Ray of hope for TB patients . . .

flickered, lighting up a small dark apartment which houses 45-year-old Jacob Chigariro and his family at Matapi Flats in Mbare.
The day is May 18 and Chigariro – a father of three children aged 15, nine and six – sits on an old brown couch near the candle, almost setting it off each time he coughs.
He sometimes tires of covering his mouth.
His wife transfers the candle to a small stool in a corner they use as a kitchen and gets back to sorting tomatoes and leaf vegetables from her small vending stall outside the hostel.
She confides in this writer that it has been a long time since her husband fell sick, and at first they thought he was bewitched.
“He started coughing and would sweat at night in 2009 for months. We bought all cough syrups, but nothing worked. He went to the clinic and was given antibiotics and still there was no change. He returned to the clinic where they collected sputum.
“They took two sputum samples – one on the spot and the second the following morning.
“These tests were conducted on three different occasions as they did not find anything. They conducted a chest X-ray and found out he had TB.
“He was given pills which he took for some time, but stopped when he went to search for a job in South Africa.
“He returned home sick and we went back to the clinic where they gave him Rifampicin and Isoniazid for free, though the drugs did not work.
“They said they suspected that he had developed multi-drug resistant tuberculosis since he had stopped treatment midway and did not respond to the medicine he was initially given.
“He went for further tests in March and we are just waiting for the results to come in two months’ time,” said Chigariro’s wife Caroline.
She said she has been taking care of her bedridden husband and has taken their children to Rushinga, their rural home fearing to spread the disease to the minors.
She also worries, that just like the candle wax, her husband’s life is slowly coming to an end as his condition continues to deteriorate everyday.
“It’s like he is fading with each passing day. I am afraid he may wake up dead before the results come,” she said.
Caroline confesses that before her husband fell ill, she had little knowledge of TB as she believed it was a disease for others and her family would not be affected.
While she worries about her husband’s fate, Caroline is not aware of new developments in TB testing and treatment of MDR.
She does not know that Government by the end of the year plans to roll out the GeneXpert device.
The GeneXpert device is a fully automated system which allows a relatively untrained operator to perform sample processing, DNA amplification, and detection of MDR tuberculosis and screening for rifampin resistance in less than two hours and only minutes of hands-on time.
Addressing journalists at a recent TB Media Training workshop in Kadoma, deputy director, TB and Aids Unit in the Ministry of Health and Child Welfare Dr Charles Sandy said the Government will, by the end of this year, roll out gene expert machines at public institutions.
He revealed that the machine was officially launched by the World Health Organisation last year and countries like South Africa have already started using it.
In Zimbabwe, only Murambinda Hospital has started using the new testing machine under the funding of Medecins Sans Frontieres (MSF).
“Government requested the National Aids Council to assist with the first 15 machines that will be rolled out to public health facilities.
“Once the machines are made available, it will take two hours to test MDR- TB in a person, a process that used to take between three and four months and most patients would have died before results came out,” he said.
He said worse off, the old tests were conducted using machines invented almost 100 years ago.
Dr Sandy added that there is no rapid TB test as yet. It could be available around 2015.
He said existing tests show poor performance in diagnosing TB in children, people living with HIV/Aids, and extra-pulmonary forms of the disease.
“TB patients are still to date left with either fair access to poor diagnostics or poor access to fair diagnostics.
“But with the new machine, results can be available while a patient waits in a clinic.
“The only manual step, adding sample treatment reagent to the specimen cup before loading the cartridge, kills over 99.9 percent of TB bacilli in the specimen,” he explained.
He also said the test detects TB in essentially all smear-positive samples and the majority of smear-negative samples.
“The presence of non-tuberculosis mycobacteria does not confound testing,” he added.
Dr Sandy said the same device may in the future be used for HIV viral load detection.
“The device that automates the procedure is a computer-driven, sophisticated piece of equipment that will require reliable energy supply, security and maintenance.
“Test costs will be much higher than the cost of tests routinely done at lower level laboratories, where high performance detection and drug resistance screening are not currently performed.
“Laboratories performing the Xpert MTB assay will require BSL-1 laboratory infrastructure and equipment,” he added.
According to Dr Sandy, technicians require training in BSL-1 safety precautions and the use of the GeneXpert device.
“A reliable source of electricity is needed as well as a room that can be secured outside working hours. All buffers and reagents are included in the cartridge while a plastic Pasteur pipette is used to transfer sputum to the Xpert MTB cartridge,” he said.
He revealed that Cepheid, Inc., and its distributors will be the only source of consumables and maintenance, so a long term supply and service agreement will be necessary.
He also said drug resistant TB is not very common but a result of someone who has failed to adhere to treatment.
He said diagnosis of MDR is complicated as drugs are expensive and someone has to take them for two years.
Dr Sandy noted that they identified few cases of MDR and have made efforts to make sure that those few cases get the treatment they require.
“MDR-TB needs to be treated for a longer period, and because the treatment has worse side effects, treatment of this form is much more difficult. MDR TB is not common but usually develops when people fail to complete their course of TB treatment,” he said.
UZ UCSF Research Programme Manager Dr Nehemiah Nhando said new drug resistant strains have caused the re-emergence of TB as a health threat even in regions where until recently medical treatment had kept the disease at bay.
He said the TB epidemic in Zimbabwe is largely HIV-driven.
According to Dr Nhando, approximately 47 000 cases of TB were notified in 2010.
He said to control TB there is need for early diagnosis and prompt treatment especially of pulmonary diseases.
He stated the use of observed or supervised treatment where necessary and extensive use of the BCG vaccine as other import factors that contribute to the control of the disease.
Zimbabwe’s 2010 Millennium Development Goals Status Report says Zimbabwe is ranked 17 out of the world’s 22 high-burden TB countries.
The country’s TB incidence rate significantly increased during the last decade, rising from 97 per 100 000 people in 2000 to 411 per 100 000 people in 2004 and to 782 per 100 000 in 2007.
The report says the increase is attributed to the high incidence of HIV and Aids and it is estimated that 72 percent of all TB patients are co-infected with HIV.
“In addition to the targets set for MDG 6, Zimbabwe has made considerable efforts to adhere to international and regional TB related strategies such as the Global Plan to stop TB 2006-2015.
“Zimbabwe adopted the Stop TB strategy in 2006, as recommended by WHO. The country has also developed a five year strategic plan for national TB control,” he report states.
The report further explains that in relation to the global indicator for the rate of successful TB treatment, Zimbabwe attained a record high of 78 percent in 2007.
However, this is still low in comparison to the global benchmark target of 85 percent recommended by WHO.
Likewise, TB case detection rates have not improved; they continue hover below 40percent, far below the target of 70 percent.
The report adds that the MOHCW has made recent moves to improve ten diagnosis of TB by revamping the functionality of its 115 diagnostic centres and ensuring that non-functioning sites become operative.
It also says the training of microscopists is a current priority.
“Due to high TB /HIV co infection, there have been efforts to scale up collaborative activities at all levels of the health delivery system.
Joint collaboration between the TB patients accessing ART programmes has seen 69 percent of TB patients accessing HIV testing services and cotrimoxazole preventive therapy.
However, due to lack of funding and the weakening of the health system, only a minority of TB patients are accessing ART.
Scaling up of early infant treatment, and collaborative TB and HIV interventions has also had a profound impact, as have improvements in quality of care and treatment services, the establishment of policies that scale up and decentralisation of services such as task-shifting, and the strengthening of local production of HIV and Aids-related medication.
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