting two patients a month we want to prove through TBREACH that we are able to bring two additional cases to make it four patients in a month. So these are patients who if it was not for the project would never come to the health care facility.”
According to Chesire the volunteers act as agents of change. “They are able to tell their story, they are able to be treatment supporters, and they are able to encourage others living with HIV to go for a TB test. Because we know people living with HIV are 50 times more likely to develop TB,” she says. The volunteers go door to door, find out if there is anybody who has the signs and symptoms and if that is the case, fill in the referral form and send it to the nearest health care facility. They also provide health education on TB, its treatment and the importance of completing treatment.
Projects like these also help fight stigma against the disease. “These volunteers are already open about their TB and HIV status, they are already recognized by the community and at the health care facilities. We work with volunteers who live in the communities,” Chesire explains. As such, they can encourage others to acknowledge their (risk of the) disease as well.
The project is expected to reduce delays in diagnosis, cut down patient costs and encourage people to seek treatment soon. “At the end of the day, it is really about empowering TB patients,” Chesire says.
Initiatives like this should continually be funded by donors, Chesire applauds the Stop TB Partnership and CIDA for realizing and supporting former and current TB patients to rightfully take their place in TB control, as this is an initiative that many donors shy away from. Such initiatives should be scaled up, as they are in line with empowering TB patients and communities, a component of the Stop TB Strategy.
(The author is a freelance journalist, a Fellow of CNS Writers' Bureau and Associate Communications atTuBerculosis Vaccine Initiative – TBVI)