CAPE TOWN, South Africa – It wasn’t necessarily the health system in Zimbabwe that saved Constance Manwa when she was diagnosed with multidrug-resistant tuberculosis two years after being diagnosed with HIV. While an integrated care system had detected her HIV when she went in for prenatal care, the same system failed to quickly diagnose her MDR-TB, only correctly diagnosing her condition five months after she showed symptoms. At that point, Manwa was emaciated, relying on a walking stick and leaning on her mother to walk.
What saved her, Manwa said on Friday at the Union World Conference on Lung Health, was the support she received from community groups, and from caring health care workers who went the extra steps needed – beyond medical care – and gave her the strength her to continue taking treatment when the 22 pills she had to take daily made her feel weak and dizzy, along with other debilitating side effects. Two years later, Manwa is free from TB.
It’s the kind of community support and engagement Manwa received that is the key to ending the HIV and TB epidemics, other panelists said at the plenary session. No longer can the HIV and TB responses rely on medical solutions, Mark Dybul, head of the Global Fund to Fight AIDS, TB and Malaria, said. “These are not purely medical diseases, these are diseases of societal injustice,” he said, and the answer to defeating these diseases lies in addressing the societal enablers that drive the epidemics, from poverty to gender inequality to LGBT discrimination.
“Appropriately, a lot of emphasis is placed on health systems and universal health coverage, but if we see a health system as ending in a clinic or hospital, we will fail in these diseases and most diseases,” Dybul said.
“Health systems can exclude and discriminate,” he said. “We need to bring communities to the center.”
Going deep into communities to reach people with the services they need and lift them up with support, Dybul said, is the best way to break down the societal barriers that drive disease, particularly the barriers that drive the epidemics among sex workers, LGBT communities, migrant workers, and even young girls in sub-Saharan Africa, who with disproportionately high rates of HIV, Dybul said, are a marginalized, vulnerable population.
He offered TB Reach as an example of effective community outreach. The Stop TB Partnership’s program has decreased incidence and increased TB case detection rates from an average of 33 to 50 percent in communities with TB Reach projects, and it’s this type of community-based intervention the global TB and HIV responses need right now, Dybul said, instead of relying on old systems and hospitals and clinics.
“A number that drives me crazy is the 20 percent funding gap in global tuberculosis control,” Dybul said. “We have a 20 percent funding gap and a 1.5 percent decline in new infections every year, how do I explain to policymakers that we can get to a 90 percent decline with just 20 percent more money?” he said.
“We need more money but if we invest the money for better programs that reach into communities, we can drop the rates rapidly enough that in the long term, we’ll need less resources,” Dybul said.
Manwa is now a volunteer social worker who provides support to other people living with and affected by HIV and TB. She said it’s helpful for people when they talk to her because when they see that she is healthy and living a fulfilling life, they become hopeful that they can manage their own illnesses.
“People tend to listen more to people who are in the same situation,” she said, “rather than the professionals who are reciting things they learned from books to them.”