In Uganda, tuberculosis and HIV contribute 60% of the disease burden in the population according to the Ministry of Health, and yet TB/HIV collaborative interventions are not moving as fast as would be expected. There is low utilization of TB/HIV services and health workers seldom discuss the relationship between TB and HIV with patients. The HIV prevalence remains high at 7% and continues to be a risk factor for tuberculosis in the community.
SORAK Development Agency developed a project that reached out directly to 12,000 persons affected with tuberculosis and HIV with accurate prevention messages using participatory theatre approaches (music, dance, drama, poetry, discussions, puppetry, life testimonies and storytelling) as well as mobilizing them for TB and HIV preventative and treatment services. This led to increased TB case reporting, treatment adherence, psychosocial support with 80% of tuberculosis patients getting cured and the remaining 20% continuing with treatment by the end of this project.
According to the National Tuberculosis and Leprosy Programme, health care providers generally display negative attitudes towards TB and HIV patients. SORAK Development Agency used the National Strategic Plan for HIV/AIDS Organizations of Uganda AIDS Commission to identify knowledge gaps on tuberculosis and HIV/AIDS among rural underserved communities. Then SORAK carried out a participatory preliminary survey in 2009 in the targeted community. The survey indicated that there was indeed a need for more TB /HIV information, and SORAK Development Agency set out to implement our project.
During the survey findings dissemination meetings, which attracted stakeholders from the targeted community, we determined that there was need for an action plan. We solicited suggestions and recommendations from participants that helped us determine which activities to include in our project. At the end of the meetings, we created a write up detailing the project, which aimed to use advocacy, communication, and social mobilization to contribute to sub-county and district level planning, and fill the deficiencies in knowledge that contribute to low utilization, low referrals for TB and HIV services, inadequate psychosocial support, low adherence to treatment, limited disclosure of TB/HIV results to spouses, and negative attitudes of health workers towards TB/HIV patients. Use of participatory theatre, electronic media, dialogue and engagement meetings, and home based visits were chosen as key strategic means of reaching out to the targeted population.
Monitoring and evaluation of this project focused on tracking impact, reach, and scaling up collaborative management of TB and HIV. Qualitative approaches were used to examine behavior change process and effectiveness of the intervention and quantitative approaches provided numerical information about the impact and coverage. Monitoring was continuous and participatory, undertaken by implementers, donors, and the beneficiaries. It was guided by a monitoring plan, and the findings helped guide necessary modifications, such as intensification of participatory theatre and home based visits.
Local leaders were involved in the project activities and they have made it possible for us to continue sharing messages that are relevant to TB and HIV care, prevention, and control at every community interaction forum. Local parish-based Drama groups were trained and involved in the participatory theatre activities and they will carry on even after the end of the project. Care givers and health service providers have been empowered with interpersonal/patient-health worker relationship and care. With these skills and change in attitude, health workers continue with good relationship with the clients even after the end of the project.
Due to our intervention, TB and HIV prevention and treatment needs have been incorporated in the district operational plan in an effective and participatory manner. TB and HIV patient family members, community, local leaders and government officials have stepped up efforts of TB and HIV care, prevention and treatment. There has been effective learning and improved knowledge and skills among community members through education on TB and HIV care, prevention and treatment. The patient/health worker relationship has improved and positive attitudes towards TB and HIV patients are exemplified by increased health worker driven home-based care, prevention and treatment for TB and HIV patients.
SORAK Development Agency's Website: http://sdauganda.org/