Empowering Marginalized Populations through Comprehensive TB Services: EGPAF-Lesotho Technical Assistance Support to Matrix

In 2009, members of Lesotho’s LGBTQIA+ community founded a non-governmental organization (NGO) to advance the human rights of themselves and their peers. Matrix serves this priority population with a diverse set of programs that span health promotion, clinical services, and political advocacy.

Chief among its services are TB prevention and screening and gender-based violence (GBV)/ intimate partner violence (IPV) interventions. All its efforts are framed by the larger organizational mission to create an environment in which LGBTQIA+ persons enjoy safe and meaningful engagement with society.

Technical Capacity Assessment

Matrix’s Technical Capacity Assessment revealed gaps in both clinical and non-clinical areas. These gaps included competencies that the organization itself knew to be lacking based on the major challenges it faced.

Lay workers’ technical understanding of various TB symptoms and case presentations limited their ability to use national screening tools. This resulted in low confidence about their skillsets and their roles as health educators. These factors had a tangible influence on programmatic success.

Training of Trainers

EGPAF held theoretical and practical training sessions that focused on TB screening for adults and children. The theoretical training was informed by EGPAF’s signature approach of intensive case finding for TB, directly addressing Matrix’s need to scale-up screening for this demographic.

In the practical sessions, participants applied their newly acquired knowledge by practicing their screening skills, determining TB preventive therapy (TPT) eligibility, and educating clients about their risk of TB infection. Matrix staff then conducted step-down training sessions at the community level for lay staff in all 10 districts.

Ultimately, the tailored technical training helped lay counselors:

  • Understand potential presentations of TB infection
  • Use screening tools to identify adults and children eligible for TPT
  • Educate clients about TB prevention methods (e.g., cross-sectional ventilation) 
  • Remain cognizant of the need to discuss TPT with children below age 15 and clients who are newly HIV diagnosed and/or not virally suppressed

Prior to EGPAF’s TB training, Matrix did not initiate clients on TPT. Now Matrix ensures that every client who tested positive for HIV is referred to health centers to initiate on TPT. Immediately after the training, 7 clients tested positive for HIV and all were placed on TPT at their drop-in center. 

TA Activities: Mentorship and Supportive Supervision

EGPAF leveraged other aspects of its capacity building model to ensure Matrix could sustainably implement the knowledge it gained through training. The partner received ongoing support at the district level via mentorship and TA in the area of supportive supervision.
These approaches preserved a culture of formal and informal discussions between EGPAF and Matrix staff, making it easier to track progress and solicit feedback. This transparency was particularly beneficial as the local partner worked to refine its existing supervision mechanisms.

Peer staff had previously reported feeling demoralized by healthcare workers who did not deem them knowledgeable enough to offer TB education services. Step-down training helped Matrix empower lay staff with enhanced technical capacity in TB preventive services. This change was then affirmed through supportive supervision, as staff members were recognized for their improvements and encouraged to seek any help needed to further refine their skills.

Self-Reliance

EGPAF also used mentorship and supportive supervision TA to strengthen Matrix’s technical capacities in quality improvement / quality assurance (QI/QA) and Monitoring & Evaluation (M&E). EGPAF TA staff helped develop a QI action plan and a QI mechanism to monitor post-training TB screening through the EpiC project. In applying their new skills, Matrix M&E staff quickly noticed over-testing among adult clients and immediately launched a QI project to remedy the issue through risk prioritization. Ultimately, TA in the areas of mentorship and supportive supervision empowered this partner to take ownership of the capacity development process and address programmatic shortfalls from multiple angles.

Networking and Advocacy: Creating a Network of Sustainable Support Structures

Matrix’s increased self-reliance made it a better advocate for the local LGBTQIA+ community. Noticing some residual stigma among its lay staff, the local partner embarked on strategies to combat this issue at the national level. Recognizing stigma as a larger socio-cultural phenomenon that influences service provision in often insidious ways, Matrix opted to highlight this issue among key stakeholders. The Ministry of Health, international partners, and other local organizations were invited to engage in dialogue about the impact such factors exact upon the LGBTQIA+ community. By using these conversations to build informed, collaborative relationships, Matrix places itself in a better position to advocate for the people it serves. Moreover, it reminds EGPAF to constantly evaluate the extent to which its TA activities tackle the larger socio-cultural factors that can help or harm the mandate to scale up service quality and delivery.