TB: When adherence matters

WHO Africa Region Director Dr Moeti

WHO Africa Region Director Dr Moeti

Roselyne Sachiti Features Editor
A little black pot and a stainless steel kettle rest on a two-plate electric stove in a small poorly ventilated room. It is 10 in the morning and Primrose Dzangare of Jo’burg Lines in Mbare is preparing breakfast for her husband Lucky.

Lucky has not been well for sometime and prefers perfectly cooked hot sweet potatoes and a cup of warm tea with lots of milk for breakfast.

Sometimes he prefers rice with peanut butter.

It has been a month since he returned home from South Africa where he worked, selling various wares on the streets on Johannesburg CBD.

Lucky was not fortunate.

His move from Joburg lines to Johannesburg resulted in him getting lost in his search of financial emancipation.

Instead of getting more money and living his dream life, the bright lights of Egoli blinded and led him into a dark corner full of vices.

“I went to South Africa in 2010 and for four years, I forgot about my family in Zimbabwe and never sent money. I cohabited with different women, some from Zimbabwe, others South Africa,” said Lucky.

Primrose said he only sent money twice while in South Africa and would say life was hard there, too.

“He came home pale, coughing and very sick in March last year and tested HIV positive.

“He also had TB,” said Primrose.

In September, last year, Lucky felt better after taking both TB medication and ARVs and returned to Egoli, promising his wife and seven year old son that their life would now improve as he was a changed man.

But just last month, a loud knock woke her up at 6am.

A taxi driver hired by Lucky at Roadport bus terminus wanted to make sure he was at the right house since he was delusional.

“I saw Lucky looking paler than ever. He only had a small bag on him. We went to the clinic where he confessed that he had stopped taking his TB medication and ARVs because he felt better. The nurses said he now has multi drug resistant TB (MDR-TB),” said Primrose who is also HIV positive.

Lucky is among a number of Zimbabweans and Africans who because of various reasons do not adhere to their TB medication and end up with MDR-TB.

The dual epidemic of TB and HIV also continues to be a major factor in morbidity and mortality among people living with HIV, especially in sub-Saharan Africa, undermining efforts to prevent and control HIV.

In Zimbabwe it is estimated that approximately 80 percent of TB cases are co-infected with HIV.

The country has set a comprehensive treatment, care and support programme which includes prevention, care and management of TB/HIV co-infection in order to mitigate the effects of the HIV and AIDS pandemic.

On March 24, 2015 Zimbabwe joined the world to commemorate World Tuberculosis Day.

The World Health Organisation (WHO) message this year was simple “Gear Up to End TB”.

WHO regional Director Dr Matshidiso Moeti said every year, there is an estimated 9 million new TB cases worldwide but consistently 3 million cases are either not diagnosed, not treated, or are diagnosed and not registered by national TB control programmes.

“Reaching, treating and curing all those with TB especially the vulnerable groups and communities is a critical part of the solution and we need to do more – including work across all sectors to prevent TB through poverty reduction and social protection and achieve universal health coverage,” she said.

Vulnerable populations include children and women, people living with HIV, people with diabetes, refugees, miners and ex-miners, prisoners and drug users whose access to basic health care services may be limited.

“The poor are also at risk, especially homeless persons and individuals living in densely populated communities.

According to Dr Moeti available information indicates that significant progress is being made to bring the TB epidemic under control in Africa.

“The previously increasing trend of TB cases has been halted and the Region is observing a declining trend of TB in the last four years.

“In spite of this progress, TB continues to be a major public health concern,” she added.

Sadly, the African Region remains with the highest TB and TB/HIV co-infection rates in the world and the emerging challenge of drug resistant TB (MDR-TB) is yet to be adequately addressed.

“Over the last 12 months, WHO estimates that TB was responsible for over half a million deaths in the Region. TB and TB/HIV spread is fuelled by among others; poor access to health services, lack of trained health care providers, and weak health care delivery systems.

“I therefore call upon all countries and partners to intensify efforts to reach, treat, and cure everyone with TB and to pay special attention to underserved areas and vulnerable people. I urge the public to overcome TB barriers, correct misconceptions about the disease, and promote healthy behaviours,” she said.

She outlined the importance of adherence saying patients and their families should stick on to TB treatments in order to improve cure rates, control the spread of infection, and minimise the development of drug resistance.

“As we commemorate the World TB Day, I call on Governments to ensure that their TB control programmes fully embrace the “End TB Strategy” interventions. This calls for accelerated global efforts to find, treat and cure all people with TB. WHO will continue to support countries to strengthen the health systems to make this a reality,” she said.

In a statement, the Global Fund to Fight AIDS, TB and Malaria and Stop TB Partnership feels human rights abuses are an important factor impacting the TB crisis.

“As countries mark World TB Day, the Global Fund to Fight AIDS, Tuberculosis and Malaria with support from the Stop TB Partnership have chosen to highlight this topic this week.”

Every year, 3,3 million people are either not diagnosed or not treated and among those missed are the most vulnerable.

The statement said addressing TB – from transmission to treatment – involves considering a wide range of human rights issues that should not be ignored.

“The absence of an adequate standard of living and a lack of legal aid for people in prison fuels overcrowding and the spread of TB. Structural gaps in health systems lead to the development and then transmission of drug-resistant TB while legal and social barriers to accessing care and those who fear disclosure of their identities prevent equal treatment for vulnerable groups.

“These include the poor, migrants, indigenous people, drug users, and women and girls who particularly face inequalities in accessing gender-sensitive health services.”

Global Fund to Fight AIDS, TB and Malaria and Stop TB Partnership further says the way treatment is provided to people with TB may also unintentionally drive them away from health services.

“Medical detention and isolation, when used without first trying less restrictive measures, can endanger the privacy of patients and undermine the trust between communities and health care workers.

Globally, human rights expert and a member of the Stop TB Partnership Coordinating Board Timur Abdullaev of Uzbekistan, has been part of a group that advices the Global Fund on all matters relating to human rights and HIV, TB and malaria.

“We are pushing hard for a “paradigm shift” away from solely top-down approaches that treat communities vulnerable to the disease. The Global Fund and partners are focusing on a right-to-health approach that places the people who use these services at the centre by giving them a voice to ensure that health services are designed in a way that is accessible to them,” said Abdullaev.

Executive Secretary of the Stop TB Partnership, Dr Lucica Ditiu said there is need for more advocacy on TB issues.

“For me, it is unacceptable in the year 2015 to have people facing human rights abuse because of TB – forced treatment, detention, expulsion and social marginalisation. I feel responsible for not raising our voice loud enough in order to address the issues of TB and human rights at a different level,” said Dr Ditiu.

Head of the Global Fund, Mark Dybul said those most vulnerable to TB should be included and embraced to end the TB epidemic.

“We are grateful for the efforts that the Global Fund is making in supporting human rights and the funding model gives everyone opportunities to do it right. My question is: do we want to do it right?”

“Diseases have a way of thriving on the fringes of society, where people are isolated, stigmatised and denied their human rights,” said Mr Dybul.

 ◆ Feedback [email protected] or [email protected]

Pin It