Tuberculosis (TB), Human Immunodeficiency Virus (HIV) and acquired immunodeficiency syndrome (AIDS) are public health issues globally. South Africa is one of the countries with high prevalence of TB, HIV and AIDS in the general population. The total number of people diagnosed with TB in the country accounted for 3.6% of the total cases globally in 2019, and those living with HIV (PLWHIV) were estimated to be 8.45 million in 2022 (Statistics South Africa 2022; World Health Organization [WHO] 2020). However, South Africa has made significant progress in turning the tide over the last decade by adopting WHO recommended diagnostic technologies and therapies for both prevention and management of the disease such as TB. In addition, HIV management and access to antiretroviral treatment (ART) have improved (Marinda et al. 2017; National Institute for Communicable Diseases 2022).

In 2021, 74% of people living with HIV were on ART in South Africa (Joint United Nations Programme on HIV/AIDS 2021). With increased access to ART, the number of AIDS-related deaths has declined from 278, 741 in 2007 to 85, 796 in 2022 (Statistics South Africa 2022). The programme is mainly managed by nurses who are responsible for dispensing the ART in primary healthcare settings while CHWs provide a supportive role (Mottiar & Lodge 2018). The CHWs are ancillary workers recruited in communities to provide promotive and preventive healthcare to the communities to reduce the burden placed on nurses in primary healthcare facilities (Knettel et al. 2021). A study by Knettel et al. (2021) conducted in Tanzania revealed that CHWs are well placed to establish rapport, trust, source of education and encouragement to clients. Among other duties, the CHWs assist in the prevention of TB, HIV, and AIDS and improve care across the continuum of care, on both individual and community levels (Datiko et al. 2015). The CHWs have helped to reduce maternal and child morbidity and mortality rates and the burden of communicable and non-communicable diseases in low- and middle-income countries (LMICs) (Feroz, Jabeen & Saleem 2015).

However, the CHWs are not given adequate support by health systems in the LMICs (Feroz et al. 2015). Despite the lack of support, their scope of practice has expanded in recent years because of changes in the healthcare system (Schleiff et al. 2021). In South Africa, some CHWs are appointed as primary healthcare ward-based teams and are paid stipends while others are still working on a voluntary basis. Their scope of practice ranges from pretreatment counselling, assisting with initiation and uptake of ART, TB screening, bed bath and feeding of those who are critically ill, providing health education, HIV testing and many other tasks that they provide based on circumstances of the patient during home visits. The WHO (2007) guidelines on task shifting suggested that the low categories must be trained before they are given tasks, which are beyond their scope of practice.

A study by Hughes et al. (2012) that was conducted in Free State revealed that more than 95% of CHWs were knowledgeable about TB and HIV, with only a few being unaware of important TB and HIV facts. This is despite not receiving any training related to basic HIV counselling and testing, as well as basic TB directly observed treatment support. Another study in the Eastern Cape found that a simple, user-friendly TB booklet with pictograms increased CHW knowledge. However, the country lacks standardised training manuals to provide CHWs with knowledge of tuberculosis, HIV, and AIDS (Okeyo & Dowse 2018). As a result, it is critical to assess CHWs’ knowledge of TB and HIV and AIDS in order to identify their learning needs, which will inform the development of a standardised training programme for CHWs to improve their competence in healthcare delivery.

Furthermore, Mwai et al. (2013) reported that CHWs improved the reach, uptake, and quality of HIV services, as well as the dignity, quality of life, and retention in care of HIV-positive people. While some participants believed that CHWs do an excellent job of maintaining confidentiality, others believed that CHWs can occasionally compromise confidentiality, limiting their ability to effectively facilitate linkage to care and management of chronic diseases (Rachlis et al. 2016).

The CHWs generally provide TB, HIV, and AIDS care in the communities from which they come, necessitating the use of Ubuntu when providing care to them. Ubuntu means ‘Ubuntu ngu muntu nga bantu’ in Xhosa, which translates to ‘person is a person through others’ (Moloko-Phiri et al. 2023; Mulaudzi et al. 2022; Mwai et al. 2013). Ubuntu is widely regarded by Africans as a form of human interconnectedness and dignity towards others, first in one’s cultural group and then to all other human beings (Waghid & Smeyers 2012). As a result, there is a need to educate CHWs on the importance of incorporating Ubuntu into their patient care, which promotes dignity towards others. Thus, leading to the prevention of disclosing confidential information of the patients. Furthermore, Ubuntu emphasises the importance of respecting and valuing others, as well as compassion and care for one another. Despite this, there is little documented evidence of community health workers’ knowledge of Ubuntu-Informed Care in TB, HIV, and AIDS services in Gauteng province, South Africa.

The aim of this study was to assess CHW’s knowledge of Ubuntu-Informed Care in TB, HIV, and AIDS Services in Gauteng province, South Africa. Most participants passed the test. However, the mean score was slightly above the pass mark, which demonstrates that the participants had limited understanding of TB, HIV and AIDS. Most participants failed questions related to TB and prevention of mother-to-child transmission of HIV. However, most participants correctly answered the questions specific to Ubuntu philosophy. With regard to demographic characteristics, level of education had an impact on the total score such that participants whose level of education was below Grade 12 had the lowest scores.

Our results are similar to previous studies Minnery et al. (2013); Rachlis et al. (2016). A study by Minnery et al. (2013) which was conducted in Peru reported areas of concern regarding the knowledge of CHWs on the diagnosis and management of TB, HIV, and AIDS. Similarly, the CHWs’ lack of knowledge on HIV treatment and management was reported by Rachlis et al. (2016) in a study that was conducted in Kenya. In addition, similar studies showed that CHWs often do not have proper training in HIV management, limiting their capacity to deliver effective treatment (Ngcobo et al. 2022; Rajabiun et al. 2021). These findings are worrisome especially in low- and middle-income countries such as South Africa where HIV, AIDS, and TB exert a heavy toll. There is a need to empower the CHWs and accelerate efforts in the fight against TB, HIV and AIDS to achieve the Sustainable Developments Goals number 3, which ‘aspires to ensure health and well-being for all, including a commitment to end the epidemics of HIV/AIDS, tuberculosis, Malaria and other communicable diseases by 2030’ (United Nations Development Programme 2023).

The CHWs are key players in the fight against HIV infection, prevention, and management of HIV and AIDS in resource-restricted communities (Cianelli et al. 2011). They are the first point of contact with patients in the communities and are often responsible for providing health education and other important information to patients regarding health-related matters (Okeyo & Dowse 2016). The perception that communities have about CHWs depends on how well they can communicate health information pertaining to diseases such as TB, HIV, and AIDS. Therefore, it is imperative that they possess accurate knowledge of health problems that are prevalent in their communities. The results of this study support calls for the need to use different strategies to empower the CHWs. The suggested strategies include training of the CHWs to ensure efficient timely care and management of TB, HIV, and AIDS. (Rachlis et al. 2016; Sander et al. 2015). With proper education and training, the CHWs can assess various illness and make necessary follow-up in the communities (Rachlis et al. 2016).

In addition, our results showed that CHWs with low level of education achieved low scores. In the previously cited study by Rachlis et al. (2016) the lack of knowledge among CHWs was also attributed to low level of education or a lack of formalised training for the CHWs. An implication of this result is the need to seriously consider level of education when recruiting the CHWs and the need for supportive supervision of the CHWs to introduce and practice Ubuntu-informed care. The findings also support suggestions that CHWs should be provided with resources such as posters, charts, pamphlets, and brochures for health education in the community (Mukanga et al. 2011; Rachlis et al. 2016). The CHW can also give out these resources in the community to disseminate information about different diseases. The study’s findings revealed that CHWs had a good understanding of how the Ubuntu philosophy and values could be applied when testing and managing clients with tuberculosis, HIV, and AIDS. According to a previous study, there is a need to promote the use of Ubuntu concepts in improving safe sexual practices and positive attitudes towards PLHIV in Africa (Knettel et al. 2021). Our study supports Tarkang, Pencille and Komesuor (2018) findings that Ubuntu encourages values of inclusiveness and respect, which can help reduce stigma against PLHIV, and emphasises that by cultivating a culture of empathy and compassion, Ubuntu may result in better sexual health outcomes, especially among youth. Although most of the CHWs answered the questions on Ubuntu philosophy correctly, our interactions during training revealed limitations in their overall knowledge, emphasising the significance of including these ideas into training programmes. This concept can be a valuable resource for maintaining confidentiality, which is a critical requirement when delivering HIV and AIDS health promotion interventions.

The aim of this study was to assess the knowledge of CHWs on TB, HIV, and AIDS in a selected district of Gauteng province in South Africa. The results show that CHWs have limited knowledge on the management of TB, HIV and AIDS prevention in maternal and child healthcare. This highlights the need for targeted training interventions to improve the knowledge of CHWs on TB, HIV and AIDS in this area. Addressing the identified knowledge gaps is crucial to enhance the effectiveness of CHWs in community health promotion and disease prevention. Such interventions may have the potential to strengthen the healthcare system’s response to the challenges posed by TB, HIV and AIDS, ultimately contributing to improved health outcomes in the community. A further qualitative study could be conducted to explore the CHWs’ learning needs to inform interventions that are aimed at empowering them. Interventions that address the identified knowledge gaps can enhance the effectiveness of the CHWs and strengthen the healthcare system’s response to the challenges posed by TB, HIV and AIDS.