We need people – people like those in TB Alert, who are focused and ambitious and care for people at grass roots in the UK, India and Africa. Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership
TB Alert launched the COTHAZ project in February 2011 to help address TB and HIV co-infection in Zambia, with funding from the Department for International Development. COTHAZ stands for Community-led TB-HIV Advocacy in Zambia. It is a three-year partnership with seven Zambian NGOs, working in six areas of the country: Kabwe, Katete, Luanshya, Masaiti, Lusaka and Kitwe.
The COTHAZ project works at three levels: raising awareness of TB among local communities; advocating for better TB services at local level; and engaging with national government to secure funding and support for improved TB services. This joined-up approach means more people are channelled into more effective local TB services.
COTHAZ helps to raise awareness of TB in local communities through outreach visits by 100 trained project volunteers. Many of these volunteers have experienced TB, and are living with HIV themselves. So they speak with particular empathy and authority, and embody the message that TB is curable and HIV can be treated – which helps to de-stigmatise the two illnesses.
The volunteers receive TB and HIV training, so that they can back up their personal experience with accurate knowledge and advice to help counter the myths that surround TB. They are also trained to help identify people that have worrying symptoms, and to refer them – or anyone that approaches them with concerns – to appropriate local services for TB and HIV testing.
COTHAZ awareness raising activities are chosen to best fit the area of need and the demographics of the people within that area. Meetings with local religious and community leaders help pave the way for wider work in the community. Film, drama and music are used to convey complex messages in an engaging way, to a population where many have low literacy levels. Mixing door-to-door visits and group discussions gives people the opportunity to discuss their concerns privately, if they fear stigma, whilst creating a more tolerant environment by breaking down taboos. In areas that are too remote for volunteers to easily visit, radio broadcasts provide an excellent medium to reach more people.
It is through these activities that people like Patrick Mubanga access life-saving treatment.
Case study: Patrick Mubanga
Advocating for improved and accessible local services
Through their community outreach work, COTHAZ staff and volunteers gain valuable insights into the issues local people face in accessing and using TB services. The project provides training in advocacy for staff and volunteers, so that they can represent local communities at local government level, driving improvements in TB services. The project aims to address issues around staffing and infection control in local clinics. Infection control, such as improved ventilation, helps to prevent other patients from being infected with TB whilst waiting to be seen for other conditions. Until COTHAZ’s intervention, this was a particular problem at the Kamitondo clinic.
Case study: Kamitondo Clinic
Engaging with national government
COTHAZ is leading a growing network of TB-HIV non-governmental organisations to hold the national government to account, and exert pressure for increased funding for TB prevention and treatment. To effect change, COTHAZ are working directly with the government through ministerial meetings, but also indirectly by generating public support through the media and activating this support through public petitions. One aim of this work is to improve access to isoniazid preventative therapy for people living with HIV, to reduce their risks of developing TB. This would help people like Felix Nyirenda, who fell ill with TB a second time, having already been treated successfully for TB in the past.
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