Tom R . Muyunga-Mukasa
A Theory and Practice formulation and synthesis specialist who through the Adaptive Public Health Framework and TB/HIV/Malaria Prevention /Elimination iterations has contributed to better life outcomes aspirations for grassroots-based communities from the perspective of displacement, forced migration, technological, psychological, medical, civil, structural, behavioural, social, cultural, political, physical, economic and gender enabling or responsive determinants. Muyunga-Mukasa has published research articles, systematic reviews, generating reports, and abstracts; research interests include forced migration, displacement, governance, diversity, inclusion, equity, health, development, epidemiology of infectious diseases, evidence-based medicine and monitoring and evaluation. As well, Muyunga-Mukasa provides support to CBOs as they consolidate, repurpose and re-organize to contribute to the efforts toward the eradication of HIV, TB and Malaria by 2030 integrating COVID-19 response and recovery; climate smart action; and pandemic preparedness.
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Papers by Tom R . Muyunga-Mukasa
Mobilization, material access and meaningful engagement of refugees in health promotion initiatives of local host countries improves uptake of vaccines. Vaccine uptake is higher following targeted campaigns because they are strategic and improve vaccine uptake and efforts to vaccinate larger populations (Osumba, 2021). This is true for refugees too. Unlike in the general population who are citizens and enjoy several amenities, refugees are disproportionately impacted by cultural, social, political, economic, civil and gender enabling and responsive determinants.
Findings:
The pre-disposing factors or variables that influence contexts of equity and inequity in the case of refugees are: social, cultural, economic, political, civil and gender enabling and responsive contexts.
Conclusion:
Pre-disposing factors impact quality of life, health seeking practices and contexts driving healthy living among refugees.
Recommendations:
Vaccines whether new (e.g., TB Vaccine) or the ones we have been using over time provide long-term immunity. They are provided as single or multiple doses which makes them the tools to offset barriers such as transport to clinics and may minimize hesitancy inclinations for marginalised populations. Further investigations of the causes of differential inequity, poor vaccine coverage and the effectiveness of interventions for increasing vaccine uptake are urgently needed for refugees to address vaccination and immunization disparities.
Methods: We conducted a qualitative cross-sectional study in three purposively selected regions of Uganda, Tanzania, and Kenya. We collected data through focus group discussions (n = 21) and in-depth interviews (n = 40) with people in the lowest wealth quintile residing in the health and demographic surveillance systems and exit interviews at selected hospitals. We analyzed the data using a framework approach focusing on the three public health goals and the four-healthcare access dimensions: geographical accessibility, affordability, availability, and acceptability.
Results: PPM, COP and Health financing policies reduced financial barriers and improved access to health services for the poor in the study counties. However, for many it was limited, and this limitation was a barrier limited the extent to which they benefited from these reforms. Responses on barriers were: Staying with members of an extended family/clan was a burden, long distances, expensive medication, lack of food, lack of public transport, poor condition of the roads and high transport costs especially in rural areas limited access to health facilities. Continued charging of user fees despite their abolition, delayed insurance reimbursements to health facilities where beneficiaries were seeking care from, and informal fees exposed the poor to out of pocket payments. Stock-outs of medicine and other medical supplies, dysfunctional medical equipment, shortage of healthcare workers, and frequent strikes adversely affected the availability of health services. Acceptability of care was further limited by ridicule from the healthcare providers, discrimination by healthcare workers and ineffective grievance redress mechanisms which led to a feeling of disempowerment among the poor. Conclusions: Pro-poor health financing reforms improved access to care for the poor to some extent. Low-Income friendly reforms can be effective, there is a need to address barriers to healthcare seeking through addressing the civil, social, political, economic, cultural and gender determinants. This in turn leads to full engagement by all actors.
Conclusion: When communities are fully engaged, it creates a feeling of being connected to one another individually and feeling part of a bigger purpose as a team working together on a collective endeavour. When everyone feels recognized and appreciated, they are motivated to collaborate, and this addresses social isolation. Empowering community members to be part of the efforts to eradicate HIV, TB and Malaria by 2030, enables them to rethink their role and giving agency and autonomy to be innovative and entrepreneurial — to lead new projects and shape their own contributions to the effort instead of having tasks imposed on them in a top-to-bottom approach.
METHODOLOGY: Key Informant interviews of 22 refugee respondents who have been in Kenya since 2016. Literature review of 100 dailies from September to October 2019 on minority and marginalized strategies and counter strategies to address inequality, promote visibility and inclusion.
FINDINGS: Minority inclusivity requires understanding of the politics of popular vote; and organizing for movement building to address systemic injustices with refugee input. They participate in poverty eradication drives; access health, opportunities for housing, affordable education, participation in livelihood activities and demand for quality before the law.
CONCLUSION: Humans are connected to animate and non-animate worlds (Ubuntu wisdom). These connections are market-places. Governments can promote contexts for harmony (equality enforcement) and stabilize institutionalized service delivery. This builds a culture of justice which defends civic, religious and identity-related freedoms and enshrines protections. Leading, to economic emancipation, humanization of refugees and asylum seekers.
RECOMMENDATION: Research into services targeting refugees influence engagement in economic activities will throw light on social mobility and economic prosperity.
Mobilization, material access and meaningful engagement of refugees in health promotion initiatives of local host countries improves uptake of vaccines. Vaccine uptake is higher following targeted campaigns because they are strategic and improve vaccine uptake and efforts to vaccinate larger populations (Osumba, 2021). This is true for refugees too. Unlike in the general population who are citizens and enjoy several amenities, refugees are disproportionately impacted by cultural, social, political, economic, civil and gender enabling and responsive determinants.
Findings:
The pre-disposing factors or variables that influence contexts of equity and inequity in the case of refugees are: social, cultural, economic, political, civil and gender enabling and responsive contexts.
Conclusion:
Pre-disposing factors impact quality of life, health seeking practices and contexts driving healthy living among refugees.
Recommendations:
Vaccines whether new (e.g., TB Vaccine) or the ones we have been using over time provide long-term immunity. They are provided as single or multiple doses which makes them the tools to offset barriers such as transport to clinics and may minimize hesitancy inclinations for marginalised populations. Further investigations of the causes of differential inequity, poor vaccine coverage and the effectiveness of interventions for increasing vaccine uptake are urgently needed for refugees to address vaccination and immunization disparities.
Methods: We conducted a qualitative cross-sectional study in three purposively selected regions of Uganda, Tanzania, and Kenya. We collected data through focus group discussions (n = 21) and in-depth interviews (n = 40) with people in the lowest wealth quintile residing in the health and demographic surveillance systems and exit interviews at selected hospitals. We analyzed the data using a framework approach focusing on the three public health goals and the four-healthcare access dimensions: geographical accessibility, affordability, availability, and acceptability.
Results: PPM, COP and Health financing policies reduced financial barriers and improved access to health services for the poor in the study counties. However, for many it was limited, and this limitation was a barrier limited the extent to which they benefited from these reforms. Responses on barriers were: Staying with members of an extended family/clan was a burden, long distances, expensive medication, lack of food, lack of public transport, poor condition of the roads and high transport costs especially in rural areas limited access to health facilities. Continued charging of user fees despite their abolition, delayed insurance reimbursements to health facilities where beneficiaries were seeking care from, and informal fees exposed the poor to out of pocket payments. Stock-outs of medicine and other medical supplies, dysfunctional medical equipment, shortage of healthcare workers, and frequent strikes adversely affected the availability of health services. Acceptability of care was further limited by ridicule from the healthcare providers, discrimination by healthcare workers and ineffective grievance redress mechanisms which led to a feeling of disempowerment among the poor. Conclusions: Pro-poor health financing reforms improved access to care for the poor to some extent. Low-Income friendly reforms can be effective, there is a need to address barriers to healthcare seeking through addressing the civil, social, political, economic, cultural and gender determinants. This in turn leads to full engagement by all actors.
Conclusion: When communities are fully engaged, it creates a feeling of being connected to one another individually and feeling part of a bigger purpose as a team working together on a collective endeavour. When everyone feels recognized and appreciated, they are motivated to collaborate, and this addresses social isolation. Empowering community members to be part of the efforts to eradicate HIV, TB and Malaria by 2030, enables them to rethink their role and giving agency and autonomy to be innovative and entrepreneurial — to lead new projects and shape their own contributions to the effort instead of having tasks imposed on them in a top-to-bottom approach.
METHODOLOGY: Key Informant interviews of 22 refugee respondents who have been in Kenya since 2016. Literature review of 100 dailies from September to October 2019 on minority and marginalized strategies and counter strategies to address inequality, promote visibility and inclusion.
FINDINGS: Minority inclusivity requires understanding of the politics of popular vote; and organizing for movement building to address systemic injustices with refugee input. They participate in poverty eradication drives; access health, opportunities for housing, affordable education, participation in livelihood activities and demand for quality before the law.
CONCLUSION: Humans are connected to animate and non-animate worlds (Ubuntu wisdom). These connections are market-places. Governments can promote contexts for harmony (equality enforcement) and stabilize institutionalized service delivery. This builds a culture of justice which defends civic, religious and identity-related freedoms and enshrines protections. Leading, to economic emancipation, humanization of refugees and asylum seekers.
RECOMMENDATION: Research into services targeting refugees influence engagement in economic activities will throw light on social mobility and economic prosperity.
Grandparents are living longer, staying stronger, avoiding being loners but their pockets are not deeper. This study used context specific methods to generate the character of the unique socio ecological contexts in which Grandparent Headed Households (GHH) thrive, ensure survival and sustenance turning these households into spaces for the development of culturally-appropriate interventions that might impact their health and the health of those in their care.
Methods:
This qualitative descriptive study was based on the conduct of in-depth, semi-structured interviews and Focus Group Discussions with 92 grandparents residing in Kiyovu village (Rakai) (22) and Kimaanya (Masaka City) (70), who are the primary caretakers for grandchildren. A rapid appraisal was used to identify the households; key informant interviews were conducted based on the premises of the Life course perspectives and the Social Ecological Model (SEM). The basic assumptions were that enabling and responsive contexts including intrapersonal, social-cultural, organizational, and policy factors influence individual health and health practices and that these influences are interrelated and reciprocal. Data was analyzed by the research team using line by line coding of the audio recorded transcriptions of the interviews.
Findings:
All ninety-two (92) respondents had grandchildren under their care. 13 households had both grandparents; 52 were grandmother headed households; and 25 were grandfather headed households. 75 Households had 8 grandchildren and above with some not biological relations; 15 had 5 grandchildren; 2 had 4 grandchildren each. All 92 claimed that assumptions of invincibility prevail in many Ugandan communities yet GHH experience both barriers and facilitators to maintaining the healthy lifestyles; 80 claimed prestige connected to being a GHH, which is a space invigorating self-esteem, self-respect, self-recognition and self-preservation. 12 claimed that being a GHH is not enough without economic sustenance. They relied on formal and informal networks to help with caretaking responsibilities. All 92 stated that they experienced notable barriers to self-care and personal health related to having the primary responsibility of their grandchildren, including lack of resources and unresolved traumas due to loss of their children who are the biological parents of the grandchildren.
Conclusions:
GHH are increasingly taking up care roles but this is making grandparents more vulnerable to health threats elevating their risk for many chronic diseases.
Recommendation:
There is need for a health and ageing policy in Uganda to promote health related interventions targeting seniors/elderly persons because many are ageing actively.
More and more people are settling in semi-urban or rural communities. This is the case of Greater Masaka Region of Uganda which is the bread-basket of Uganda. But it was an epicenter for the spread of HIV with numerous high prevalence and hotspots such as Lyantonde, Lukaya, Kasensero, Kalangala, Kyabakuza and Nyendo in the 1980s. But, with the advent of ARVs more people are living longer and able to engage in productive lifestyles as well as get sustenance. The aim of this study was to characterise factors that affect uptake of medicines against TB, Malaria and HIV in three districts that make up the Greater Masaka Region. At the same time, this study characterised the different experiences at a time when more people are living longer, ageing with HIV and resettling in rural Ugandan communities.
Methods:
99 long HIV Survivors followed since 2010 and who made a conscious decision to live in rural communities were enrolled in the study. Thirty-three (33) from Rakai (20 females: 13 males); 33 from Ssembabule (13 males: 20 females); and 33 from Kyotera (25 females: 8 males). Context-specific methods used for data collection were: Rapid Appraisal; Semi-structured Interviews; Focus Group Discussions; Exit Interview for sharing information between health seekers and providers; and using a quantitative survey instrument embedded with qualitative questions to characterize responses. Interviews were transcribed and analyzed using descriptive statistics and deductive-inductive content analyses. A ranking of responses informed our results.
Results:
In all 3 districts, Hunger (95); Food security (76); Housing stability (72); Transport costs (71); Waiting time (71); Access to treatment (67); Community Health Volunteers (55); and Adherence Counsellors (54) were highlighted as enablers or disablers to uptake of services and adherence.
In all 3 FGDs, Hunger (15); Food security (12); Housing stability (12); Transport costs (11); Waiting time (11); Access to treatment (10); Community Health Volunteers (5); and Adherence Counsellors (4) were highlighted as enablers or disablers to uptake of services and adherence.
10 Health-workers who were identified as Key Informants highlighted: work-related pressures (10); attendances and appointments (9); Stockouts (9); access to social support networks (8); access to treatment (9);and access to counselling (8) were enablers and disablers to uptake of services and adherence on top of Hunger (10); Food security (10); Housing stability (10); Transport costs (10); Waiting time (10); Access to treatment (10); Community Health Volunteers (5); and Adherence Counsellors (6).
Conclusion:
Ageing with HIV is a risk factor for heart disease and diabetes. Deterioration of adherence may compound life of people ageing with HIV due to social determinants of health. This contributes to optimal and sub-optimal prevention decisions across the three diseases (TB, Malaria and HIV). Future studies should explore how prevention interventions may address risks and vulnerabilities to avoid drug-resistance or sub-optimal adherence.
In predominantly heterosexual settings, anal-sex debut disinhibition and subsequent repeat events are not frequent topics yet these events are mentioned anecdotally. This study sought to find out how knowledge of the benefits of VMMC can be a motivator or demotivator drive uptake of Voluntary Male Medical Circumcision (VMMC). VMMC has several benefits which include reducing vulnerability to acquiring cervical or anal cancer, HIV, STIs among sexual partners.
Methodology:
A big N (110); purposive study of sexually active female and male spouses/partners whose male spouses were legible for circumcision; screening out those with views against circumcision; enlisted Peer Counsellors engaged in direct interventions to be our key informants (10); and the use of Focus Group Discussions (FGDs).
Findings/Results:
Several reasons for discouraging their male partners arose: low (10 responses) reduced penis size; medium (30 responses) loss of self-esteem; high (80 responses) sex starvation (depravation of conjugal enjoyment). Eighty (80) which is 73% of the respondents claimed that sex starvation during the period of healing was the reason to why they didn’t support their male partners to opt for this operation. FGD outcomes revealed other demotivators: sixty-six (66) which is 60% said that insertive role spouses are the bread winners, they claimed the healing period takes long hence impacts sex-for-finances favours; forty (40) which is 40% asserted VMMC reduced the penis size after the fore skin is removed hence reducing sexual pleasure and make it painful for because circumcised males took long to reach orgasm; thirty (30) which is 30% remarked that they preferred their men unique due to the fact that circumcision was a preference for the majority of people. They added that circumcision would make the spouses a choice for other people who preferred circumcised men. Twenty (20) which is 20% remarked that they had reached the period where sex wasn’t the principal entity in their marriage so there was no reason for a man to circumcise unless he has some other people outside their marriage (infidelity). Ten (10) which is 10% said VMMC was a method brought to Africa to make men impotent. On the VHTs, five (5) mentioned that women who don’t not accept husbands to go for circumcision give starvation as the main reason; (3) said the main reason was that they had fear of impotency in their husbands; and two (2) claimed VMMC fueled infidelity.
Conclusion:
Lack of conjugal enjoyment during the3-4 weeks of healing may be a cause of disputes which spill into Sexual/Gender-Based Violence (SGBV). In addition to sensitization, people need to learn and understand the advantages of circumcision, further research on how partners can become champions of circumcision as a component of the HIV prevention continuum in high-risk hetero-bisexual populations in Uganda is called for.
Methods: A qualitative study, using administered questionnaires to 42 persons in 3 Community Based Organizations (CBOs) who were followed for 12 months (August 2021-July 2022), anecdotal recollections and desk review of literature on unique Refugee Status Determination (RSD), HIV/AIDS, TB and SRH issues.
Results: In a post-COVID19 era, Refugee-Led CBOs are opportunities for empowerment that facilitates optimal health outcomes but these are impacted negatively due to issues are unstable housing, unsecure nutrition, lack of livelihood projects, living in fear, restricted liberties, no routine targeted sexual reproductive health services and no disposable cash to be used for transport to facilitate timely and regular clinic attendance reduce instances of catastrophic events and meeting the needs.
Conclusion: Culturally sensitive integrated service delivery targeting refugees is missing yet it catalyses quality life and optimal care outcomes.
Introduction:
Between April 2022-November 2022 we collected all reports to analyse them for iteration that addressed apparent fitting in with international and local TB Prevention goals and Health Promotion work.
We have the following aims:
-gauge progress toward defeating HIV, TB and malaria and ensure a healthier, safer, more equitable future for all.
- informing interventions in low-and middle-income countries-based contexts and actors such as government, civil society, international organizations, private sector actors, academia, media and cultural institutes.
-translate the lessons to improve evidence use in TB Prevention health policy programming and planning.
-showcasing local application of strategies for ensuring Broadness, Evidence, Boldness and Advocacy (BEBA) iterative tools to meet the needs and preferences of TB affected in Kenya, Tanzania and Uganda.
Methodology:
The engagements included: the development of an in-house health promotion cultural stimulation tailored along the days of the week: 32 Lung Health-Mondays; 32 Trek, find, test and treat Tuesdays; 32 Wellness Wednesdays; 32 TB Thursdays; 32 Fix-it-N-Fit-in Fridays; 32 Saturate best practices Saturdays; 32 Self-care Sundays; 123 physical Focus Group Discussions; attending 12 Virtual-based Public dialogues (2 Uganda-based; 8 Kenya-based; and 2 Tanzania-based); 102 Zoom meetings; and literature reviews of 305 internet and email-based correspondences; 27 Organization Development trainings; and working with 187 CBOs (founded by women, youth, adolescents, TB Affected Persons, PLHIV Positive Clubs, TB Survivor Clubs, People With Disabilities, Refugee-Led Organisations, working with Soccer/Football Clubs and other entities).
Conclusion:
Our motto is: Think local and act global. Our work showcases local examples that cascade into international goals. We hope with this kind of information, consumers will access the kind of healthcare-related data they will use to inform decisions for preventing diseases, prolonging life and promoting health at different levels, engage in practices promoting their own health and the health of others.
Three (3) specific achievements made in progress towards TB elimination by our organization since 2018 are:
1. Mainstreaming Global Fund funding aspirations in 1,187 CBOs in 25 African countries through Organisation Development trainings.
2. Strategic Public Health Promotion to ensure science and lived experience stories inform each other.
3. Animate "leave no one behind" through affirmatively working with Key Populations, Vulnerable Populations, Priority Populations; Injecting, Drug, Alcohol and Substance Users; Persons with co-morbidities; Persons with Disabilities and Refugees.
We saw little to no progress toward TB elimination due to the following challenges which we feel impeded progress:
1. Support for Housing stability for 197/302 Persons with TB (beneficiaries).
2. Support for food security for 231/578 beneficiaries.
3. Transport vouchers to attend clinics following a Positive AAFBs test for 172/263 beneficiaries.
Recommendation for national and global decision-makers to address TB in the communities:
TB should be considered as both a Clinical manifestation and a non-clinical (civic, cultural, political, social, economic and gender) enabling and responsive contexts.
• Reaching all people through TB detection, diagnosis, treatment, care and prevention
1. Strategic Reach Out: Use various means to reach beneficiaries such as football, community events, market days, music, dance and drama and talent exhibition events to attract beneficiaries.
2. Testing: A move away from the microscope to molecular tests.
3. Treat: treatment that addresses all demography and vulnerabilities of the populations, e.g., Children, adolescents, adults, seniors, persons with disabilities and the like.
4. Detection: Detect Drug sensitivity; Drug resistance; and other barriers to healthy outcomes
5. Care: People centered care that addresses needs and preferences for all TB affected persons as well as no to stigma/discrimination.
6. Prevention: Primary/Secondary/Tertiary/Quaternary Prevention at upstream, midstream and downstream levels (comprehensive approach).
• Accelerating the development of, and access to, essential new tools to end TB” (e.g., rapid molecular tests, vaccine, digital tools for real-time data)
1. Provide ICT literacy and numeracy skilling.
2.Rapid molecular tests, vaccine and New Medicines provided at subsidised costs at all levels of health facilities.
3. Provide nutrition advise and address hygiene needs and preferences.
• Investing the funds necessary to end TB (e.g., domestic funding, Global Fund)
1. Involve public and private institutions; Commit to making the investments as well as improving community-built structures.
2. Committing to accountability, multi-sectorality and leadership on TB (e.g., from Heads of State, country coordinating mechanism).
3. Involve all actors in promoting TB Prevention and elimination activities.
• Leveraging COVID-19 as a strategic opportunity to end TB
1. Ensure housing stability
2. food security
3. livelihood projects
4. eco-conservation
• TB response be strengthened or transformed in a post-pandemic world as follows:
1. Provide funds, logistics and training to grassroots-based organisations to engage in End TB goal-oriented activities.
2. Improve community-built structures.
3. Housing stability, food security, livelihood assurance and eco-conservation must be emphasized.
Design/Methods: We administered a structured short questionnaire to respondents and conducted 5 focus group discussions inquiring into services and what the unique characteristics attributed to at-risk groups were. Respondents included: 650 MSM, 11 lesbians, 3 indigenous MSM from Benets and 7 Ndorobo tribes, 71 regular substance users, 47 were living with TB, 02 intersex, 05 transgender, 195 female sex-workers, 82 fisher folk and 150 leaders.
Results: At-risk population groups face barriers determined by socioeconomic standing, lack of insurance, safety concerns, social norms, family obligations, shortage of culturally sensitive/trained personnel in the service sector, and services or equipment that are not adapted to address the diverse needs and requirements representative of at-risk population groups. Identity and gender shape access, use, adherence and outcomes of prevention, curative, and care services. At-risk population groups faced hardships accessing opportunities for Universal Health Coverage and engaging in HIV Prevention practices. The difficulties were enhanced by ridicule, frequent residential changes, difficulty in accessing services such as sex/gender re-assignment, violence, abuses, religious and media-led stigmatizing campaigns. These affect agency, self-determination, productivity, autonomy and health seeking practices for individuals in these at-risk groups.
Conclusions: Identity or gender-responsive and culturally sensitive services leverage Universal Health Coverage and attaining of Sustainable Development Goal 3. A further disaggregated study into how each at-risk population group is affected can inform programming to challenge injustices pandered by criminalization. Summary: The socioeconomic standing or social spaces (towns, suburbs of Kampala, CBOs/CSOs/FBOs/ LLGs, Village Health Teams, men and young males’ board game spots, repair garages, furniture marts, and kiosks}; security, as well as political, legal, cultural and media organs impact health seeking practices of at-risk populations e,g., those with TB.
Studies show that Persons who were living with TB upon testing negative after completion of medication need further support. That support comes with costs and in this study, we find out that the costs are characterized as: social, spiritual, psychological, mental, physical, financial, and cultural aspects which must be fulfilled to ensure completeness and full recovery. We followed 197 Persons in 6 TB Survivor Support Clubs in Kenya to characterize the costs and pathways to care after a negative TB evaluation.
Intervention or response:
A person recuperating needs reconnection, reassurance and counselling which restores dignity and at the same time prepares them for self-esteem building. These individuals return to the clinic or hospital for regular check-up, rebuild and reconnect with members of the social networks and pursue means to support themselves. We conducted a cross-sectional study of 197 patients with a negative TB evaluation at six (6) TB Survivor Support Clubs in Machakos, Kajiado, Nairobi Counties. Patients were traced 9 months post-evaluation using contact information from TB registers. We collected information on healthcare visits and implemented locally validated cost characterizing questionnaires to assess the social, psychological, mental, physical, cultural, and financial impact of their symptoms post-evaluation.
Results/Impact:
197 (100%) surveyed participants returned to healthcare facilities post-evaluation, with a median of 3 visits each. All incurred catastrophic costs (i.e., spent >30% annual household income); 100/197 reported indirect costs related to lost work. All 197 responded that costs are incurred before and after they test negative are financial, social, cultural, mental, psychological, and physical.
Conclusion:
Costs after a negative TB evaluation need to be captured by existing definitions of non-TB catastrophic health reports as these affect biosocial-cultural-medical facets of life. This can inform better policy, planning and programming if we are to eradicate TB by 2030and shows the relevancy of TB Survivor Support Clubs. Summary: TB Survivor support comes with costs characterized as: social, spiritual, psychological, mental, physical, financial, and cultural aspects. We followed 197 Persons in 6 TB Survivor Support Clubs in Kenya to characterize the costs and pathways to care after a negative TB evaluation.
DESCRIPTION: A 9-month cross-sectional study, using contacts to regularly check compliance to strategic plans, updates of record books, checklists and minutes to track community outreach events promoting prevention.
LESSONS LEARNED: The report indicates that the CBOs connected beneficiaries to HIV testing, access to treatment, promoting care, referrals for non-communicable diseases care, attending clinic check-ups for viral suppression and uptake of integrated services including addressing vertical HIV transmission, SRH services, dental and ear, Family planning, spacing cancer screening, paediatric AIDS and other services. It is clear that the 7 CBOs were the constant reminders and motivation to adherence during the COVID-19 lockdown and during the easing for 784 Persons Living with HIV and 54 Living with TB. Through constant visibility and mobilization, they maintained a food supply-chain, checked in on each other and mobilized money which sustained 48 who would have faced housing instability and food insecurity.
CONCLUSIONS: Grassroots-based systems can be leveraged as health and social protection continuum spaces. This in turn supports wellness, livelihood, and enabling environments for people living with, at risk of, or affected by HIV to reduce inequalities and allow them to live and thrive.
Methodology: Between October 2021 to September 2022, we interacted with people using different methodologies such as Key Informant interviews (in our case: 2,930). We were able to characterize lived experiences, impacts, explored synergies and identified solutions and respondents’ priorities.
Findings: Communities have indigenous solutions to most of their needs and have ways to navigate the different categories of supply chains through identified resources. The resources are the local systems and structures which can be tapped into to address issues as they arise. All respondents revealed that family members, extended families or clans, support groups, area leaders (at traditional, cultural, civil society, religious, educational, industrial or production levels), local government structures (social services, roads, security, and state structures) and development partners included what they understood as PPM and COP.
The needs expressed at individuals, households, communities, local governments, and sectors levels feature a broad array of multi-scalar and multi-temporal, social, political, economic, and environmental determinants which may act as facilitators of barriers to the Zero HIV, TB, and Malaria by 2030 goal.
Conclusion: This presentation forms a conceptual framework that can be used to facilitate assessments and comparative analyses of vulnerability, develop a comprehensive typology of an enabling and responsive context. Our results reveal essential elements of a pragmatic approach for local- or wider scale vulnerability analysis and for planning appropriate solutions within the context of multiple interacting determinants.
Recommendations: This review focuses on community understanding of PPM and COP as aspirations of the Global Fund. However, the framework, typology and approach will be useful for understanding civil, economic, political, cultural, gender and social determinants as we strive for zero HIV, TB and Malaria by 2030.
Methodology: Key informant interviews of 145 respondents, characterizing of vulnerability, appropriation, and adaptation through data appraisal.
Findings: All access anti-malarial services. 12 are injecting drug users; 32 are People living with sickle cell disease (SCD), 12 use tramadol infusion IV combined with nonopioids was effective to relieve moderate to severe pain due to Vaso-occlusive crisis and 10 had mild VOC-associated pain that required non-steroidal anti-inflammatory drugs (NSAIDs) e.g., Diclofenac and ibuprofen. All 67 PLHIV were virally suppressed and were provided TB Preventive treatment: 65 in all receive pain relief support; 10 have antidepressant withdrawal effects following tapering and use. 13 Persons with Epilepsy received medication, counselling about epilepsy, capacity building to live positively with epilepsy, and self-esteem building sessions. For Key, vulnerable and priority populations, harm reduction goes beyond just drugs because they need other support services such as transport to/from clinics, constant follow up, stable housing and food security.
Conclusion: A broad array of multi-scalar and multi-temporal, social, political, economic, and environmental determinants form the comprehensive typology of drivers and vulnerabilities experienced by the respondents. This in turn informs the essential elements for planning appropriate interventions.
Recommendations: This review provides insights for a framework, typology and approach useful for understanding vulnerability and planning adaptation to multiple vulnerabilities of different Key, vulnerable and priority populations in various social-ecological contexts.
There is a disparity of expectations between TB care and Prevention service providers and the beneficiaries. Between January to September 2022, we conducted community-wide-active-case finding, engaged in planned activities to reduce prevalence of TB such as linking those in need to care services and promoted practices geared at reducing risk of getting TB at individual and household levels for 10 identified communities. The international TB Treatment Goals are testing; treatment; adherence until cured. But the local realities are different. This paper seeks to showcase the localized needs of Persons living With TB in Uganda, Kenya, and Tanzania.
Method:
We reached 1,120 persons (200 in Tanzania; 600 in Uganda; and 320 in Kenya). 591 had tested negative following completion of TB treatment and were part of TB Survivor Clubs; 521 were on TB treatment medication. The COVID-19 Pandemic has had a negative impact on health seeking practices of the people already made hard by civil, social, economic, political, cultural and gender determinants.
Findings:
All respondents living with tuberculosis had zero monthly income but relied on the community social support and philanthropy networks. 591 admitted that they almost discontinued their medicines because of housing instability (120); food insecurity (140); and loss of economic livelihood (70). 70 admitted that engaging in eco-conservation friendly projects were opportunities for them to regain their self-esteem in communities that tended to stigmatize Persons with TB or an active TB history.
Conclusion:
community-wide-active-case finding, engaging in planned activities to reduce prevalence of TB such as linking those in need to care services and promoting practices geared at reducing risk of getting TB at individual and household levels foster Tuberculosis elimination programmes. Such practices address income loss for households and restoration of income which impact self-esteem, housing stability, food security and eco-conservation programmes.
Recommendations:
Planning, programming, and policy priorities must target the civil, social, economic, political, cultural and gender determinants which are key in ensuring the well-being of those living with tuberculosis or have got cured and have a negative TB diagnosis but need to be part of the TB Survivor Clubs to avoid relapse.
Facilitate TB prevention vaccine development, Prevention Literacy to inform health seeking habits, stabilize housing, ensure food security, empower people to take charge and participate in efforts to end TB epidemic. Tuberculosis (TB) is an ancient disease; widely distributed across the world; and is the leading cause of death from bacterial infections. TB’s unclear pathogenic mechanisms, difficulty in screening for specific antigens, lack of ideal adjuvants, and the limitations of animal models make it harder to get a vaccine yet. Outcomes of TB are related to its virulence and the immunity of TB patients. Due to adverse effects, co-morbidities and social determinants of TB, without effective vaccines prevention is better than cure (Singh-Minot, et al., 2008; WHO, 2024; Zhuang, et al., 2023; 7 Zumla, et al., 2013).