Vusumuzi DubeRobin Muchetu, Senior Reporter
AN estimated 80 percent of people with Tuberculosis in Zimbabwe suffer the catastrophic costs of accessing treatment while some are battling stigma and other co-morbidities leaving Zimbabwe high on the list of countries that have a TB burden.
Zimbabwe was recently removed from the list of top 30 countries burdened by TB alone although it remains under global watch list with close surveillance.
According to the Union Zimbabwe Trust (UZT), an organisation that supports the country’s national response to TB-HIV, Zimbabwe remains among top 30 high burdened countries for TB-HIV co-infection and drug resistant forms of TB.
However, in a bid to ensure they close the tap on new infections, adherence and other challenges, UZT has highlighted the importance of community health workers in educating communities on TB and also eventually ending TB.
UZT executive director, Mr Ronald Ncube: “CHWs are critical in TB programming because they assist with raising awareness on TB and active TB cases found in the community. They support with community health education and behaviour change campaigns. They also screen community members for TB, referring those with early signs and symptoms of TB for further assessment at health facilities. Contacts of confirmed TB patients are also traced by community health workers and assessed for signs and symptoms of TB.”
He said for TB patients who are on treatment, CHWs provide treatment adherence support and palliative care, following up all those who interrupt treatment to retrieve them back to care.
Mr Ncube said they also create demand for TB services by sensitizing communities on TB services available in their communities.
According to the Community Health Strategy (2020-2025), one of the strengths noted was the considerable coverage of Village Health Workers (76 percent) against a target of 80 percent by 2020.
Mr Ncube said this strength was however, threatened by inequitable distribution of health workers as not all wards and villages were adequately covered.
“Ideally, there should be one CHW per 100 households in the community. The current Community Health Strategy seeks to address these gaps and harmonize the role of CHWs to enhance efficiencies in community service delivery,” he added.
Jointed Hands Welfare Organisation medical officer Dr Simbarashe Manjengwa said community health workers were key in the fight against TB.
“CHWs are instrumental in raising awareness on TB at community level. The way CHWs raise awareness is also more effective because they use simple non-technical language. They provide health education at health facilities.
“They assist with TB screening and referral of presumptive clients to the health center for testing,” said Dr Manjengwa.
He said community health workers extend these key health services to the community at household level thus increasing uptake and accessibility of these services.
UZT noted that similar to other countries in the Sub Sahara region, TB in Zimbabwe was fuelled by HIV with 54 percent of notified patients found to be co-infected with HIV in 2020.
In 2020, mortality was 14 and 40 per 100 000 population among HIV negative and HIV positive TB patients respectively.
Provinces mostly affected are those in the southern region such as Bulawayo, Matabeleland South, Midlands due to higher population mobility between Zimbabwe and neighbouring countries like South Africa.
Mr Ncube said the UZT has taken a special interest in artisanal small-scale miners, an often-neglected high risk group, where they are reaching out to them in their mining pits to screen them for TB and other occupational lung diseases such as silicosis.
With support from the Centre for Disease Control, the UZT is the implementing partner for a grant to strengthen TB preventive therapy in the country.
“This is an operations research initiative to inform any adjustments we need to make as a country in implementing this important intervention particularly among people living with HIV,” he said.
Through the STOP TB Partnership, the UZT is implementing a US$600 000 grant in Midlands, Bulawayo and Matabeleland South that seeks to roll out newer and shorter treatment options for patients with drug resistant TB.
“In the past we used to use unfriendly treatment options of up to 24 months, with months of daily injections associated with lots of side effects. Newer regimens are much shorter, more tolerable and taken orally for just nine months,” said Mr Ncube. UZT notes that close to two thirds of TB patients notified in the country are also co-infected with HIV.
The associated residual HIV stigma means some of the TB patients may delay accessing services for fear of being labelled HIV positive.
@NyembeziMu
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