WAAF

TB EFFORTS

WAAF addresses the fight against TB using an innovative preventive strategy – TB Preventive Therapy (TPT)

The core mandate of the West Africa AIDS Foundation (WAAF) and its onsite ART facility; the International Health Care Centre (IHCC) is to ensure the health and wellbeing of all. A critical strategy employed has been advocacy for and support of innovative evidence-based prevention and treatment strategies.
In August 2020, WAAF was awarded a one-year small grant advocacy project on short course (3HP) Tuberculosis Preventive Therapy by Treatment Action Group Inc. (TAG).
TAG is one of the members of a consortium implementing the IMPAACT4TB project. This aims at implementing innovative strategies to deliver 3HP; a short course TPT regimen to high-risk groups within several project countries. TAG is responsible for leading advocacy to support IMPAACT4TB at a global level and connecting to regional and national CSOs.
WAAF’s project, titled Increase the knowledge of and demand for TPT among Health Care Workers & PLHIV in the Greater Accra Region of Ghana” had its main goal of achieving exactly what the title states: an increase of knowledge and an increase of demand for Tuberculosis Preventive Therapy among both Health Care workers (HCWs) in selected ART facilities, as well as among PLHIV receiving services from these facilities.
To achieve this goal, WAAF worked in line with 2 main objectives: They are, To increase awareness on TPT regimen among health care workers in 6 ART facilities in Greater Accra Region. And to increase demand for TPT amongst health care workers providing HIV treatment and people living with HIV.  
WAAF engaged key stakeholders in the pre-implementation stage of this project with the purpose of receiving support in selecting ART facilities to engage and to ensure WAAF’s work is complementing existing TPT services within the region and to prevent duplications. After interactions with the National AIDS Control Program (NACP) and the National Tuberculosis Control Programme (NTP), WAAF saw the need to shift advocacy focus from 3HP TPT to TPT in general (3HP and IPT) due to the unavailability of the short course TPT (3HP) in the country at the time. NTP provided details of facilities which currently provided TPT services and based on that list WAAF reached an agreement with the following 6 ART facilities within the region:

  1. Shai Osudoku district hospital
  2. Princess Marie Louis (Children’s) hospital
  3. Korle Bu fevers unit
  4. Kaneshie polyclinic
  5. Ga West municipal hospital
  6. International Health Care Center.

On December 10th, 2020, WAAF organized a one-day orientation on the project and on TPT for 20 health care workers (ART nurses and Models of Hope) from the 6 selected facilities.  Invited stakeholders from NTP, NACP and CHAG were also present.
After the orientation, the health care workers engaged were expected to share the information and knowledge received with colleagues and clients of their units.
The TPT advocacy project has been implemented from January to June 2021 with support of the engaged health care workers with technical support from WAAF.
Advocacy was provided through 3 approaches namely.

  • One on one interaction with PLHIV
  • ART waiting room department discussions/talk
  • PLHIV Support group discussions facilitated by Models of Hope

With these 3 approaches, PLHIV have received information and awareness on TPT, its benefits and availability. Ensuring the clients are known to the preventive therapy and its benefits, it was expected to see an increase in demand which would result in an increase of TPT uptake within the 6 facilities where the advocacy took place.

ACHIEVEMENTS

During the 6 months of implementation, a total of 12,999 PLHIV received information on TPT delivered at the 6 ART facilities. Majority, 8,465 people, were reached through ART waiting room department discussions/talk, 1,637 were reached through one-on-one interaction and the remaining 517 were reached through support group. 4,023 were male and 8,976 were female.
Graphs below present the number of PLHIV who have been reached with advocacy on TPT during the project implementation.

With an increase in the number of health care workers and PLHIV being more knowledgeable about TPT, the project’s goal was to see an increase in number of PLHIV being initiated on TPT. During the 6 months of implementation, the facilities saw a significant increase in clients starting TPT. Starting off with only 2 people being initiated on IPT TPT at one facility in January, in June alone a total of 127 people were initiated on TPT (both 3HP and IPT). Cumulatively, the number of PLHIV clients initiated on TPT during the period was 298 (see graph below for details).

LESSONS LEARNT:

  • Expanding the advocacy focus from 3HP to include IPT, TPT contributed to making the project successful since 3HP only became available in selected facilities in May/June 2021. In June, the final month of project implementation, 3 of the 6 implementing facilities had stock of 3HP commodities, and this contributed to a jump in TPT initiation for that month.
  • Unavailability of TPT commodities and cost related to X-ray screening were identified to be the two major barriers to TPT uptake when the project started in January. Clients who were referred for chest X-ray screening to rule out active Tuberculosis before TPT initiation, could not or would not cover the cost related to X-ray and this was the major reason why TPT initiation was low among the 6 facilities during January, February and March. The revised TPT guidelines resolved this challenge, so clients are no longer required to do X-ray but could have TB disease ruled out by using the symptoms-based screening tool.
  • TPT is highly acceptable among PLHIV, and removing barriers such as extra costs for the clients (e.g. Chest X-ray or other required laboratory testing) increases the uptake of TPT.

CONCLUSION:

Advocacy on TPT targeting HCWs and PLHIV has resulted in an increase in demand for TPT by PLHIV and the supply of TPT by HCWs resulting in a significant increased uptake of TPT within the implementing facilities and the project is confident this will go a long way in not only supporting the fight against TB but will also enhance HIV treatment outcomes and ultimately save more lives.
The project has also showcased that the fight against HIV and TB needs concerted effort and more so, between various actors. This public, private, mix partnership, where health care workers from both private and public health facilities took on advocacy roles on top of their regular service delivery duties and together with NGO actors worked with beneficiaries leading to 12, 999 PLHIV knowing of the benefits of TPT and 298 having initiated on TPT, is proof that together, HIV and TB can be beaten.