Community-led Differentiated Models for Tuberculosis/Human immuno deficiency virus Care in Hard-to-Reach Indigenous Communities
1
Programs, Letloa Trust, Ghanzi, Botswana
Popul. Med. 2026;8(Supplement Supplement 1):A559
ABSTRACT
INTRODUCTION:
Ghanzi district is classified as a high tb‑burden district with elevated tb notification rates driven by overcrowding, poor living conditions, alcohol and drug use, and limited access to health services. With a population of 56067 across 18 sparsely distributed villages, service delivery is logistically difficult. national estimates show high HIV prevalence (BAIS V 20.8% ages 15–64) with ghanzi recording 15.4%. letloa trust–kuru health implemented community‑led differentiated service delivery (DSD) models to improve access to integrated tb and hiv care in hard‑to‑reach communities.
METHODS:
in partnership with the national tb programme, FHI 360, and district health management teams, letloa trust integrated tb, hiv, RMNCH, and NCD services into community platforms. interventions included community medication refills (CMR) for clinically stable ART clients, community hiv care for unstable PLHIV, treatment interrupters and new ART initiates, and community tb care including DOTS, family DOTS and contact tracing. CHWs were trained in local languages to provide adherence support, PHDP‑aligned counseling and to serve as liaisons between facilities and communities. program monitoring captured service uptake, client counts and partnership indicators.
RESULTS:
the program supported 490 PLHIV through CMR and 250 PLHIV through community hiv care, while 133 tb patients received community tb services. outreach identified 220 female sex workers and enabled HIV testing for 350 individuals. strong facility‑community partnerships were established in ghanzi and charleshill and organizational capacity to deliver integrated community‑based tb/hiv services was enhanced.
CONCLUSIONS:
community‑led DSD models reduced travel burdens, decongested facilities and improved ART adherence, viral suppression and tb treatment outcomes while strengthening health system–community linkages. letloa trust’s culturally grounded approach demonstrates a scalable, indigenous‑led pathway to advance progress toward the 95‑95‑95 and tb epidemic control targets.
Ghanzi district is classified as a high tb‑burden district with elevated tb notification rates driven by overcrowding, poor living conditions, alcohol and drug use, and limited access to health services. With a population of 56067 across 18 sparsely distributed villages, service delivery is logistically difficult. national estimates show high HIV prevalence (BAIS V 20.8% ages 15–64) with ghanzi recording 15.4%. letloa trust–kuru health implemented community‑led differentiated service delivery (DSD) models to improve access to integrated tb and hiv care in hard‑to‑reach communities.
METHODS:
in partnership with the national tb programme, FHI 360, and district health management teams, letloa trust integrated tb, hiv, RMNCH, and NCD services into community platforms. interventions included community medication refills (CMR) for clinically stable ART clients, community hiv care for unstable PLHIV, treatment interrupters and new ART initiates, and community tb care including DOTS, family DOTS and contact tracing. CHWs were trained in local languages to provide adherence support, PHDP‑aligned counseling and to serve as liaisons between facilities and communities. program monitoring captured service uptake, client counts and partnership indicators.
RESULTS:
the program supported 490 PLHIV through CMR and 250 PLHIV through community hiv care, while 133 tb patients received community tb services. outreach identified 220 female sex workers and enabled HIV testing for 350 individuals. strong facility‑community partnerships were established in ghanzi and charleshill and organizational capacity to deliver integrated community‑based tb/hiv services was enhanced.
CONCLUSIONS:
community‑led DSD models reduced travel burdens, decongested facilities and improved ART adherence, viral suppression and tb treatment outcomes while strengthening health system–community linkages. letloa trust’s culturally grounded approach demonstrates a scalable, indigenous‑led pathway to advance progress toward the 95‑95‑95 and tb epidemic control targets.
| eISSN: | 2654-1459 |
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