Maputo, Mozambique—Health care workers like Eleutéria Jaime face a dual challenge in the fight against tuberculosis. Their clients are often suffering from HIV, the virus that causes AIDS; of all TB patients in Mozambique, 61 percent test positive for HIV. And for HIV-positive patients, TB is a leading cause of death.
That means Jaime and her colleagues at the Rural Hospital of Chicumbane—located in an area of the country with the highest prevalence of HIV (25.1 percent)—must be ever-vigilant in making sure their patients take their medicines and stick to their treatment regimen, which takes at least six months. She also cares for patients who are difficult to treat because they have multidrug-resistant TB (MDR-TB), a particularly stubborn form of TB that is resistant to standard antibiotics.
Despite these challenges, the Government of Mozambique, with support from Jhpiego and the President’s Emergency Plan for AIDS Relief (PEPFAR), has embarked on a five-year national plan for TB infection control. As part of this initiative, Jhpiego helped lay the groundwork for the national program by reviewing standards of care and local infection control policies at 30 health care facilities in three provinces. Jhpiego’s assessment found that few facilities had TB infection control policies, and even where policies existed, health workers knew little about how to prevent or control TB. These findings helped inform guidelines and practices for the TB Infection Control National Policy, which was signed by the Minister of Health earlier this year.
Following that seminal work, Jhpiego and partners set out to help Mozambique implement its campaign to stop TB. Jhpiego has led efforts to prepare workers and facilities across the health system to carry out the national plan, improve detection of TB, address challenges associated with treating patients with MDR-TB and promote proper “cough etiquette” and other TB prevention behavior in clinics and health centers.
To build and strengthen a TB-competent work force, Jhpiego has helped educate more than 200 health care workers in infection control and prevention strategies. Jaime was among them, and, she says, she is now better able to serve her clients and to reinforce the often simple measures that help prevent the spread of TB—for example, covering one’s mouth when coughing and keeping windows open in patient areas to circulate the air.
“I did not have much idea about the issues relating to TB-MDR and TB transmission and infection control,” said Jaime. “I was really pleased to be able to learn more about these issues and how I could motivate my patients to keep fighting TB, how I could protect myself and the patients and their families from TB transmission. It helped me to provide better care and instructions to the patient on cough etiquette and infection control both while in the hospital and at home.”
Every year, more than 7,000 Mozambicans die as a result of TB. Residents who are HIV-positive are more vulnerable to the threat of TB, and in a country with an HIV prevalence rate of 11.5 percent among adults, the challenge of containing that threat is great. The Ministry of Health (MOH) is focused on strengthening health services to avert the spread of TB and provide improved care to its people. One of the key strategies to fight TB is the implementation of collaborative HIV/TB activities.
“The National [TBIC] Plan is crucial to guide the activities to be implemented to control TB transmission in Health Care Units and group settings,’’ said Dr. Alexandre Manguele, Mozambique’s Minister of Health. “We hope therefore to be able to guarantee safer and healthier health care facilities and services for all Mozambicans.”
From promoting cough etiquette in small rural health facilities to establishing strong TB and general infection control policies in hospitals, Jhpiego is partnering with Mozambican organizations to share evidence-based practices and strategies to strengthen health care and protect health care providers where they work.
Red Cross Mozambique is one of the front-line organizations working to prevent and control TB in the community, especially in remote areas where access to health facilities is more difficult. Red Cross volunteers play an active role in supporting the MOH with its community TB-DOTS (Directly Observed Therapy Short-Course) strategy, which includes a focus on having a friend or relative watch and support a TB patient in taking his or her medicine properly. But many volunteers did not know how to protect themselves and the community against TB infection. Nor were they fully confident about dealing with MDR-TB clients.
Last fall, at the request of the MOH and the World Health Organization, Jhpiego supported TB infection control training for 22 Red Cross medical officers. This training covered twin challenges—treating persons with HIV, or those with MDR-TB. A majority of these medical officers manage 139 field supervisors, who in turn train and oversee 1,404 volunteers working in the 11 provinces of Mozambique. Last year, these Red Cross volunteers reached 62,227 families with updated information on TB prevention and control.
“After the training, I was confident to teach the volunteers about TB/HIV issues, adherence to treatment importance and how to motivate clients, the risks of multidrug-resistant TB and how to protect themselves and their clients against TB transmission,” said Celeste Langa, a supervisor with the Red Cross. “I feel privileged and I am happy to hear that people in Jhpiego are concerned with the TB and TB-MDR challenge we face in our country, especially in my province Maputo.”