Tuberculosis (TB) remains a major public health challenge in Tanzania, with an estimated incidence of 237 cases per 100,000 population and more than 62,000 cases undiagnosed or unreported annually. People who use drugs (PWUD) are disproportionately affected, with TB incidence estimated to be 12 times higher than in the general population due to factors such as HIV co-infection, homelessness, incarceration, poor nutrition, stigma, and criminalization of drug use.
In Tanga and Morogoro regions, an estimated 7,527 people use drugs, including both injecting and non-injecting populations. Fear of arrest, police harassment, discrimination in health facilities, and lack of tailored services significantly limit access to TB prevention, diagnosis, and treatment—particularly for women who use drugs.
In response, MUKIKUTE, in partnership with DAHW – German Leprosy Relief Association, is implementing a community-based, low-threshold TB intervention targeting PWUD in Tanga and Morogoro. The project aims to reduce the TB burden among PWUD by improving access to client-centred, gender-responsive, and rights-based TB services through close collaboration with government TB programs, MAT clinics, community-based organizations, and peer networks of people who use drugs.
The overall objective (Impact) is to contribute to improved health outcomes among people who use drugs in Tanga and Morogoro regions by reducing the burden of tuberculosis.
Status of Project Implementation and Achievements
Outcome: Improved Access to Quality TB Services for PWUD
A comprehensive hotspot mapping and baseline survey were completed in both regions to guide targeted interventions.
985 people who use drugs were screened for TB at community hotspots and MAT clinics.
608 individuals were identified as presumptive TB cases, with sputum samples collected and transported to diagnostic facilities.
57 PWUD (41 men, 16 women) were diagnosed with TB and successfully initiated on treatment.
14 trained ex-TB peer supporters provided community-based directly observed treatment (ComDOT), supporting adherence and reducing loss to follow-up.
Early evidence shows very high treatment adherence, particularly among clients linked to methadone facilities, with completion rates reaching up to 99% in supported settings.
Output 1: Strengthened Community-Based and Gender-Responsive TB Services
40 ex-TB peer educators were trained and deployed to conduct TB screening, referrals, treatment support, and community sensitization.
24 primary healthcare workers were trained on key-population-friendly, human rights-based, and gender-responsive TB services.
128 women who use drugs were reached through targeted home visits and hotspot outreach led by trained female ex-TB peers.
72 clients were referred for advanced TB diagnostics, including X-ray and specialist assessments.
Quarterly coordination meetings with government and community stakeholders were successfully conducted to monitor progress and address implementation challenges.
Output 2: Reduced Socio-Cultural and Economic Barriers
TB awareness among PWUD has improved through peer-led individual and group education sessions, dispelling myths and increasing uptake of screening services.
National, regional, and district sensitization and project launch meetings strengthened ownership and alignment with the National TB and Leprosy Programme.
PWUD actively participated in World TB Day commemorations, promoting visibility and advocacy.
Five self-help groups of women who use drugs were established, and 75 women received entrepreneurship and business skills training.
Partnerships with VETA and SIDO were established to support vocational training and economic reintegration, with additional trainees enrolled for Year 2.
Five income-generating businesses were initiated with seed funding, supporting livelihoods and reducing reliance on high-risk coping strategies.
Overall Impact (Early Results)
The project has successfully demonstrated that peer-led, community-based, and rights-oriented TB services can effectively reach people who use drugs—an otherwise underserved population. Early results show increased TB screening, improved case detection, strong treatment adherence, enhanced gender responsiveness, and reduced structural barriers to care. These outcomes provide a strong foundation for scaling up interventions and achieving sustained reductions in TB morbidity and transmission among PWUD in Tanga and Morogoro.
