TB champions share ongoing challenges and gaps in care in their provinces
One of the biggest challenges to reduce South Africa’s TB burden is people’s ability to complete their treatment. But, in two provinces, the country’s TB ambassadors are working to fix this.
The TBAC team reached out to dedicated TB champions in the Eastern Cape and Western Cape to discuss the challenges in the provinces and how they mobilise people and help link them to care.
Provincial TB champions raised concerns about patients being lost-to follow up and how cross-border and inter-districts movements affects treatment completion. They share their insights on the realities on the ground and the work being done to keep people in care.
The welcome back campaign
Melikhaya Lusiti, co-hairperson of the AIDS Council Civil Society Forum in the Eastern Cape, explains that one of the province’s biggest challenges is that people are not receiving treatment because they often migrate between provinces, countries and districts. This constant movement makes it difficult to maintain consistent treatment, trace patients and reinitiate them into care once they’ve disengaged from the health system.
“It’s especially difficult with patients who have changed districts and even worse when they’ve moved between provinces,” Lusiti noted.
The Joe Gqabi and Alfred Nzo districts experience even worser challenges due to their borders with Lesotho. Many cross-border patients seek health services in these areas, adding to the strain on local health systems and complicating patient tracking efforts.
Another long-standing issue is the tracing of former mineworkers, with many ex-miners lost to the system after returning home without proper follow-up care. “The Eastern Cape was an exporting province for mineworkers,” Lusiti explained. “Many of them came back sick and were lost in the system because there was no proper follow-up care when they returned home, but that’s something we are trying to do now, tracing former mineworkers and linking them back to care.”
To help address these challenges, the province has been implementing the National Welcome Back campaign, a programme focused on reinitiating patients who have stopped taking their treatment and linking them back to care. Lusiti explains that the campaign is especially important in areas where frequent migration and cross-border movement make it difficult to trace and retain patients in care.
According to Lusiti, to mobilise communities, provincial TB ambassadors have partnered with healthcare professionals to coordinate outreach activities. They found that people respond better to peers and TB survivors, people who can speak from their lived experiences.
“Through the Nerve Centre that we have in the province, there was a communication plan that was developed where we will do community radio talks on TB, sharing information about where to go for services and who to contact. There will also be Facebook Live sessions to interact with people and answer their questions. aimed at educating the public about TB,” Lusiti further explained.
Despite these efforts, stigma around TB remains an issue, with many people are still unaware that TB is both preventable and treatable. Lusiti believe that more focused communication and advocacy are urgently needed to break these misconceptions, particularly as TB can affect anyone, regardless of their HIV status.
Different provinces, similar problems
In the Western Cape, the challenges mirror some of those seen in the Eastern Cape, with added concerns around treatment disengagement and patients being lost-to-follow-up.
Neliswa Nkwali, chairperson of SANAC Civil Society Forum in the Western Cape explains that many patients begin TB treatment but stop attending clinics or miss appointments before completing their medication. “The challenge we have is with people who disengage from treatment. These are patients who start TB treatment but, along the way, stop going to the clinic, miss their appointments or don’t finish their medication.”
“Food insecurity also plays a major role, as TB treatment can be difficult to take on an empty stomach, which affects adherence rates,” Nkwali added.
Another pressing issue is the poor linkage between hospitals and local clinics. “Patients start treatment in hospital, but they are not properly linked to their local clinics for follow-up, which results in many being lost before completing treatment,” Nkwali stated.
To address these gaps, the Western Cape TB ambassador usually conducts door-to-door visits in collaboration with health facilities to find patients who have stopped treatment and encourage them to return to care. However, resource shortages and safety concerns for outreach teams working in high-risk areas remain significant barriers.
Both TB champions have called for greater investment in TB services, improved communication strategies and stronger community outreach to ease the burden of TB, ensure people stay help people stay on treatment and raise awareness to reduce stigma in communities.