In Zambia, Making TB Prevention Therapy More Accessible to People Living with HIV

Tuberculosis (TB) is a major cause of illness and death in Zambia. According to the Ministry of Health (MOH), 17,000 of the 62,000 people who contract TB every year die. Fifteen thousand of those who die are people living with HIV (PLHIV), making TB the leading cause of death among PLHIV. Results from the first National TB Prevalence Survey (2015) found that the risk of having TB in Zambia is five times higher in PLHIV than in people who are HIV negative.

TB preventive therapy (TPT) helps people who are at high risk of contracting TB avoid it. The World Health Organization recommends the use of isoniazid (INH) medication for TPT. In PLHIV, TPT works with and independently of antiretroviral therapy (ART) to reduce TB morbidity and mortality.

However, over the past few years, Zambia encountered numerous barriers to TPT implementation at the national level. These included supply chain challenges in the procurement and distribution of required drugs; TPT knowledge gaps among health care providers; inadequate demand-creation among clients; and suboptimal coordination between national TB and HIV programs.

In response to these challenges, the USAID Supporting an AIDS-Free Era (SAFE) project embarked on a TPT surge initiative. A plan to guide all SAFE-supported facilities on TPT implementation was developed during a three-day meeting in November 2019. With support from PEPFAR to procure INH and vitamin B5, the plan set a phased approach that included capacity building through training, followed by intensive supervision and mentorship to facility-based staff and district and provincial supervisors; support for forecasting, quantification, and timely ordering and reporting of drugs; partnering with PLHIV; TPT promotion programs on community and TV radio stations; and a detailed monitoring and evaluation plan with weekly reporting and quarterly data quality checks.

USAID SAFE actively participated in and supported the MOH TPT surge, and the SAFE TPT surge plan was used to formulate the national TPT surge plan. These tandem efforts have resulted in 131,534 ART clients initiating TPT, and 111,261 (85 percent) of those completing TPT. The target for clients completing TPT was 88,840, meaning the effort had an overall achievement rate of 108 percent.