Closing a Deadly Gap: How Patient Voices Restored TB Screening at Ndlavela Health Center

In April 2025, patients on antiretroviral treatment at Ndlavela Health Center revealed a dangerous gap: they were not being screened for tuberculosis. For people living with HIV, this is not a minor oversight — TB is the leading cause of death among people living with HIV worldwide, and without early detection, it can progress rapidly and silently. By missing routine screening during consultations, the facility was unknowingly leaving its most vulnerable patients exposed to a preventable death.

“I’ve been receiving treatment at this hospital for years, but I’ve never been screened for tuberculosis. That worries me deeply, because people with HIV are at high risk of contracting TB. It’s frightening to think I could have the disease without knowing it—and without receiving treatment. We already live with so much stress, and knowing that something so important was overlooked makes you feel abandoned and frustrated.”
Patient, 45 years old, resident of Ndlavela neighborhood

To address this challenge, the health advocate and members of the village health committee held a meeting with the health facility’s management, HIV clinicians, and the medical records team. As a result of this meeting:

• Patient file review: Clinicians, supported by the records team, were instructed to randomly review patient records that lacked confirmation of TB screening and to add a reminder note flagging the need to conduct screening at the patient’s next appointment.
• Waiting area interviews: The records team was instructed to conduct informal interviews with patients in the waiting area to identify those who had not yet undergone TB screening.
• Clinical protocol training: The HIV focal point conducted training on the national HIV care and treatment protocol, emphasizing the essential services to be delivered at each consultation — including TB screening.

These efforts produced rapid and measurable results. According to the latest update from the ART committee at the facility, more than 1,000 patients received TB screening between April and June 2025. Monitoring visits conducted by the health advocate and health committee members confirmed that patients were receiving TB screening consistently during their consultations.

“Hearing this from patients was a wake-up call. We didn't hesitate — TB screening for patients on ART is non-negotiable, it protects lives. We're grateful patients spoke up, and we're committed to making sure every person who walks through our doors receives the full care they're entitled to.”
Dr. Carolina Vasco, HIV Focal Point, Ndlavela Health Center