How Peer Counseling Strengthens TB Treatment in Peru

Note: The following was originally published in Spanish on Socios En Salud's blog.

Sometimes, when she accompanies a person affected by tuberculosis (TB), Marlene Osorio can tell when someone has taken their medication and when they've missed a dose or two. It's not intuition, but memory. Almost ten years ago, she had the disease and, at one point, hid one of the many pills she had to take every day.

"Every person with tuberculosis experiences something I've also experienced," said Osorio. She still remembers how, after recovering, she felt a tireless curiosity to better understand what she had been through. "As a person with tuberculosis, a lot of things happen to you, and that's when you need other people," she said.

She decided to join the Organization of People Affected by Tuberculosis-or Organización de Afectados por la Tuberculosis (OAT) in Spanish-to provide support to people with TB in Peru who, like her, were seeking help from someone who had experienced the disease firsthand, faced difficulties accessing health services, and overcame the many challenges of their care.

This experience encouraged her to join an intervention in 2023 that was aimed at developing a pilot program for peer counseling for patients with TB. Implemented by Socios En Salud, as Partners In Health is known in Peru, in coordination with the country's Ministry of Health and the National Multisectoral Health Coordinator, this initiative is part of the 2022-2025 TB-HIV Country Project.

As a first step, Osorio completed the TB peer counseling course, the Curso de Consejería de Pares TB, offered through the pilot program to strengthen her skills. Since October 2024, she and her classmates have been providing counseling sessions in health facilities in northern Lima.

Peer counseling is a support strategy in which trained individuals-known as peer counselors-who have recovered from TB or are in the final stages of treatment to provide emotional support and guidance to others affected by the disease. Their role is crucial in TB prevention and TB care, as it helps improve treatment adherence and increases the likelihood of current patients successfully recovering.

"In my time, apart from my family, I lacked even one person who would listen to me. My case was terrible, as my treatment for multidrug-resistant tuberculosis (MDR-TB) lasted almost two years," said Jessica Palacios, who was cured of TB 15 years ago and is now part of an OAT in the Villa María del Triunfo district, southeast of Lima.

Like Osorio, Palacios was one of the 34 people invited to participate in the course's pilot. With a decade of experience as a peer counselor, she says the training has provided her with valuable tools.

"The teaching we've received follows guidelines, methodology, and dynamics," she said. "Helping others is what has motivated me. I give a little of my time to the patients, I listen to them, we talk, we gather information, we exchange experiences."

Empower to Transform

TB remains a public health problem in Peru. Despite effective treatments, their success is hampered by inconsistent follow-up and the vulnerability of those affected. In 2020, 4.6% of TB patients discontinued treatment, and in 2019, the attrition rate for MDR-TB cases reached 18.5%.

For this reason, Peru's Ministry of Health incorporated peer counseling into its technical strategies as part of the guidelines for TB prevention and control. This program promotes health with a focus on human rights, equity, and cultural sensitivity.

"It highlights the importance of accompaniment, education, and psychosocial support to strengthen treatment adherence and TB prevention," said Diana Yupanqui, training specialist for the Country Project.

"When we present ourselves as people who has been through the same thing, people are more willing to listen to us-unlike when they receive instructions from medical personnel," explained Sofía Canchari, a peer counselor who had TB 15 years ago and is taking the TB peer counseling course this year.

Both times the course was offered-the first in 2023 and the current session in 2025-a call for applications was held for OATs associated with the TB-HIV Country Project. Selection criteria included OAT membership, at least six months of participation, and personal experience with TB. In the second course, applicants also underwent qualitative interviews to assess their knowledge of TB and their responses to simulated TB cases in different settings.

"So far, the course has allowed me to better understand the disease, the recovery process, and the adverse effects of medications-all things we must clearly explain to patients," said Canchari, who is completing this training with 23 classmates from Metropolitan Lima and regions such as Chimbote, Iquitos, and Trujillo.

Yupanqui highlighted the course's educational approach saying, "It integrates reflection and practice as pillars of the training process." Structured in three units, the program covers essential topics such as community TB care, the background of the disease, and peer counseling. This final section includes two in-person workshops designed to simulate counseling sessions, enhancing communication skills and socio-emotional management.

"Each teacher is unique in their approach to teaching. There are many new aspects, such as terminology and medications, many of which I never took myself," said Alberto Amaya, another peer counselor who overcame MDR-TB 18 years ago and is currently also teaching the course. "I have experience supporting people with TB, but with this training I'll be able to do it even better," he added.

Empower with Knowledge

Osorio knows that her work goes beyond sharing information. She seeks to connect with each person affected by TB she visits in districts such as Puente Piedra, Independencia, and Comas, conveying confidence and clarity in her messages. To achieve this, she combines theoretical knowledge with real-world application, adapting to the needs of each patient.

"I explain to patients that they should take care of themselves and protect others. I always give them an example: 'Have you seen Goku [the character from the cartoon Dragon Ball]? When you hit him, he gets stronger. That's how bacteria are. If you don't take the pills, they'll become resistant and the medication won't work anymore,'" she said.

Osorio and Palacios know that the first 30 days of treatment are critical to preventing dropout, especially for the people with substance use disorders whom they support. Each case presents a complex challenge, often made harder by the task of helping them confront TB's stigma through education.

"Before, we didn't know our rights," Palacios said. "Now, health centers are more empathetic. In addition to supporting TB patients, we hold talks at markets, churches, and soup kitchens to discuss stigma and discrimination."

Peer counseling is also empowering. "Thanks to the training, I've changed a lot. I used to be very shy; I struggled with public speaking. Now I don't care if people know I had TB-what matters most is that the community learns how to prevent the disease. And I tell patients: "Don't be discouraged, this disease can be cured."

By strengthening the skills of those who have experienced TB firsthand, Partners In Health transforms personal experiences into tools for change. With each new cohort of counselors, the support network grows, demonstrating that recovery is a path no one should walk alone.