Since July 2011, ICW Eastern Africa has been implementing a one year TB/HIV Project with the support from the Stop TB Partnership Challenge Facility in Uganda in 2 districts of Mubende and Mityana
The Project is aimed at building the capacity of women living with HIV in understanding of the TB basic science, the policy and its components and in advocacy skills so that they are fully engaged in the TB/HIV policy implementation and ensuring quality and appropriate TB,TB/HIV services are available to women living with HIV and also to focus on reproductive health and maternal and child health services for women living with HIV by integration of TB screening and testing and prevention beyond these HIV clinics.
ICWEA trained 24 HIV positive women in TB, TB/HIV basic science, policy and advocacy skills in 2 districts so as to equip them with the necessary skills and information on TB in order to demand for increased access to TB, TB/HIV services and integration of TB services in HIV treatment and maternal health services for women living with HIV. The ICWEA TB/HIV program has led to the formation of a core group of committed TB advocates in the 2 districts who are now engaged in various TB/HIV work at community level.
Trained TB/HIV women Advocates from Mubende and Mityana districts, together with the PLWHIV leaders for both districts and Gift Maridadi a Staff of ICWEA (kneeling second from the left) after the TBHIV Training at NEW Highway Hotel Mityana
Working together with the trained 24 women TB//HIV Advocates, ICWEA carried out a Monitoring exercise on the availability and accessibility of TB/HIV services in the 2 districts. The Monitoring exercise was in addition aimed at identifying some of the barriers for positive women’s access to TB, TB/HIV services and gaps in service delivery in relation to the National TB/HIV policy which the country put in place in 2006. In-depth interviews were carried out with key informants who included Ministry of health personnel who included the District TB focal person, the HIV/AIDS focal person, the in charge of the Health Facilities, the staff of the Health facilities, (TB and HIV clinics, Laboratory technicians, maternal health care providers) as well as focus group discussions which comprised both men and women, and people who were on treatment for TB or completed treatment, HIV or both A total of 20 health facilities in Mubende and Mityana districts designated to provide TB and TB/HIV services participated for the monitoring exercise. These were health centres at Level IV and 111. A total of 4 policy makers where interviewed from the 2 districts – ( 2 from Mityana and Two from Mubende) These were the HIV Focal persons and the TB focal person on each of the two districts. In addition data was also collected from a total of 198 community members- People living with HIV and others who have had TB before and are accessing the services from the health centres.
The findings from the Monitoring Exercises in the two districts were communicated in Dialogue meeting to the District TB and HIV policy makers, health care service providers, media, and other civil society organisations to get commitment to address the key gaps and recommendations identified during the monitoring exercised The meeting that took place on the 16th and 17th April were attended by representation from the LC5 office, Mayors, office Health Centres that participated in the monitoring exercise, District HIV and TB focal persons and Core group of advocates. The reports were presented and key outcomes:
- In Mityana District the TB Focal person and HIV focal office in Mityana pledged to start working together while implementing their work and requested that the HIV clinic to quickly initiate TB /HIV co infected patients on ART which had not been happening.
- The constant delays in the delivery of TB drugs by the National Drug Authority was re-echoed, that even when one refers the TB patients to the clinics, they are no drugs to be given out and this is big challenge in TB patients.
- The health care provider will make a deliberate effort to ensure that the TB intensified case finding tool is used at the health facilities so as to identify and treat more TB in the communities.
- The HIV focal person pledged that after this meeting, he will ensure that TB is integrated in the HIV programs and vice versa.
- ICWEA should look out for more support so that the TB/HIV program can continue because this looked like the start of the project in the communities.
- The core advocates should engage in community meetings to be able to pass on the information to the bigger communities through the local leaders.
- The government should be very vigilant on MDR TB and the health care providers requested that the government should come up with a clear position on MDR TB, as they are still faced with these patients and they are grappling with either to send them home or keep them at the hospital
- Formation of a networks of EX TB patients who would also form pressure groups to advocate for the better TB/HIV services’
- ICWEA should increase on the number of persons trained from the 12 in the district to a bigger number
- The LC 5 secretary for Health thanked ICWEA for the initiative it took to address TB in the community and promised to work with the community advocates to improve on some of the issues raised which are within their jurisdiction
- The ICWEA strategy of empowering communities to take charge of their issues has been effective and this strategy needs to be shared out to also other so that it is emulated to also bring the men on board.
- MDR TB has become a serious issues in the community and thus the core advocates have an important role in monitoring the TB patients on treatment so that they adhere to their treatment and avoid any of these fatal situations
Other areas that the TB/HIV advocates are engaged in are working on include: Home visiting to homes of TB suspects and have started engaged the Health Care Providers to improve HIV and TB service delivery at the health centres – Giving Health Talks on TB and Referral of TB patients– Almost all the Advocates reported that they are involved in giving health talks in the communities and at different foras that include the health facilities, other Community based organisations, work with the agricultural sectors networks at community levels. Advocates have created partnerships with other community networks to scale sup their work. – From Busimbi Sub county in Mityana district, the 3 Advocates have been selected by the HIV focal person to carry out TB, TB/HIV sensitisation at 3 different Health centres and also to one community group – Nakaseta Initiative for Adult Education and Development – In Bageza Sub county, the TB/HIV Advocate had been identified by SOLACE Development agency, and the National Agricultural Development services groups -NAADS in the Sub county as a TB/HIV resource person and during one of the SOLACE meetings which was attended by approximately 50 persons, she gave a talk about TB, TB/HIV including the signs and symptoms, TB routine screening for HIV positive persons meeting which led to a good number of them going for Testing.
Compiled:
Dorothy Namutamba Program Officer,
