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Putting the ‘community’ back into community TB management: Engaging communities to strengthen capacities to act on TB symptoms in South Africa

Putting the ‘community’ back into community TB management: Engaging communities to strengthen capacities to act on TB symptoms in South Africa
Publication date: 
Oct 2019
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Background and challenges to implementation

Enhancing community tuberculosis (TB) management contributes to improving low patient diagnosis, high loss to follow-up and low adherence rates. The USAID Tuberculosis South Africa Project implemented a Community Dialogue Model in 2018 and 2019 in the peri-urban districts of uMkhanyakude, KwaZulu-Natal province and West Coast, Western Cape province, South Africa.

Implementation

Community capacity building, dialogue and health education through TB survivors and champions, and partnerships with radio stations were utilised to incrementally increase public awareness about TB. Stakeholders included traditional, religious and political leaders, traditional health practitioners, educators, community caregivers, healthcare workers, hospital management and media practitioners.

Results

In uMkhanyakude, 243 people were trained through four workshops. 1,451 people were reached through two campaigns, 763 with presumptive TB were tested on the spot in five communities, five were diagnosed, and two initiated on treatment. Traditional health practitioners referred two of those diagnosed.  In all communities, people who declined to be screened or tested were referred to clinics.

In West Coast, capacities of 105 stakeholders to provide TB education, identify symptoms and refer to healthcare facilities were enhanced through three workshops. Four dialogues in three communities reached 120 people. Door-to-door education and screening campaigns reached 937 people directly. 102 people with presumptive TB were identified, 71 were tested, eight tested positive and were initiated on treatment in collaboration with TB clinics.

Monthly community radio interviews to disseminate TB information reached 130,000 people via Mtuba Rise FM in uMkhanyakude and 74,000 via Namakwaland Radio in West Coast. Social media platforms were also used to generate conversations among 114,166 followers about the model to further enhance public awareness of TB.

Conclusion

In uMkhanyakude, public healthcare facility headcounts increased and a 17.4% increase was recorded in TB screening over 12 months. This suggests that the initiative contributed to more informed clients accessing services.

In West Coast, while public healthcare facility headcounts decreased, presumptive clients tested increased by 8.7% and the positivity rate by 8.2%, suggesting quality screening and that more people with TB accessed services. Educating communities about TB services supports identification of people with TB.