Tuberculosis Prevention in Vulnerable Communities

“When a clinician thinks about a person affected by TB precisely as a person first instead of a ‘case to be reported’ or ‘a problem to be tackled,’ good things can happen.”

– Blanca Lomeli, Program Director, SOLUCIÓN TB


According to the World Health Organization (WHO), 10.4 million people became sick with tuberculosis (TB) in 2016 and 1.7 million died of the disease, making TB the top infectious killer of humans. The Stop TB Partnership’s Global Plan to End TB calls for at least 90% of people with TB – including key and vulnerable populations – to be reached, and for at least 90% of them to successfully complete treatment.

TB is mostly known for physical symptoms – like fatigue, a cough that lasts 3 weeks or longer, and coughing up blood – but what is less talked about is how it is also a social illness that can involve alienation from family members, isolation, and stigmatization. Tuberculosis prevention and care are critical to keeping communities healthy.

TB is an infectious disease that is mainly transmitted through the air when someone with the disease coughs or sneezes. Many people can have what is called ‘latent TB’ but never develop the TB disease. Those at high risk of developing TB include:

  • People with HIV infection;
  • Babies and young children;
  • People who are sick with other diseases that weaken the immune system (e.g. diabetes);
  • The elderly; and
  • People who did not complete TB treatment in the past.

While TB is curable, it requires a rigorous course of antibiotics over many months. Failing to take the medicine as prescribed can lead to antibiotic-resistance, making it harder to treat and making the prevention of tuberculosis more important than ever.

PCI worked in partnership with the National TB Program in Mexico to train community health volunteers to oversee TB medication intake; raise awareness about the disease so people with symptoms can access detection services; and empower those affected to seek health services, complete treatment, and fight stigma and discrimination. The 13 priority states across Mexico where PCI worked accounted for 65% of all TB cases in the country.

PCI has also collaborated with Mexico’s Ministry of Health (MOH) to strengthen collaboration with two priority programs: HIV/AIDS and Diabetes. Most TB cases in the country relate to these two diseases, making these co-morbidities even more difficult to diagnose. Mexico has been a pioneer in the Americas in TB-Diabetes prevention and control. PCI works with the MOH to ensure a person-centered approach to prevention and control, addressing stigma and discrimination, and also to strengthen coordination, detection, and control of TB and its key co-morbidities.

man wearing mask

Turning the Tide on TB

Juan González from Guadalajara, Mexico, didn’t know much about tuberculosis symptoms and prevention before he was diagnosed with the disease in 2011. He also didn’t know that he had diabetes, which affected his immune system and made him more susceptible to developing TB. He continued his work as a taxi driver until he had to be rushed to the hospital, where he received his dual diagnosis. Mr. González believes he was lucky to have received the care and support from dedicated TB workers from the Ministry of Health, whom PCI had been working with since 2006 to improve collaboration, prevention, and care for TB-diabetes and TB-HIV/AIDS cases. TB workers from the Ministry of Health carried out home visits to oversee treatment intake, provide the necessary information for prevention within and outside the household, and to advocate for those affected as they learned to navigate their new lives living with an infectious disease, until treatment was completed.

Health managers and workers from federal, state, municipality, and local health center levels received training to raise awareness about the needs of people with TB and the barriers they face to complete treatment, so services responded to their needs. New information on TB co-morbidities was also disseminated widely and effectively, so people seeking services for diabetes or HIV, for example, were tested for TB and vice versa.

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Creating Meaningful and Lasting Change

PCI’s SOLUCIÓN TB program to Health Systems Strengthening helped ensure success:

  1. Identifying and addressing needs at different levels of the health system;
  2. Ensuring that the voice of those affected was part of the analysis;
  3. Implementing capacity strengthening interventions;
  4. Engaging different programs and processes beyond TB (including laboratory services, health promotion, Diabetes and HIV/AIDS programs); and
  5. Revising and updating relevant policies to include new approaches.

Throughout project implementation, a strong emphasis on learning, data analysis, documentation and sharing was key to the improvements in collaboration that transformed TB prevention and care in the country.

Over the last few years, Mexico has become a pioneer in advocacy, communication, and social mobilization for TB in Latin America. More people with TB have been diagnosed and enrolled in treatment, and more people with diabetes and HIV/AIDS have been tested, diagnosed and referred than ever before, thanks to the improved coordination between TB, diabetes, and HIV/AIDS programs that led to better integration of services.

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