Like its neighbours, Zambia was devastated by the dual epidemic of TB and HIV that swept through sub-Saharan Africa in the 1980s and 1990s. However, as the country has experienced political stability and economic growth over the past 20 years, it has also succeeded in bringing down deaths from TB by almost half since the 1990s.
But tuberculosis remains a deadly killer disease and HIV transmission is still high. Each day, more than 150 people fall ill with TB — many of them HIV positive — and 31 people die from it.
Stats and facts: TB in Zambia
In 2012, there were 31 avoidable deaths a day from TB in Zambia.
- Number of new TB cases: 60,000
- Deaths from TB: 11,500
- Incidence: 427 per 100,000 of population
- Proportion of people with TB not diagnosed: 32%
- Percentage of cases with HIV: 59%Percentage of cases with HIV: 59%
- Estimated new TB cases with multi-drug resistance: 0.33%
Because TB-HIV co-infection is such a huge problem in Zambia, it makes sense to tackle these conditions together rather than separately. TB Alert’s Community-led TB-HIV Advocacy (COTHAZ) project involves seven local NGOs working throughout six areas of the country to raise awareness of TB-HIV. The project, funded by the Department for International Development, is helping poor communities in Kabwe, Katete, Luanshya, Masaiti, Lusaka and Kitwe areas.
The COTHAZ project works at three levels:
- raising awareness of TB among local communities
- advocating for better TB services at the local level
- engaging with national government to secure funding and support for improved TB services.
This joined-up approach makes for a win-win situation — meaning more people are involved in delivering better local TB services.
Local awareness raising
COTHAZ helps to raise awareness of TB in local communities through outreach visits by 100 trained project volunteers. Many of these volunteers have had TB, and are living with HIV themselves, so they are able to show people firsthand that TB and HIV can be successfully treated.
As part of their training, the volunteers are given current medical information about TB and HIV, to help them counter the many myths that surround TB. They are also trained to help people identify symptoms, and to refer suspected cases for further testing.
Staff and volunteers work with religious and local leaders to make sure each COTHAZ activity best suits the needs of the community. Film, drama and music are used to convey complex messages in an engaging way to a population with low literacy levels.
Combining door-to-door visits and group discussions gives people the opportunity to discuss their concerns privately, if they fear stigma, while creating a more tolerant environment by breaking down taboos. In areas that are too remote for volunteers to easily visit, radio broadcasts are able to reach large numbers of people.
A COTHAZ volunteer helped save Patrick Mubanga’s life.
Championing better 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, enabling them to represent these communities at local government level and seek better TB services. They advocate for improved conditions in local clinics, including adequate staffing and effective infection control. Improved ventilation, for instance, made it less likely for TB to be passed on in the busy waiting rooms of clinics, like the one in Kamitondo.
Find out how local advocacy helped patients at Kamitondo Clinic.
Engaging with national government
COTHAZ is leading a growing network of TB-HIV non-governmental organisations urging the national government to make funding for TB prevention and treatment a priority. To achieve this, COTHAZ participates in ministerial meetings with the government. It is also involved in media campaigns and public petitions to generate wider support for this cause. For instance, COTHAZ is pushing for better access to isoniazid preventative therapy for people living with HIV, to reduce their risks of developing TB.