Zimbabwe’s fight against tuberculosis shows that the country has overcome the tide with the number of cases reported declining by 3 000. The decline is, however, marred by the HIV-TB co-infection.
Not all people with TB are HIV positive but statistics have, however, revealed that 75 percent of tuberculosis patients have a compromised immune system.

Dr Charles Sandy, Ministry of Health and Child Care deputy director for the Aids and TB Unit, disclosed during a workshop for journalists early this year that a total of

38 367 TB cases were reported in 2011 as compared to 41 305 recorded in 2012, representing a 7,1 percent decline.
He attributed the decline in HIV prevalence to the improved supply of anti-retroviral drugs nationally.

“The decline in new TB cases is mainly due to the success of the anti-retroviral programme which the ministry and its partners have launched nationally,” said Dr Sandy.

Despite the decline in TB cases the country, however, faces a new threat with the increasing number of patients who develop multi-drug resistant TB.

Multi-drug resistant TB is when a patient fails to respond to medication. In 2011, a total of 156 patients were diagnosed with the multi-drug resistant strain with the figure rising to 244 in 2012.

MDR-TB is caused by an organism that is resistant to isoniazid and rifampin, which are the two most powerful drugs used in TB treatment. MDR-TB develops in otherwise treatable TB when the course of antibiotics is interrupted and the levels of drug in the body are insufficient to kill 100 percent of the bacteria. This can happen due to a number of reasons:

  • Patients may feel better and stop taking their antibiotic course.
  • Drug supplies may run out and a patient lives far from a health facility thereby delaying in getting a resupply.
  • Patients may forget to take their medication from time to time or may have severe reactions where they vomit each time they take the medication, thereby rendering it ineffective.

Cases of MDR-TB are few among non- immuno-compromised patients but they do occur in healthy people, but are less common.
Dr Sandy highlighted that the best method of avoiding MDR-TB is prevention through adherence.

“MDR-TB is usually caused by poor adherence to treatment of normal TB so the best way to prevent it is to adhere to the course of treatment as prescribed by the health provider. TB is an infectious disease that is caused by mycobacterium tuberculosis and primarily affects the lungs but it can also affect organs in the central nervous system and lymphatic system,” he said.

As the country makes strides in the fight against TB, a worrying trend is shown as MDR-TB patients find little solace in accessing medication. A MDR-TB patient who was admitted at Karoi District Hospital defaulted on treatment and is reported under the lost to follow up cases. The patient was also on ART.

The case was found out during advocacy dialogues held in Mashonaland West province by Zimbabwe HIV Aids Activists Union and the Zimbabwe National Network of People Living with HIV and Ministry of Health and Child Care officials. Most of the participants said central Government and non- governmental organisations involved in HIV-related work had done little to address the TB problem which has resulted in some patients developing MDR-TB.

According to the World Health Organisation, MDR-TB takes longer to treat and can only be cured with second-line drugs, which are more expensive and have more serious side effects. When second-line drugs are misused or mismanaged, extensive drug-resistant TB can develop. Since XDR-TB is resistant to both first and second-line drugs, treatment options are very limited, and the risk of death is therefore extremely high. Both MDR-TB and XDR-TB can be spread from person to person.

According to ZNNP+ district focal person for Karoi Mrs Charity Nyamutowa, the Karoi MDR-TB patient who was admitted at Karoi Hospital’s wooden ward escaped due to poor conditions.

“The patient was quarantined in a wooden ward and had to use nearby Blair toilets for ablution facilities. The conditions were inhuman and the patient felt better off leaving despite being aware of the dangers,” said Mrs Nyamutowa.

She said the patient also felt that the health care providers did not feel secure handling such cases as evidenced by the isolation of the Karoi patient. The outreach which also visited Mashonaland East found out that it is not only at Karoi Hospital where MDR-TB patients face such challenges but a national challenge.

In some provinces such as Mashonaland East, MDR-TB patients are treated at their homes making it even more difficult for directly observed treatment supporters to travel long distances.

Community and family involvement is crucial in a patient’s response to TB management. Greater community involvement is needed to control tuberculosis in the face of under-resourced primary health care infrastructure as the case of Karoi Hospital.

Karoi community members pledged to work with Government to address the high tuberculosis burden adding there was need to establish TB focal persons in the communities they lived.

“In the health response we have HIV focal persons, PMTCT focal persons and even male circumcision focal persons, so there is a need to have TB focal persons if we are to effectively capture all patients at risk and those with multi-drug resistant TB. This way communities rise to the occasion and assist in the response to TB management,” said Mrs Nyamutowa.

Responding to a question on whether communities were getting updated and correct information on TB, ZNNP+ Mashonaland West provincial co-ordinator Masimba Nyamucheta said there was still a gap.

“Unlike HIV, we haven’t gone a long way in giving out updated and relevant information on TB to communities and caregivers. It is a challenge that we have. We need to use opportunities offered by these meetings to inform our next steps.”

Caregivers to TB patients were exposed to bacteria called myco-bacterium tuberculosis hence they require that they too be screened for tuberculosis. For the Karoi patient who went away without completing treatment, possible death is most likely. The patient is also passing the same strain and this poses great danger to people with compromised immunities in contact with the patient.

MDR-TB, if not treated with the seriousness it deserves will derail the progress achieved in the fight against tuberculosis.
We can end up with cases of extensive multi-drug resistant TB which are more complicated to treat and use highly expensive drugs.
Caregivers of TB patients need to know that sunlight destroys the bacteria, so windows need to be opened every day.

Proper ventilation and less crowding help in mitigating the spread of TB since it is spread from person to person through the air. WHO says when people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.

“About one-third of the world’s population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot transmit it.

“People infected with TB bacteria have a lifetime risk of falling ill with TB of 10 percent. However, persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill,” said WHO.

So from the above information one’s immunity is not only weakened by HIV infection but by a host of other illnesses thereby making one prone to getting the multi-drug resistant TB strain likely.

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