Afya Hatua project improves TB case identification and treatment in Shinyanga
Thomas Otulo Kakoyo’s story is a testament to the life-changing impact of timely detection and treatment of tuberculosis (TB).
In the heart of the Shinyanga region, where prevalent witchcraft beliefs often hinder individuals from seeking medical attention, Thomas’s journey from a TB patient to a Peer Educator at Ngokolo Health Centre (HC) is a beacon of hope.
“Though life-threatening, TB is not necessarily a killer disease. Through proper medication, it can be cured,” Thomas said.
Like many others in the region, Thomas initially turned to local remedies to treat ailments, only to find himself trapped in a cycle of illness and despair. However, his life took a turn for the better when he sought treatment at Ngokolo HC on recommendation from a peer educator.
“Before visiting the facility, I was ignorant of TB and thought I had been bewitched, but through proper counselling and testing, I was diagnosed with TB and immediately started the appropriate treatment,” he said.
Thomas’s battle with TB and HIV co-infection in 2021 serves as powerful motivation for his work. Starting TB treatment, followed by antiretroviral therapy, he witnessed a remarkable improvement in his health. From a frail 38 kg, he regained vitality and strength, now weighs a healthy 70 kg.
Despite facing challenges of stigma, Thomas is determined to educate others in his community about the importance of seeking proper medical care and treatment services for TB and HIV.
His story inspires those around him to take charge of their health and not succumb to the myths and superstitions that often prevent individuals from receiving the care they need.
Through his resilience and dedication, Thomas has become a symbol of hope and empowerment for those affected by TB in the Shinyanga region. He is living proof that with the right support and treatment, TB is a disease that can be overcome.
Supported by the CDC/PEPFAR-funded Afya Hatua Project, implemented by Tanzania Health Promotion Support (THPS), Thomas has now made it his mission to help others in their fight against TB. Since 2022, Thomas has been working as a Peer Educator at Ngokolo HC, where he tirelessly advocates for TB and HIV prevention, care, and treatment services.
Rehema Emmanuel, a laboratory technician at the Shinyanga Regional Referral Hospital, hailed the Afya Hatua project for improving efficiency in TB case identification in the region.
In the past, patients would have to wait for a month or longer for paper-based notifications of their test results, prolonging their suffering and delaying their access to life-saving treatment. But now, thanks to the efficiency of the ESRS, clients can receive their results within a week and start their treatment without unnecessary delays.
Geoffrey Madirisha, a Clinician at Ngokolo CTC said from October to December 2023, the clinic screened 475 individuals for TB, with 15 of them testing positive and immediately starting treatment. Additionally, 18 eligible recipients of care at the clinic were initiated on TB preventive therapy, significantly reducing their risk of contracting the disease.
With the support of dedicated healthcare professionals like Rehema and Geoffrey, along with the resources provided by the CDC/PEPFAR Afya Hatua project, individuals affected by TB in the region have a fighting chance at overcoming this disease. Through early detection and prompt treatment, patients can regain their health and live fulfilling lives once again.
“Through THPS support, the regional laboratory has been enhanced with an Electronic Sample Referral System (ESRS). This facilitates swift delivery of TB test results to the health facilities, allowing patients like Thomas to begin treatment promptly,” she said.
DREAMS program reducing HIV infection in adolescent girls and young women in Shinyanga
Agnes William is only 23 years old, but she has already faced more challenges than most people her age.
Growing up in the rural region of Shinyanga, Tanzania, Agnes was diagnosed with HIV at a young age, a result of mother-to-child transmission. Her mother passed away when Agnes was just a little girl, leaving her to navigate the complexities of living with the virus.
Despite the support of her local health clinic and access to antiretroviral therapy (ART), Agnes struggled with adherence to her medication due to the daily regimen of pills and the stigma surrounding HIV in her community, putting her at risk of developing drug resistance and compromising her viral suppression.
As a result, Agnes had experienced multiple interruptions in her ART uptake, putting her at risk for developing drug resistance and compromising her viral suppression.
“For a long time, my father gave me the medication without disclosing my HIV status. As a result, I frequently skipped taking my medication until I became extremely ill”, she said.
Despite her health condition being unstable, Agnes was able to complete her secondary school education and enrol in college in 2019. However, while at the college campus, the matron discovered ARV drugs in Agnes’ bag during a routine inspection. The matron then spread the news of her HIV status around the college, which made life difficult for Agnes. Despite the challenges, she continued her treatment until she successfully graduated from college in 2021.
It was not until Agnes was introduced to the DREAMS program in 2022 that things began to change for her. DREAMS, which stands for Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe, is an initiative aimed at empowering adolescent girls and young women (AGYW) to make healthy choices and achieve their full potential.
Through a combination of mentorship, educational support, and access to community resources, DREAMS seeks to reduce the risk of HIV transmission and improve the overall well-being of AGYW.
As a DREAMS Ambassador at Ukune Health Centre in Ushetu District, Agnes was able to not only receive the support she needed to adhere to her ART medication but also to become a role model for other young women in her community.
By sharing her own story of resilience and determination, Agnes was able to dispel myths and misconceptions about HIV and encourage others to seek out the care and treatment they needed.
With the support of the CDC/PEPFAR-funded Afya Hatua Project implemented by the Tanzania Health Promotion Support (THPS) in collaboration with the Shinyanga Regional Health Management Team (RHMT), DREAMS services have been integrated into the care and treatment clinics in the region.
This holistic approach to HIV care not only addresses the medical needs of AGYW but also focusses on the social and psychological factors that often hinder their adherence to medication.
Through regular counselling sessions, peer support groups, and educational workshops, AGYW like Agnes have been able to build the resilience and self-efficacy needed to stay on track with their treatment.
They learned about the importance of taking their medication consistently, the potential risks of non-adherence, and how to navigate the challenges of living with HIV in a supportive and empowering environment.
As a result of her participation in the DREAMS program, Agnes was able to achieve optimal viral suppression for the first time in her life. Her viral load became undetectable, meaning that the virus was no longer replicating in her body, and she was able to live a healthy and fulfilling life without the constant fear of illness and stigma.
Inspired by her own transformation, Agnes has continued to advocate for the rights and well-being of AGYW in her community by leading peer support groups, conducting outreach activities, and raising awareness about the importance of ART adherence and HIV prevention.
Through her efforts, Agnes has been able to foster a sense of solidarity and empowerment among AGYW in Shinyanga, transforming their shared experiences of hardship into opportunities for growth and resilience.
“Through these outreach activities we identify the AGYW in risky environments and provide them with pre-exposure prophylaxis (PrEP). We also refer them to nearby clinics for family planning services. Those who test HIV positive are immediately linked to care and treatment clinics and we follow-up on their treatment adherence”, said Agnes.
“In the past month alone (January – February 2024), we have managed to enroll 9 AGYW into PrEP services and 75 into family planning through the DREAMS program”, she said.
With the help of the DREAMS initiative and the dedicated support of the Afya Hatua Project, Agnes and other young women in her community have been able to overcome the obstacles to ART adherence and create a brighter future for themselves and their communities.
Mama Nesi, the unsung hero, leading efforts to suppress HIV among recipients of care in Shinyanga
Juliana Charles Jisandu, also known as ‘Mama Nesi’, is a Peer Educator at the Kambarage Health Centre in the Shinyanga Region.
Her goal is to ensure that all patients receiving care at the health centre are achieving HIV Viral Load (HVL) suppression through their antiretroviral therapy (ART) treatment.
Juliana’s journey to becoming a Peer Educator began when she was diagnosed with HIV in 2009 after suffering from severe tonsillitis. She started ART treatment in January 2010 and soon experienced a remarkable recovery, which inspired her to become a beacon of hope for others in her community.
Her passion for helping those affected by HIV prompted her to lead efforts of educating her community members about the available prevention, care and treatment services.
In 2021 Juliana received training from the THPS through the CDC/PEPFAR Afya Hatua project, which equipped her with the tools and knowledge needed to actively monitor and support her fellow people living with HIV in their adherence to Antiretroviral Therapy (ART) services.
Armed with the skills of a Peer Educator, she now works tirelessly to ensure that every individual enrolled in ART at Kambarage Care and Treatment Clinic is not only virally suppressed but also in good health.
Juliana’s remarkable work has touched many lives, including that of Furaha Ngosha (not his real name), a five-year-old boy who was abandoned by his mother. When Juliana discovered that Furaha had missed his ART refill appointments at the health centre, she began tracing the child and eventually found him in poor condition at his grandmother’s home.
It transpired that Furaha’s mother was divorced by her husband after he learned that both Furaha and his mother had HIV. Furaha was consequently left in the care of his grandmother, who was unaware of his condition and the medication he needed to stay healthy. As a result, Furaha’s health deteriorated, and his HIV viral load increased to dangerous levels.
Juliana, in her peer educator role at the clinic, discovered Furaha listed among children who had missed their ART refill appointments at the health centre, she began tracing the child and eventually found him in poor condition at his grandmother’s home.
Without hesitation, the clinic resumed Furaha’s treatment with Juliana closely supporting to ensure he received the proper medication and care he needed to get better. Thanks to Juliana’s intervention and dedication, Furaha’s health began to improve. His viral load started to decrease, and he slowly regained his strength and vitality.
Furaha’s story is a testament to Juliana’s dedication and unwavering commitment to improving the lives of members of her community who are affected by HIV.
“For three consecutive months, Juliana came home and administered the ARV drugs to my grandson every evening. She also ensured that Furaha was properly fed before taking medications. Sometimes she brought milk for him”, said Esther Zunzu, Martin’s grandmother.
As word spread about Juliana’s remarkable work, more and more people in the community sought her help in managing their HIV care. Her tireless efforts and compassionate nature made her a beacon of hope for those affected by HIV in the community. Juliana, or ‘Mama Nesi’ as she was fondly called, continued to inspire and empower others through her work, proving that with determination and compassion, anything is possible.
In addition to her role as a Peer Educator, Mama Nesi collaborates closely with community-based Health Care Providers to implement the ‘WATEJA MARAFIKI INITIATIVE’, which focuses on following up with recipients of care who have high HVL, providing them with the support and guidance they need to stay healthy.
As of December 2023, Kambarage Care and Treatment Facility had served 2066 clients enrolled in ART, including 89 children, and Juliana is part of this remarkable achievement that has made a positive impact on the lives of those in her community.
Juliana’s resilience, compassion, and determination make her a true hero in the fight against HIV. Through her tireless efforts, she continues to save lives and inspire hope in the hearts of those she serves.
Mama Nesi, with her indomitable spirit, is a shining example of the power of one person to make a lasting impact on the world.