Addressing HIV and IDU issues vital for TB programs in Nepal

Photo by MMMpicturesMore than 90% of people diagnosed with tuberculosis (TB) in Nepal successfully complete treatment, according to Dr Dirgh Singh Bam, Secretary of the Ministry of Health and former Vice-President of Nepal’s Anti-Tuberculosis Association (NATA).

But Dr Bam also says that the poor performance of Directly Observed Treatment Short-course (DOTS) programs has resulted in the development of drug-resistant forms of TB, including multi-drug-resistant strains of the disease.

About 1.8% of all new TB infections in Nepal involve multi-drug-resistant TB (MDR-TB), which is resistant to isoniazid and rifampicin. These drugs are part of ‘first-line’ TB treatments and resistance can occur when they are misused or mismanaged.

People with TB who do not complete a full course of treatment run the risk of developing MDR-TB, which also results from the prescription of the wrong medication, incorrect dosages, and the provision of low-quality treatment.

Dr Bam says that 29% of all TB cases in Nepal involve HIV co-infection, particularly among injection drug users (IDUs). “Without addressing HIV and IDU issues, it will be very difficult to effectively respond to TB,” Dr Bam says.

IDUs and people with both HIV and TB are also at a risk of contracting hepatitis C (HCV) in Nepal. HCV is an infectious blood-borne viral disease, which can cause liver inflammation. Chronic HCV can lead to cirrhosis (scarring of the liver) and liver cancer.

HCV transmission rates are higher than that of HIV, and the condition is often more severe in IDUs. People who share injection equipment are vulnerable to HCV and HIV infection, says Dr Bam, and in Nepal, there is a separate health program to respond to HCV.

“Community participation is very essential for effective TB and HIV care in Nepal,” Dr Bam said. The Patients’ Charter for Tuberculosis Care, outlines the rights and responsibilities of people with TB and it empowers those with the disease and their communities.

Dr Bam said the Patients’ Charter for Tuberculosis Care could be used as a tool to empower people with TB to be aware of their rights and responsibilities, which would also improve the performance of TB-related programs.

Bobby Ramakant-CNS

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