TB awareness month: medication to the streets

Tuberculosis (TB) causes thousands of deaths in South Africa and abroad each year. The month of March is dedicated to raising TB awareness, culminating on March 24 when World TB Day is observed across the globe. In a weekly series, the Berea Mail will publish articles to raise awareness about TB. This week we visit Overport Clinic to find out more about TB treatment, testing and taboos.

DOCTORS had lost hope of treating Multidrug-resistant (MDRTB) patient, Thokozani Ndebele after she defaulted from treatment several times. Now she is two months away from completing her course and it’s all because of a peer-led accompaniment program run by Advance Access & Delivery (AA&D). Based in Greyville, AA&D SA is a local branch of the global organisation which runs programmes in India, Peru, Russia, and the United States.

Through their peer program, formerly homeless scouts, known as ‘peers’ locate TB patients living on the Durban streets and deliver medication with a meal. Medication is pre-packed by nurses at Belhaven Harm Reduction Centre, which was co-founded by AA&D, Durban University of Technology and the South African Network of People Who Use Drugs (SANPUD). It was founded in June, 2020, to treat substance abuse through methadone treatment. In October of the same year, AA&D launched the peer-led accompaniment program which now caters to seven TB patients.

According to Michael Wilson of AA&D, the accompaniment program draws on the work of the late, Dr Paul Farmer who pioneered the idea of patient accompaniment in the late 80s and early 90s in rural parts of Haiti, Peru, and Russia.

“This model takes the onus off the patient so that it’s not their job to collect the medication. This extends the reach of the clinic into the places where the patient lives. In some cases that is in homeless shelters or under bridges,” said Wilson.

As a TB survivor, AA&D social worker, Torres Luna said support is crucial in the recovery process. She works alongside peers in the program.

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“When I had TB, I didn’t default because I had shelter – I had a home where I could eat anything I wanted. Not only that, but I had emotional support when I wasn’t feeling well. That is what our peers do, they offer support. It’s easy to be patient for three hours at a clinic when someone is waiting with you. For the homeless, lack of support is a huge challenge along with a lack of food,” she said, “Food is the main reason homeless people default. Doctors will direct them to take pills after breakfast. Where are they going to get breakfast from?”.

Constant support is what makes the peer program successful.

“You can explain the six-month treatment to a patient, but they will still default because no one is supporting them emotionally. A peer is there from Monday to Sunday, making sure the patient takes their medication. Last year we successfully discharged about 10 patients who had been defaulters before they were enrolled in the peer program,” said Luna.

Trust is key to the success of the accompaniment program and peers are carefully selected.

“Ideally they would have some lived experience of life on the streets and shared experience of substance use. We came up with the idea of peers – people who know what street life is like, who understand what ‘hustling’ is. Peers understand that they may need to deliver medication to a patient at 06:00 because he will be hustling by 6:30,” explained Wilson.

The significance of support

AA&D works closely with Lancers Road Clinic and King Dinizulu Hospital.
“Often patients can’t stay in hospital for a long time because they are used to a life on the street. They end up absconding and leaving the hospital. We then enrol them in our program,” said Wilson.

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A contract is signed by both peer supporters and patients at the beginning of the program. Drug sensitive TB is treated for six months while MDRTB patients face a year to 18 months of pills.“It’s a mutual contract where the peer commits to to accompanying the patient, delivering medication and support on a daily basis while the patient agrees to invest in their treatment. It’s a beautiful relationship the peers have with their patients,” said Wilson.

How it all started

AA&D was founded in 2015 in the United States and Wilson, who moved to South Africa in 2018, met social worker, Torres Luna in 2020 during the Covid-19 hard lockdown when a methadone program was launched at the shelter for the homeless.
“During that time period, we realised that a lot of people staying on the streets were off their chronic medication. We quickly realised there were a number of reasons for this. People who live on the street have a very busy lifestyle. Taking time to go to a clinic means taking time away from their ‘job’. A lot of people think the homeless do not work, but actually, hustling is a job and someone staying on the streets doesn’t get time off,” he said.

To supporrt Tb patients in the programme donate soap, porridge, tooth paste, toothbrushes, juice or tinned food (with a pull tab). Donations can be dropped off at the AA&D office, Wheeler House (10 De Mazenod Road)between 09:00 and 16:00. Call Wilson on 076 187 2667.

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