Aim of the project
The project’s overall aim is to enhance access to human rights based, gender responsive, patient centered and community driven TB care and prevention services for key and vulnerable populations in Temeke and Kigamboni municipalities, Dar es Salaam city, Tanzania and focused on 4 sub populations i.e people who use drugs (PWUD), healthcare workers, prisoners and fishers folks
Importance of the project/programme and what evidence suggest the problems exist
PWUD are at increased risk of TB, 23-fold higher the national rate and face multiple challenges in accessing high quality TB services due to homelessness, police brutality and incarcerations. Drug use is criminalized and possession for personal use subject PWUD to arrests and imprisonment.
Gender disparities, stigma and discrimination exacerbate the spread of TB among TB KVP. The 2017 LEA states that HCWs are friendly with persons with TB during diagnosis and later stigmatize and discriminate against the same with positive TB test result.
There are drug interaction with PWUD affected with TB, living with HIV and attending methadone clinics requiring patient centered, human rights-based approach to support adherence to all medications to achieve desired treatment outcome.
Evidence suggests that prisons are overcrowded and greatly contributes to the spread of TB among inmates. Resources are limited to support interventions and HCWs are not capacitated to deliver human rights-based TB response
NSP VI 2020 – 2025 has adapted Stop TB Partnership: Data for Action for TB KVP and Underserved Populations and considers key and vulnerable populations susceptible to TB to include PWUD, prisoners, HCWs. There are limited studies on TB among PWUD in Tanzania and also seeks intensified TB case-finding among prisoners, HCWs
A National TB response CRG Plan 2020 – 2023 based on qualitative assessments highlights the barriers to accessing TB services, the impacted populations and proposing key actions to be taken to achieve national strategic targets. An analysis of the STP CRG assessment on the key dimensions of the right to health framework outlines the country gaps for action.
National policy guidelines for collaborative TB/HIV activities 2016 cites that available data from recent studies in Tanzania gives high prevalence of HIV among key populations and specifically PWUD coupled with high rates of new TB infection and advises implementation of collaborative TB/HIV activities.
Impact
During the reporting period, a total of 6022 people (3986 men, 2036 women) were engaged on OneImpact. Out of those, 2828 people (2042 men, 786 women) reported TB-related challenges on OneImpact, submitting a total of 3974 reports, whereby 2807 challenges were resolved, which is 71% of all submitted challenges.
Thanks to the sensitization meetings with law makers and enforcement officers, the project was able to engage prisoners, a key population that was previously not reached by CLM and CRG interventions. As such, 222 prisoners (217 men, 5 women) were registered on OneImpact and submitted their challenges, with self-stigma (92%) the biggest challenge facing the sub population, thus highlighting a need to increase counseling and education for prisoners.
The project also engaged people who use drugs (PWUD), a marginalized key population in Tanzania. 945 PWUD (734 men, 211 women) submitted TB challenges with stigma at family level (31%). MUKIKUTE used these numbers to advocate for a holistic, pragmatic, and community-oriented approach to to TB related health and support services for the community.
OneImpact CLM has also been useful in providing accurate legal support services information and availability for key populations affected by TB. Community health volunteers with the support of paralegal officers have provided efficient legal support on identified human rights related challenges.
