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Knowledge, Attitudes and Practices on TB and TB/HIV in Tanzania

In 2009, the MoHSW (through the NTLP) collaborated with PATH to conduct a
knowledge, attitudes and practices (KAP) study in ten districts across the regions
of Arusha, Mwanza, Dar es Salaam, Pwani, Morogoro and Mbeya. The aim was to
identify factors that infl uence communication to effectively promote combined TB and TB/HIV services in Tanzania. The study revealed a range of knowledge gaps, attitudes and sub-optimal health behaviours.

Accurate knowledge on the causes, symptoms, treatment and prevention of TB was low in communities, although much higher regarding HIV/AIDS. The relationship between TB and HIV/AIDS was poorly understood. For example, most people did not know that TB was a common opportunistic infection for HIV and many believed that responding well to TB treatment proved one did not have HIV. Most TB patients themselves had quite good knowledge about TB and HIV transmission, treatment and prevention, which was obtained only after they started attending TB and HIV care services at health facilities. While there were vigorous mass media campaigns and community based education about HIV, TB education was only seen in health facilities. Health education and promotion materials were insuffi cient and poorly distributed and the limited print materials available did not target the highest risk groups in the community.

Although people poorly understood the connection between TB and HIV, they feared both diseases and discriminated against those who had either disease. Individuals with TB or HIV are likely to be isolated and viewed as immoral and unworthy of resources. TB patients reported that stigma was widespread in households,communities and among healthcare workers in non-TB health facilities. While stigma attached to HIV/AIDS was regarded as worse, presenting symptoms of wasting, persistent cough and fever similar for both diseases are often misread as a sure indictor for AIDS. Stigma about HIV led to feelings of shame and lack of motivation to seek treatment for TB symptoms.

In general, the onset of symptoms like cough, weight loss, fever, etc. does not trigger timely search for TB or HIV care. Instead, patients delay seeking appropriate health care due to:
• Attempts at self-medication through local drug shops.
• Belief in traditional healers (who refer patients to health facilities only after their condition becomes serious).
• Slow referrals from health facilities to TB clinics.
• Lack of knowledge about TB and HIV, the importance of early diagnosis, and the
availability of free services for both TB and HIV treatment and care.
• User fees
Delayed or denied permission from husband or family elders. (among women)

People used a variety of media and communication channels to get information,
depending upon where they lived. Urban leaders preferred the use of radio, TV, and printed materials and those living in towns preferred to limit their involvement in community activities. People from rural areas, however, preferred direct involvement in awareness campaigns and the use of local entertainment groups.