While the problem of TB/HIV co-infection has long been recognized in Zimbabwe, limited resources, poverty and brain drain among others continue to hamper efforts to address the matter. Zimbabwe’s Ministry of Health and Child Welfare even has an AIDS and TB Unit aimed at coordinating the national response to the two epidemics. In the past few years, however, TB has emerged as a leading killer, especially among HIV positive people, who are often not identified though long-established TB tests. Statistics shows that the success rate of directly observed treatment is just 74 percent, far below the WHO recommended rate of 85 percent.
According to estimates, in 2010 about 47 000 cases of TB were notified compared to 37 000 in 2007 and of these cases it is estimated that approximately 80 percent of them were also infected with HIV.
“TB is still among the top five diseases causing morbidity and mortality for our population. TB is also the major cause of mortality among people living with HIV and AIDS,” said the Minister of Health and Child Welfare, Henry Madzorera.
“In spite of this high burden of disease our National TB Control efforts have demonstrated some improvement over the past two years basing on results achieved on the then two main global indicators of TB control. The case detection of all types of tuberculosis increased from 37 percent in 2007 to 48 percent in 2009. The Treatment Success Rate increased from 64 percent in 2006 to 74 percent in 2009.”
In Zimbabwe, just like in countries where there is a generalised AIDS epidemic, people infected with human immunodeficiency virus (HIV) are also at risk of developing tuberculosis (TB), an opportunistic airborne infection. According to the World Health Organization, TB caused one in four AIDS-related deaths in 2010.
“In Africa, HIV is the potent factor in the progression of latent TB. People living with HIV are susceptible to TB infection. TB is the most common serious infection associated with HIV infection. The two diseases go hand in hand. This call for an integrated and collaborative approach in dealing with the two conditions,” said Dr. Patrick Hazangwe, a WHO official.
Each year an estimated one million people need simultaneous treatment for both TB and HIV. Caring for them is one of the major challenges facing health care systems in the limited-resource settings with the highest burdens of these closely linked diseases. According to Madzorera, a significant proportion of people with TB are not reached with accurate diagnosis and appropriate care due to lack of equipment.
“Our goals are clear. One hundred per cent of TB patients should be tested for HIV and 100% of people in HIV care services should be screened for TB. All people living with HIV should be receiving preventive treatment or anti-TB drugs as appropriate,” he said.The TB problem is compounded by the fact that patients often fail to complete treatment because they cannot afford the transport costs to and from health centres.
To complicate matters, the brain drain of qualified front-line health care workers from Zimbabwe has resulted in poor healthcare delivery. Lack of medical practitioners coupled with obsolete machinery has also worsened the problem.
Chief K.Masimba Biriwasha - CNS
(The author serves as Editor-in-Chief of iZimbabwe, born in Zimbabwe, is a children's writer, poet, playwright, journalist, social activist and publisher. He has extensively written on health. His first published book, 'The Dream Of Stones', was awarded the Zimbabwe National Award for Outstanding Children's Book for 2004)